Form 4130-4 Application for Exchange-of-Use Grazing Agreement

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Form 4130-4
(November 2009)

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FORM APPROVED
OMB NO. 1004-0041
Expires: July 31, 2011

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

APPLICATION FOR EXCHANGE-OF-USE GRAZING AGREEMENT
(43 CFR 4130.6-1)
1. Name (last, first, middle initial)

FOR BLM USE ONLY

Date Filed
State Code
Office Code

2. Address (include street, city, State, and zip code)

Auth. Number

3. I own/lease the following-described lands (List by legal subdivision and for those lands which are leased, indicate the effective and expiration dates of the lease. You may
also use the location plat on page 2 to display the lands that you are offering for exchange of use.)

4. The estimated average livestock carrying capacity (expressed in Animal Unit Months (AUM’s)) of all lands described above is

AUM’s, as rated for

 cattle  sheep or goats  horses or burros  other

(list animal kind).

5. These lands are situated within the
Allotment,
Field Office / District,
and are accessible and suitable for livestock grazing the same periods as the public lands. I understand that the grazing use allowed on public lands cannot exceed the average
livestock carrying capacity of the private lands offered. I will confine my livestock to the number, kind, period or periods of time, and areas of use authorized. I herein grant
administrative access to these private lands to employees of the Bureau of Land Management (BLM) for the purposes of administering this agreement.
6. I hereby apply for the following grazing use on intermingled and adjacent public lands within the above-named allotment to be effective for a period of
years from

, 20

to

, 20

, unless sooner terminated by either

part by written notification.
ALLOTMENT NAME AND NUMBER

LIVESTOCK
NUMBER
AND KIND

GRAZING PERIOD
BEGIN DATE (mm/dd)

END DATE (mm/dd)

FORAGE AMOUNT
(ANIMAL UNIT MONTHS)

NOTICE TO APPLICANT – BLM may issue an exchange-of-use grazing agreement (otherwise referred to as an EOU) to authorize use of public lands to the extent of
the livestock carrying capacity of the lands offered in exchange-of-use so long as the lands offered in exchange-of-use: (a) occur within the same allotment as the grazing
use to be authorized under the EOU, (b) the use authorized by the EOU is in harmony with the management objectives for the allotment and is compatible with existing
livestock operations, and (c) the EOU specifies terms and conditions that ensure orderly administration of the range, including the fair and equitable sharing of the
operation and maintenance of range improvements. No fee shall be charged for this grazing use. An EOU has no priority for renewal and cannot be transferred or
assigned. (43 CFR 4130.6 and 4130.6-1 (a) and (b)). If your application is approved, BLM will issue you an EOU Grazing Agreement Authorization.
REQUESTED BY:
Signature of Applicant

Printed Name of Applicant

Date

Title 18, U.S.C., Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or
fraudulent statements or representations as to any matter within its jurisdiction.
FOR BLM USE ONLY – In accordance with 43 CFR 4130.6-1, BLM has examined the private lands described in Part 1 of this agreement and has determined that: (a) they are
not fenced and are intermingled with public lands in the allotment(s); (b) the use of these lands will be in harmony with the management objectives of the allotment(s); (c) the
use of these lands is compatible with existing livestock operations on the allotment(s); and (d) the estimated average livestock carrying capacity of these lands, as indicated by
the applicant, is accurate.
APPLICATION APPROVED BY (Signature):
(BLM Manager)
(Printed Name)
(Continued on page 2)

(Title)

(Date)

For unsurveyed lands, attach U.S.G.S. quadrangles or sketch maps
to show land location.

LOCATION PLAT
(Location Plat may be used to display the lands offered in Exchange-of-Use)

Scale:

inch(es) equals one mile
NOTICES

The Privacy Act of 1974 and the regulations in 43 CFR 2.48(d) provide that
you be furnished the following information in connection with information
required by this application.
AUTHORITY: 43 U.S.C. 315; 316, and 1181d; 43 CFR 4100.
PRINCIPLE PURPOSE: The information is used to process this application.
ROUTINE USES: BLM will only disclose the information according to the
regulations at 43 CFR 2.56.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of this
information is necessary to receive a benefit. Failure to disclose this
information may result in BLM’s rejection of your application.

The Paperwork Reduction Act of 1995 requires us to inform you that BLM
collects this information to determine if you are eligible to enter into an
Exchange of Use Agreement with BLM. Response to this request is required
to receive a benefit.
BLM would like you to know that you do not have to respond to this or any
other Federal agency-sponsored information collection unless it displays a
currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is
estimated to average 18 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing and reviewing
the form. Direct comments regarding the burden estimate or any other aspect
of this form to U.S. Department of the Interior, Bureau of Land Management
(1004-0041), Bureau Information Collection Clearance Officer (WO-630),
Mail Stop 401 LS, 1849 C Street, N.W., Washington, D.C. 20240.

(Form 4130-4, page 2)