Form 10-660 Annual Report - Commercial Use Authorization

ANNUAL REPORT INSTRUCTIONS

COMMERCIAL USE AUTHORIZATION

OMB Control No. 1024-XXXX

Exp. Date: XX/XX/2016

INSTRUCTIONS

These instructions correspond to the numbered questions in Form 10-660.

1. Enter your contact information as it appears on your permit.

2. Enter the service you provide as it appears on your permit.

3. Enter the number of visitors who use your service. Enter the number of trips your company made to the park; i.e., a two person backpack trip for 3 days is ONE TRIP. Note: if you submit monthly reports, we only require you to add the monthly reports together.

4. Enter the average number of hours or days a customer spends in the park on one of your trips.

5. Check the box that best describes the level of importance the park plays in this CUA.

6. Enter the percentage of your activity that takes place in the park.

Example: If you raft through the park and 8 of 10 miles are inside the park, then 80% of the activity takes place in the park. OR If you spend 4 hours on a hike and the last hour is hiking outside the park then you spend 75% of the activity in the park.

7. Enter your total gross receipts for this business year.

8. Enter the dollar amount of your gross receipts that is the portion of your total gross receipts that you earned as a result of visiting the park.

If the park is the exclusive destination for your activity, then 100% of your gross receipts are a result of your visiting the park. If it is a primary or incidental destination, then estimate what percentage is a result of visiting the park. As a general rule, this should not be less than the answer to #6.

9. Provide details of any reportable injuries incurred to you, your employees, or clients this year.

10. Signature of business owner or authorized agent.

OMB Control No. 1024-XXXX

Exp. Date: XX/XX/2016

ANNUAL REPORT

COMMERCIAL USE AUTHORIZATION

DEPARTMENT OF THE INTERIOR

NATIONAL PARK SERVICE

PARK NAME

NAME, CUA COORDINATOR

COORDINATOR PHONE NUMBER

Due by <due date>

Please enter the information below. Refer to the instructions on page 1.

1. Contact Information

Holder Name: _______________________ Contact Person (if different):___________________

Business Name: ______________________ Email: (business) ____________________________

Mailing Address: _______________________ Email: (Contact Person) ______________________ (Note if Winter/Summer)

____________________________________ Website: ___________________________________

Phone: ____________________________ Fax: ___________________________________

(Note if Winter/Summer) (Note if Winter/Summer)

2. Services provided:

____________________________________________________________________________

VISITOR USE INFORMATION

3. How many clients did you serve within the park? ____

How many trips did your company make to the park this year? ____

(Use table below to report total numbers for each month. Report guide visits separately.)

(note: park will insert table for reporting visitor use information)

4. What was your average length of stay per visit in the park this year?

(For day trips show the average number of hours that you spend in the park per trip.

For overnight trips show the average number of nights that you spend in the park per trip.

If both types of trips were offered show the average length of stay for each type.)

Day Use

Number of Day Trips ______ Average Hours/trip __________

(Show trips that use lodging outside of the park, as day trips.)

Overnight Use

Number of Overnight Trips _____ Average # of Nights/trip _________

(May include 1st day travel to trailhead and last day exiting backcountry.)

5. The park is:

the exclusive destination for your clients. (This means it is the only destination being offered on the trip, not including brief stops along the way. 100% of your trip is a result of your visiting the park.)

a key destination or a significant location. (This means it is one of several sites where your services are provided. Some percentage of your trip is a result of visiting the park.)

6. What percentage of your trip is a result of visiting the park? ___________________

FINANCIAL INFORMATION

7. What were the total gross receipts from your operation? ___________________

8. What were the gross receipts earned as a result of visiting the park? __________________

See Instructions

INJURY INFORMATION

9. Did you have any reportable injuries occur during your trips this year? Yes_____ No_____

If yes, please use a separate sheet of paper to report the date and type of injury and a brief statement of the incident and the outcome of the patient care, please omit the patient’s name. A reportable injury involves any medical incident or injury requiring medical aid beyond Basic First Aid and/or when a request for medical aid/rescue assistance is made. You do not need to send in a report if you have already done so.

10. Signature: False, fictitious or fraudulent statements of representations made in this report may be grounds for denial or revocation of the Commercial Use Authorization and may be punishable by fine or imprisonment (U.S. Code, Title 18, Section 1001). All information provided will be considered in reviewing this report. Authorized Agents must attach proof of authorization to sign below.

By my signature, I hereby attest that all my statements and answers on this form and any attachments are true, complete, and accurate to the best of my knowledge.

           

Signature Date

     

Printed Name

     

Title

PAPERWORK REDUCTION ACT STATEMENT: In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), please note the following. This information collection is authorized by The Concession Management Improvement Act of 1998 (16 U.S.C. 5966). Your response is required to obtain or retain a benefit in the form of a Commercial Use Authorization. We will use the information you submit to evaluate your impact to park resources and compliance with park regulations and limitations. We estimate that it will take approximately 1.25 hours to prepare a report, including time to review instructions, gather and maintain data, and complete and review the report. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid Office of Management and Budget control number. You may submit comments on any aspect of this information collection, including the accuracy of the estimated burden hours and suggestions to reduce this burden. Send your comments to: Information Collection Clearance Officer, National Park Service, 1849 C Street NW, Mail Stop 2601, Washington, D.C. 20240.

ATTACHMENT A

CUA Annual Report

Sample Tables for Reporting

RETAIL SALES: (Farmers Markets, Special Performances, Special Events)

Month	Number of Retail Transactions	Revenue
April
May
June
July
August
September
Totals (for Season):

EQUIPMENT RENTAL:

Month	Canoes	Kayaks	Sailboards	Bikes	Misc	Revenue
January
February
March
April
May
June
July
August
September
October
November
December
TOTAL

GUIDED BACKCOUNTRY TRIPS:

Month	Number of Trips	Number of Visitors	Number of Guides1
January
February
March
April
May
June
July
August
September
October
November
December
Total

¹ The number of times the guides led trips. If there are 2 guides on each trip and 5 trips the number of guides is 10

GUIDED HIKING:

National Park Service PARK CUA Contact Phone				Commercial Use Authorization Monthly Activity Summary				Business: Phone:
Begin Date	End Date	(3)Total Days	(4) # of Clients	(5) # of Guides	(6) Total People (4+5)	(7) User Days (6*3)	Activity	Description of Trip Sample: Compton Trailhead to _______ and return
Total

MULTIPLE GUIDED ACTIVITIES:

Monthly Visitor Use Statistics
Business Name
	Year: 2013	Month:
Date of trip	Number of trips per day	Total number of people per day
1
2
3
4
5
6
7
8~31
TOTAL	0	0

NPS Form 10-660, Rev. 05/2013

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