FS-2800-22B Authorization to Conduct Paleontological Resources Resea

FS-2800-22B (v09/2012)

OMB 0596-0082

Office Use Only

Application Number:

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UNITED STATES DEPARTMENT OF AGRICULTURE

FOREST SERVICE

Authorization to Conduct Paleontological Resources Research or Collection

Authorities: 16 U.S.C. §470aaa through 16 U.S.C. §470aaa-11; Organic Administration Act June 4, 1897; proposed 36 CFR 291.13-291.23

Permit Terms and Conditions
1. This permit expires on Click here to enter text. , unless the Agency extends it in writing before that date. 2. The permittee must notify the Agency not less than 30 days, but not more than 60 days, prior to starting the project and entering on Forest Service lands. 3. All paleontological resources that are collected from National Forest System lands under permit will remain the property of the United States. 4. The collection will be preserved in an approved repository, to be made available for scientific research and public education. 5. Specific locality data will not be released by the permittee or repository unless authorized in accordance with proposed 36 CFR 291.6, or as otherwise agreed to in another agreement. 6. The permittee recognizes that the area within the scope of the permit may be subject to other authorized uses. 7. The permittee must conform to all applicable Federal, State, and local laws. 8. The permittee must assume responsibility for all work conducted under the permit and the actions of all persons conducting this work. 9. The permit cannot be transferred. 10. The permittee cannot modify the permit without the approval of the authorized officer. 11. The permittee must comply with all timelines established in the permit, and must request modification of the permit if those timelines cannot be met.	12. The permittee or other persons named on the permit must be on site at all times when field work is in progress and will have a copy of the signed permit on hand.13. The permittee will comply with any vehicle or access restrictions, safety or environmental restrictions, or local safety conditions or restrictions. 14. The permittee will report suspected resource damage or theft of paleontological or other resources to the authorized officer in a timely manner after learning of such damage or theft. 15. The permittee will acknowledge the Forest Service in any report, publication, paper, news article, film, television program or other media resulting from work performed under the permit. 16. The permittee will comply with the timeline established in the permit for providing a complete list to the authorized officer of specimens collected and the current location of the specimens*1. 17. The permittee will provide scheduled reports to the authorized officer within the timeline established in the permit*2. 18. The permittee will be responsible for all costs for the proposed activity, including fieldwork, preparation, identification, cataloging, and storage of collections, unless otherwise arranged through a specific agreement. 19. The permittee will comply with the tasks required by the authorized officer, even in the event of permit expiration, suspension, or revocation. 20. Additional stipulations, terms, and conditions as required by the authorized officer and/or the agency may be appended.
A copy of this permit must be carried in the field whenever field work is in progress and an individual named in line 8 of the Application for Permit is responsible in the field for compliance with all permit terms and conditions.
Click here to enter text. (printed name of permittee identified in line 1a of Application for Permit) (Signature of Permittee) (Date)	Click here to enter text. (Printed Name of Agency Signing Officer) Click here to enter text. (Title of Agency Signing Officer) (Signature of Agency Signing Officer) (Date)

BURDEN & NON-DISCRIMINATION STATEMENT

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0082. The time required to complete this information collection is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern the confidentiality to be provided for information received by the Forest Service.

1 The attached Paleontological Specimen Data Form may facilitate transmittal of required specimen and repository information. Use of this form by the applicant/permit holder is optional.

2 The attached Paleontological Investigation Report Form may facilitate the applicant/permit holder’s transmittal of required documentation pertaining to the authorized paleontological study. Use of this form by the applicant/permit holder is optional.

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