Form 5460-17 Substitution Determination

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FORM APPROVED

Form 5460-17
(February 2011)

OMB No. 1004-0058
Expires: May 31, 2013

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

Purchaser or Affiliate

SUBSTITUTION DETERMINATION

Contract Number
Location of Processing Facility

In compliance with requirements of 43 Code of Federal Regulations 5424.1,
regard to timber from lands tributary* to the above processing facility:

I

We hereby submit the following information with

1. Historical Base Determination:
(MBF)

a. State volume of last export sale.
b. State date of last export sale.
c. State total volume of exported private timber in preceding twelve

(MBF)

(12) months from date in b, above. (Exclude volume of last export sale.)
d. State total volume of Federal timber purchased or otherwise acquired in

(MBF)

preceding twelve (12) months from date in b, above.
2. Timber Transactions Since Historical Base Period:
a. State total volume of private timber exported in succeeding twelve (12)

(MBF)

months from date in lb, above. (Include volume of last export sale.)
b. State total volume of Federal timber purchased or otherwise acquired in

(MBF)

succeeding twelve (12) months from date in lb, above.
3. Guide to determine if substitution has occurred, complete the following table (Purchaser’s Option)
a.

MBF exported timber from base period (same as lc, above)

b.

MBF Federal acquisitions from base period (same as 1d, above)

c.

MBF exported timber after base period (same as 2a, above)

d.

MBF Federal acquisitions after base period (same as 2b, above)

If c is greater than a, and d is greater than b, substitution of Federal timber for exported private timber has occurred.
4. The above volumes were determined by:
SCALING METHODS

SCALED BY
Company Employee

Log Scale Rule Used

Scaling Bureau

Maximum Length Without Taper

Other (specify)

Taper Allowance

Comments (If additional space is needed, use page 2)

Name of Firm
Signature of Signing Officer

Title

Date

INSTRUCTIONS
To determine substitution, complete the above and return twelve (12)
Specify type of rule used, long log or short log. If volume was sold on a
months from date of last export sale. Report volumes of timber in (MBF).
scale basis, state scaling method.
Do not include exempted species.
*Tributary lands mean area from which timber is expected to be delivered to a given processing facility.
(Continued on Page 2)

Comments (continued)

(Continued on Page 3)

(Form 5460-17, page 2)

NOTICES
The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with the information
requested by this form.
AUTHORITY: The Act of August 28, 1937 (43 U.S.C. 1181a); the Act of July 31, 1947 (30 U.S.C. 601 et seq.); the Timber Resources
Conservation and Shortage Relief Act of 1990 (16 U.S.C. 620 et seq.); and 43 CFR part 5420; permit collection of the information
requested by this form.
PRINCIPAL PURPOSE: The BLM will use the information to determine whether Federal timber has been substituted for exported
unprocessed private timber.
ROUTINE USES: The BLM will only disclose this information in accordance with the Freedom of Information Act, the Privacy Act,
and the provisions at 43 CFR 2.56(b) and (c).
EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain or retain a benefit.
Failure to submit all of the requested information or to complete this form may result in delay or preclude the BLM’s acceptance of your
application.
The Paperwork Reduction Act requires us to inform you that:
The BLM collects this information to determine whether Federal timber has been substituted for exported unprocessed private timber.
Submission of the requested information is necessary to obtain or retain a benefit. 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: The public reporting burden for this form is estimated to average 1 hour per response, including
the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments
regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (10040058), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.

(Form 5460-17, page 3)