Form FS-2300-47 National Recreation Application

National Recreation Application

FS-2300-0047 (REV. 04/2013)

(FOR OFFICE USE ONLY: Regional tracking # _________________)OMB 0596-0106 Exp. 04/30/2016
FILL OUT FORM, PRINT AND SIGN
For (Activity):

/ /

Date:

Applicant Name:

Phone:
Email:

Street/PO Box:
City:

State:

Zip:

Fill in Each Blank as Required by the Location and Activity
Location or Site Desired:
1st Choice
Date Beginning:

/ /

Time:

:

AM/PM

:

AM/PM

Itinerary:
2nd Choice
Date Beginning:

Time:

/ /

Itinerary:
# In Party:
Day Use

Entry Point, Trail Name or Site Identifier:

Exit Point:

Method of Travel:

Group Organization or Event Name:

Over Night

Leader Contact Information
Name:
Vehicle or Boat Registration and License Number
Registration #:

State:

License Number:

List Number of:
Rafts:

Kayaks:

Horses:

Livestock:

Boats:

Off-Highway Vehicles:

Fees
Assessed Fee:

Cash

Check
Permit Information

Permit Number:
I agree to abide by the rules of use and/or regulations regarding this site, location or activity.

Signature:

File Code: 2330

Date:

/ /

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FS-2300-0047 (REV. 04/2013)
OMB 0596-0106 Exp. 04/30/2016

ADDITIONAL COMMENTS

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 0596-0106. The time required
to complete this information is estimated to average 15 minutes, 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 alleging discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410,
or call toll free, (866) 632-9992 (Voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (800) 8456136 (in Spanish). You may use USDA Program Discrimination Complaint Forms AD-3027 or AD-3027s (Spanish) which can be found at:
http://www.ascr.usda.gov/complaint_filing_cust.html and http://www.ascr.usda.gov/es_us/sp_complaint_filing_cust.html or upon request from a local
Forest Service office. USDA is an equal opportunity provider, employer, and lender.
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.
This information is needed by the Forest Service to evaluate requests to use National Forest System lands and manage those lands to protect natural
resources, administer the use, and address public health and safety concerns. This information is required to obtain or retain a benefit. The authority for
this information collection requirement is provided by the Federal Lands Recreation Enhancement Act.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
United States Department of Agriculture, Clearance Officer, OCIO, AG Box 7630, Washington, D.C. 20250, and to the Office of Management and Budget,
Paperwork Reduction Project (OMB #0596-0106), Washington, D.C. 20503.
File Code: 2330

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