FS-2800-22C Paleontological Investigation Report Form

FS-2800-22C (v05/2015)

OMB 0596-0082

Office Use Only

Application Number:

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United States Department of Agriculture

Forest Service

Paleontological Investigation Report Form

1. Permit number: Click here to enter text.	2. Dates of field work: Click here to enter text.
3. Permittee(s)’ name, title, affiliation, and professional contact information: Click here to enter text.	4. Name(s) of people who performed field work: Click here to enter text.
5. Project name, number, or reference: Click here to enter text.	6. Administrative area (state, county, ranger district, forest, etc.): Click here to enter text.
7. Date of report: Click here to enter text.
8. Describe project, methodology, or summary of research scope of work: Click here to enter text.
9. Describe work performed or accomplished and a summary of results and discoveries: Click here to enter text.
10. Summarize regional or local geology and/or paleontology, including context, geography, stratigraphy, and geological unit: Click here to enter text.
11. Identify potential impacts to paleontological resources by proposed land use action: Click here to enter text.
12. Mitigation recommendations to address potential paleontological resource impacts: Click here to enter text.
13. Relevant literature citations: Click here to enter text.
14. Attach Relevant associated records, including anything that aids in explaining, clarifying, or understanding the findings.
15. Were paleontological resources collected from Forest Service land during this project? ☐a. Yes ☐b. No c. If Box “a” above was checked , provide complete provenance and repository information for each specimen collected: Click here to enter text.

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 6.5 hours 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.

INSTRUCTIONS:

Completing the Paleontological Investigation Report Form

1. Permit number: Enter the agency-assigned authorization or permit number. Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

2. Dates of field work: Enter the range of dates during which field work occurred. Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

3. Permittee(s)’ name, title, affiliation, and professional contact information: Enter the permit holder’s name, title, affiliation, and professional contact information. Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

4. Name(s) of people who performed field work: Enter the names of all individuals who performed field work for this project. Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

5. Project name, number, or reference: Enter the permit holder’s self-assigned project name, if applicable.

6. Administrative area (state, county, ranger district, forest, etc.): Identify the major political and agency administrative areas in which the field work occurred. Include State, County, National Forest or National Grassland name(s), and Ranger District name(s).

7. Date of report: Enter the date this report was finalized.

8. Describe project, methodology, or summary of research scope of work: Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

9. Describe work performed or accomplished and a summary of results and discoveries: Briefly describe the actual work performed and provide a summary of findings and any discoveries.

10. Summarize regional or local geology and/or paleontology, including context, geography, stratigraphy, and geological unit: Briefly discuss the geologic/stratigraphic setting of the project area; place particular emphasis on context of any paleontological specimens that were collected.

11. Identify potential impacts to paleontological resources by proposed land use action: If the permitted activity was a paleontological survey performed in advance of a proposal for ground disturbing activity, potential impacts to paleontological resources must be described. Otherwise enter N/A.

12. Mitigation recommendations to address potential paleontological resource impacts: If the permitted activity was a paleontological survey performed in advance of a proposal for ground disturbing activity, recommendations to mitigate potential impacts to paleontological resources must be described, based on the survey results. Otherwise enter N/A.

13. Relevant literature citations: Provide pertinent literature citations that document prior paleontological studies in the project area, and/or that would place the project in scientific context. If no pertinent technical literature exists, enter N/A.

14. Attach relevant associated records, including anything that aids in explaining, clarifying, or understanding the findings: Attach to this report any records developed as part of this project that bear on the scientific context of the project findings. Such records would include, but not be limited to, field notes, photographic materials, and correspondence, that could bear on agency administration of the paleontological resources using scientific principles and expertise.

15. Were paleontological resources collected from Forest Service land during this project? Box a should be checked if paleontological resources were collected from Forest Service land. Box b should be checked if no paleontological resources were collected from Forest Service land. If paleontological resources were collected (box a was checked), provide the following for each specimen: complete geographic locality information including specimen field number and UTM coordinates, and complete repository information including repository identification, accession numbers and catalog numbers. Alternatively, the optional Paleontological Specimen Data Form may be used to provide information about collected paleontological resources.

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