FS-2300-48 National Recreation Permit

National Recreation Permit

FS-2300-0048 (REV. 04/2013)

(FOR OFFICE USE ONLY: Regional Permit #__________________) OMB 0596-0106 Exp. 04/30/2016
By applying for this permit you agree to abide by the rules of use regarding this site, location or activity.
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) 845-6136 (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.

FOR OFFICE USE ONLY
Issuing Officer:

Initials:

Signature:

Date/Time of Issue:

/ /

:

Applicant's Information
Group or Individual Name:

/ /

Signature:

Date:

Street/PO Box:

Phone: ( )

-

City:

State:

Zip:

Method of Travel:

Amount Paid $ :

License Plate No.:

Vehicle and tow type, make, model, description (ATV, motorcycle, mountain bike, power boat):

State:
Specialty Permit No. : (MS, Adv Pass, yr only)

Permit Dates:

Payment Information
Cash

Fees Assessed $

Check

Permit Application: Fill in each blank as required by the location and activity
Regional Permit No.:

Site Location Name:

BOAT LAUNCH
Launch No.

CABIN OR CAMPSITE
# of People in Group

# of Rafts:
# of Kayaks:

Site # or Cabin Name:

Powerboat:

ENTRY
EXIT

OTHER USE

Snowmobiles:

Horseback Stocks:

Motorcycles:

Other:

Mountain Bikes:
ATVs:

Boat Registration:
Expiration Date

OHVs / OTHER VEHICLE

Other:
/ /
Arrival/Launch Start Date:

/ /

Time:

:

# in Group:

Departure Date:

/ /

Time:

:

Total # of Days:

Additional comments can be written on the reverse side of this Permit Application.

Detach Permit and Display in Vehicle as Indicated. Deposit Stub in Box Provided.
File Code: 2330

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FS-2300-0048 (REV. 04/2013)
OMB 0596-0106 Exp. 04/30/2016
Detach Permit and Display in Vehicle as Indicated. Deposit Stub in Box Provided.
Hang from rearview mirror or lay on dashboard this
side up

PERMIT STUB
DETACH AND DEPOSIT IN PERMIT BOX

Regional Permit #

PERMIT

DATES OF USE
____________________________

BOAT LAUNCH

HORSE/STOCK

OHV

CAMPING

SNOWMOBILE

ATV

GROUP CAMP

MOTORIZED

OTHER

write in dates of use to validate
/ /

/ /

/ /

/ /

/ /

/ /

Region Permit #
Additional Comments

File Code: 2330

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