Form DI-9002 Paleontological Resource Use Permit Application

DI Form 9002, MM/YYYY OMB Control No. 1093-XXXX

Expires XX/XX/20XX

Department of the Interior

Paleontological Resource Use Permit Application

1a. Applicant Name	1b. Applicant Institutional Affiliation
2. Professional Contact Information	3. Field Contact Information
4. Description of Proposed Work
5. Location of Proposed Work (attach map and separate sheet if necessary)
6. Purpose and Methodology of Proposed Work (attach separate sheet)
7. Dates of Proposed Work Start: End:
8. Name of the individuals who will be responsible for supervising fieldwork or other work
9. Information about the proposed repository
10. Name(s) of organization(s) responsible for curation costs
11. I certify under penalty of perjury that the information furnished is true and correct. Knowingly making a false statement may subject the declarant to the penalty provided by 18 U.S.C. 1001 and 16 U.S.C. 3372(d). Signature of Applicant Date

Attach the following to this application (see bureau instructions on following pages for further explanation of required content):

[ ] Current resume for the applicant and individuals named on line 8.

[ ] Institutional information.

[ ] Copy of research plan.

[ ] Contract Statement of Work if appropriate.

[ ] Maps and supporting information.

[ ] Bonding information, if required by the bureau.

[ ] Explanation of how the proposed repository meets the standards for bureau approval.

[ ] Verification from the proposed repository that it agrees to receive the collection.

[ ] Names of organizations responsible for costs of curation.

[ ] Information on past performance, including civil or criminal penalties.

Paperwork Reduction Act Statement. We are collecting this information in accordance with the Paleontological Resources Preservation Act. Your response is required to obtain or retain a benefit. We will use the information you provide to evaluate your qualifications, decide whether or not to issue a permit, and decide whether or not to approve the proposed repository for deposit of any collections. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. We estimate it will take you about 4 hours to complete this application, including time to maintain records, gather information, and complete the form. You may send comments on the burden estimate or any other aspect of this form to the Office of the Secretary, Departmental Information Collection Clearance Lead, Department of the Interior, 1849 C Street NW, Mailstop MIB-7056, Washington, DC 20240.

Privacy Act Statement. Information obtained by this form is protected by the Privacy Act of 1974 systems of records INTERIOR/DOI-XX. If you fail to complete the information requested, the bureau may refuse to grant a use permit.

Instructions

Department of the Interior

Paleontological Resource Use Permit Application

BLM	Reclamation	FWS	NPS
General: Use this form to apply for a paleontological resource use permit on BLM lands. Send your completed application to the address indicated at www.blm.gov/paleontology.	General: Use this form to apply for a paleontological resource use permit on Reclamation lands. Additional information may be requested by the authorized officer or designee before a decision will be made about issuing a permit. Send your completed application to the address indicated at www.blm.gov/paleontology, which will redirect you to Reclamation’s webpage.	General: Use this form to apply for a paleontological resource use permit on FWS lands. Additional information may be requested by the authorized officer or designee before a decision will be made about issuing a permit. Applicants must also apply for a Special Use Permit. Send your completed application to the address indicated at www.blm.gov/paleontology, which will redirect you to FWS’s webpage.	Instead of applying for a paleontological resource permit under this form, NPS scientific permit applications (including paleontology) must be requested through the NPS Research Permit and Reporting System (RPRS): https://irma.nps.gov/rprs/Home
1a. Applicant Name. The applicant is the principal investigator (PI). Attach a curriculum vitae or resume that identifies the applicant’s qualifications and field experience.	1a. Applicant Name. The applicant is the principal investigator (PI). Attach a professional resume that demonstrates the PI has the academic qualifications and prior experience appropriate to carry out proposed fieldwork and analysis, report on the outcome, and perform administrative duties.	1a. Applicant Name. The applicant is the principal investigator (PI). Attach a curriculum vitae or resume that identifies the applicant’s qualifications and field experience.
1b. Applicant Institutional Affiliation is the employing or sponsoring organization with which the applicant is professionally associated.	1b. Applicant Institutional Affiliation is the employing or sponsoring organization with which the applicant is professionally associated.	1b. Applicant Institutional Affiliation is the employing or sponsoring organization with which the applicant is professionally associated.
2. Professional Contact Information. Include mailing address, email, fax and phone number, or any other information that is necessary for BLM to contact the applicant about the status of a permit or permit application.	2. Professional Contact Information. Include information that is needed by Reclamation to contact the applicant (may include mailing address, email, fax and phone number).	2. Professional Contact Information. Include mailing address, email, fax and phone number, or any other information that is necessary for FWS to contact the applicant about the status of a permit or permit application.
3. Field Contact Information. Any phone, email, or social media address that will allow the BLM to contact the permittee while conducting fieldwork.	3. Field Contact Information. Information that will allow Reclamation to contact the permittee while conducting fieldwork.	3. Field Contact Information. Any phone, email, or social media address that will allow the FWS to contact the permittee while conducting fieldwork.
4. Description of Proposed Work. Briefly identify if work under this permit would be for research or mitigation, and give a brief title (for example: recovery of vertebrate and microvertebrate fauna in the San Juan Basin of Northwest New Mexico, etc.)	4. Description of Proposed Work. A brief statement that defines the kind of work proposed. For example: Documentation of Pleistocene Trackways from Locality 27, American Falls Reservoir, Idaho.	4. Description of Proposed Work. Give the proposed work a brief title (for example: excavation of dinosaur remains from the Hell Creek Formation in the Charles M. Russell National Wildlife Refuge, etc.)
5. Location of Proposed Work. Provide the State, County, map coordinate (UTM, NAD 83), BLM district or administrative area, and any other information that would allow the BLM to identify where paleontological work would occur. Discrete areas of work should be plotted on a legible 1:24,000 scale USGS topographic map that has not been altered or photo-reduced.	5. Location of Proposed Work. Indicate state and county, map coordinate (UTM, NAD 83) and Section/Township/Range to within the smallest unit (e.g., ¼ ¼). Provide also a readable copy of a 1:24,000 scale USGS topographic map that has not been altered or photo-reduced, marked to show proposed work location(s).	5. Location of Proposed Work. Provide a State, County, map coordinate (UTM, NAD 83) and also Section/Township/Range within the appropriate ¼ ¼. Provide also a readable copy of a 1:24,000 scale USGS topographic map that has not been altered or photo-reduced, marked to show proposed work location(s).
6. Purpose and Methodology of Proposed Work. Include a narrative that identifies a research design or work plan. This should include the purpose of the work, research goals, field methods, access to field areas, and any other information that the BLM will need in order to evaluate the proposed permit application. Please identify the nature of possible land disturbance. Fieldwork that will result in excavation or disturbance of a large area, normally greater than one square meter, may require the bureau to analyze the potential effects under the National Environmental Protection Act (NEPA) and other statutes (NHPA, ESA, tribal consultation, etc.). Also, identify what proposed tools may be used, especially machinery, vehicles, or explosives. Explain the public benefit of the proposed work. Include bond information if appropriate.	6. Purpose and Methodology of Proposed Work. Provide a research design/work plan with the following information, provided at a level of detail commensurate with the nature/complexity of work. (1) purpose, research goals, planned activities, and anticipated public benefit. (2) field and analytical methods. (3) name of key personnel and their assigned roles and responsibilities for field, analytical, and reporting efforts, with a summary of their prior experience that qualifies them to perform these duties. Also define the standards of training and experience crew shall meet before they can perform these tasks. (4) a schedule for fieldwork, analysis, and report preparation, and for delivery of collected materials to the approved repository. (5) nature and extent of proposed specimen collection, and collection methods; any intent to perform consumptive use of collected specimens, and why it is required to achieve defined research objectives. Indicate planned actions to prepare specimens for curation. (6) logistical information (maximum number in field party and maximum number of vehicles; means to access sites, intent to house crews on Federal land, site preparatory work that could affect land resources; (7) name and location(s) of laboratory facilities where analytical work will be performed, with summary of materials/services they provide.	6. Purpose and Methodology of Proposed Work. Include a narrative that identifies a research design or work plan. This should include the purpose of the work, research goals, field methods, access to field areas, and any other information that the FWS will need in order to evaluate the proposed permit application. Please identify the nature of possible land disturbance. Fieldwork that will result in excavation or disturbance of a large area, normally greater than one square meter, may require the bureau to analyze the potential effects under the National Environmental Protection Act (NEPA) and other statutes (NHPA, ESA, tribal consultation, etc.). Also, identify what proposed tools may be used, especially machinery, vehicles, or explosives. Explain the public benefit of the proposed work. Include bond information if appropriate.
7. Dates of Proposed Work. Include the proposed starting and projected end date of fieldwork for this project.	7. Dates of Proposed Work. Indicate start and projected end date of proposed fieldwork.	7. Dates of Proposed Work. Include the proposed starting and projected end date of fieldwork for this project.
8. Name of the individuals who will be responsible for supervising fieldwork or other work. These persons must each be academically qualified and possess the field experience to perform this work independently.	8. Name of the individuals who will be responsible for supervising fieldwork or other work. Name key personnel (those persons performing work of a responsible nature for field, analysis, specimen preparation, or reporting).	8. Name of the individuals who will be responsible for supervising fieldwork or other work. For each individual named on line 8 attach a curriculum vitae or resume that provides a summary of education, training, and experience in the kind of work proposed and in the role proposed.
9. Information about the proposed repository (name, address, point of contact). Provide information that will help the bureau evaluate whether the proposed repository meets the approval standards described at 43 CFR § 49.205.	Information about the proposed repository (name, address, point of contact). Provide the name and address of the proposed facility and the name and contact information (phone and e‑mail) for the facility point of contact. Also provide information that will help the bureau evaluate whether the proposed repository meets the approval standards described at 43 CFR § 49.205.	9. Information about the proposed repository (name, address, point of contact). This must include a written verification, signed by a properly authorized official (who is NOT named in lines 1 or line 8 of this form) of the proposed repository, verifying the repository’s willingness to accept any collections and associated records generated during the proposed work, and to assume curatorial responsibility for such materials on behalf of the United States Government. Also provide information that will help the bureau evaluate whether the proposed repository meets the approval standards described at 43 CFR § 49.205.
10. Name of organizations responsible for curation costs. Indicate how costs of curating the collections made under the permit will be addressed. These costs are the responsibility of the permittee and must be arranged prior to collecting any paleontological resources.	10. Name of organizations responsible for curation costs. Indicate how costs of curating the collections made under the permit will be addressed. These costs are the responsibility of the permittee and must be arranged prior to collecting any paleontological resources.	10. Name of organizations responsible for curation costs. The costs of curation are the responsibility of the permittee and must be arranged prior to collecting any paleontological resources.
11. Signature of Applicant. By signing this application, the applicant certifies that the information provided is true and accurate. If BLM finds that the applicant has intentionally provided misleading or false information, or has failed to disclose facts about past performance, or otherwise failed to provide a complete and truthful application about proposed actions and their ability to perform, it is a basis for denial of a permit.	11. Signature of Applicant. By signing this application, the applicant certifies that the information provided is true and accurate. If Reclamation finds that the applicant has intentionally provided misleading or false information, or has failed to disclose facts about past performance, or otherwise failed to provide a complete and truthful application about proposed actions and their ability to perform, it is a basis for denial of a permit.	11. Signature of Applicant. By signing this application, the applicant certifies that the information provided is true and accurate. If FWS finds that the applicant has intentionally provided misleading or false information, or has failed to disclose facts about past performance, or otherwise failed to provide a complete and truthful application about proposed actions and their ability to perform, it is a basis for denial of a permit.
Additional Materials: Attach the following to this application: - Resume for the applicant and individuals named on line 8 - Institutional/Corporate information - Copy of research plan, including party size, methods that will be employed to explore for or remove the paleontological resources, proposed content and nature of any collection to be made under the permit, collection management processes, timetable for transfer to the proposed repository, and any additional information that will help the authorized officer identify the extent, nature, and impacts of the proposal. - Contract Statement of Work if appropriate - Maps and supporting information - Bonding information, if required by the bureau - Written verification, signed by a properly authorized official (who is NOT named in lines 1 or line 8 of this form) of the proposed repository, verifying the repository’s willingness to accept any collections, including and associated records, generated during the proposed work, and to assume curatorial responsibility for such materials on behalf of the United States Government. -Information on past performance, including civil or criminal penalties	Additional Materials: Unless indicated otherwise, attach the materials listed on the form, as well as other supplemental materials requested by Reclamation (see prior instruction for completing the application) or that the applicant believes will improve the application. Attach the required PI and key personnel resumes, research design/work plan: location maps, etc., defined in prior sections of the form, and written verification by the proposed repository indicating it has agreed to accept the collections, and will curate them consistent with DOI and Reclamation museum property policies and requirements. The verification must be signed and dated by a repository official who has the authority to so commit the repository and who is not named in the application as the PI or named on line 8 of the application. Additional materials that may be requested by Reclamation are: samples of work by key personnel named in line 8 of this application; references; information about past performance, including prior or current civil or criminal violations pertinent to performance under the permit or use of Federal land; proof of insurance; bonding information; statements assigning responsibility for payment of curation fees or expenses for collected materials; and other information or warranties necessary to ensure the applicant can perform work under a permit in a responsible manner.	Additional Materials: Attach the following to this application: - Resume for the applicant and individuals named on line 8 - Institutional/Corporate information - Copy of research plan, including party size, methods that will be employed to explore for or remove the paleontological resources, proposed content and nature of any collection to be made under the permit, collection management processes, timetable for transfer to the proposed repository, and any additional information that will help the authorized officer identify the extent, nature, and impacts of the proposal. - Contract Statement of Work if appropriate - Maps and supporting information - Bonding information, if required by the bureau - Written verification that proposed repository will curate collections -Information on past performance, including civil or criminal penalties -FWS Special Use Permit application