Form DI-9003 Paleontological Resource Use Permit

DI Form 9003, MM/YYYY

Department of the Interior

Paleontological Resource Use Permit

A copy of this permit must be carried whenever fieldwork is in progress, kept with fossils during transport, and shared with the approved repository.

Permit Number (all correspondence between the bureau and permittee should reference this permit number).
1a. Permittee Name	1b. Permittee Institutional Affiliation
2. Professional Contact Information	3. Field Contact Information
4. Description of Authorized Work
5. Location of Authorized Work
6. Terms and Conditions
7. Dates of authorized work (A Notice to Proceed may be required prior to the start of all fieldwork) Start: End:
8. Name(s) of individuals who supervise or conduct the fieldwork
9. Name and address of approved repository
10. Upon the execution of this permit, the permittee: (a) acknowledges, accepts, and complies with all elements of 43 CFR part 49. (b) acknowledges and accepts all of the attached terms and conditions. (c) is responsible for all costs associated with this permit unless otherwise covered by a separate agreement. Signature and Title of Permittee Date
Signature and Title of Authorized Official Date

The information required to complete this form was gathered under OMB Control Number 1093-XXXX,

BLM	Reclamation	FWS	NPS
General: This permit is issued by BLM state offices to qualified applicants.	General: This permit is issued by Reclamation to document approval of a paleontological resources work plan. It will accompany a memo issued by Reclamation’s authorizing officer. It may contain terms and conditions that alter the information or original work plan submitted by the applicant.	General: This form is the permit for the work identified in the permit application. It will accompany the memo issued by the FWS authorizing officer or designee and any subsequent Special Use Permit issued by the locality manager.	Instead of this permit, park managers issue Scientific Research and Collecting Permits (including for paleontology) in response to applications submitted through the NPS Research Permit and Reporting System (RPRS): https://irma.nps.gov/rprs/Home