Form DI-9008 Repository Receipt for Collections (Paleontology)

DI Form 9008, MM/YYYY OMB Control No. 1093-XXXX

Expires XX/XX/20XX

Department of the Interior

Repository Receipt for Collections (Paleontology)

Part 1: Permittee’s Certification of Deposit of Collections
1. Permittee Name and Contact Information	2. Permit Number
3. List of collections
4. By signing this receipt, the permittee certifies that all paleontological resources, including associated records, indicated on the list attached to this record have been deposited with the repository listed below. Signature of Permittee Date
Part 2: Repository’s Certification of Receipt of Collections
5. Repository Name and Address	6. Repository Accession Number(s)
7. Name of Repository’s Authorizing Official	8. Title of Repository’s Authorizing Official
9. By signing this receipt, the repository authorizing official certifies that all paleontological resources and associated records indicated on the attached list have been deposited with the repository under the terms of an existing valid agreement signed by an authorized official of the repository and an authorized official of the responsible Department of the Interior bureau prior to this deposit. Signature of Repository Official Date

Conditions:

1. Paleontological resources collected from Federal land under permit remain the property of the United States.

2. The repository official who acknowledges receipt of the collection may not be the same person listed on the permit, and must be authorized by the repository to receive collections on behalf of the repository

3. A bureau or Department of the Interior (DOI) official may contact the repository to verify the location and condition of collections deposited by the permittee.

4. Upon receipt, the repository agrees to curate and maintain collections in accordance with 43 CFR 49, Department Manual 411, and the terms and conditions defined in a separate agreement between the bureau and the repository for the care and maintenance of the deposited collection.

5. Specific locality data will not be released by the permittee or repository without written permission from a bureau authorized officer.

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 verify that the specimens that you collected under your permit are deposited in and received by an approved repository, as required by the Act. 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 1 hour to complete this form, 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.

Instructions

Repository Receipt for Collections (Paleontology)

BLM	Reclamation	FWS	NPS
General: After the permittee deposits the collection at the approved repository, the permittee or the repository will submit this form, or another receiving document containing the same information and conditions, to the authorized officer. When the repository is a DOI facility this form may be replaced with a form generated by DOI manual 411 or by the Interior Collections Management System (ICMS).	General: After the permittee deposits the collection at the approved repository, the permittee or the repository will submit this form, or another receiving document containing the same information and conditions, to the authorized officer.	General: After the permittee deposits the collection at the approved repository, the permittee or the repository will submit this form, or another receiving document containing the same information and conditions, to the authorized officer. When the repository is a DOI facility this form may be replaced with a form generated by DOI manual 411 or by the Interior Collections Management System (ICMS).	General. After the permittee deposits the collection at the approved repository, the permittee or the repository will submit this form, or another receiving document containing the same information and conditions, to the authorized officer. When the repository is a DOI facility this form may be replaced with a form generated by DOI manual 411 or by the Interior Collections Management System (ICMS).
1. Permittee Name and Contact Information. This is the principal investigator (PI) named in the paleontology permit.	1. Permittee Name and Contact Information. This is the principal investigator (PI) named in the paleontology use permit.	1. Permittee Name and Contact Information. This is the principal investigator (PI) named in the paleontology use permit.	1. Permittee Name and Contact Information. This is the principal investigator (PI).
2. Permit Number. This is the number that was assigned by the bureau to the paleontology use permit.	2. Permit Number. This is the number assigned by Reclamation at the top of the paleontology use permit.	2. Permit Number. This is the number that was assigned by the bureau to the paleontology use permit.	2. Permit Number. This is the number that was assigned by the bureau to the paleontology use permit.
3. List of Collections. Provide a complete listing of all specimens collected under the authority of the permit, and associated records, that are being deposited on the date indicated.	3. List of Collections and Condition. Provide a complete listing of all specimens collected under the authority of the permit, and associated records, that are being deposited on the date indicated. Also indicate condition of the collections.	3. List of Collections. Provide a complete listing of all specimens collected under the authority of the permit, and associated records, that are being deposited on the date indicated.	3. List of Collections. Provide a complete listing of all specimens collected under the authority of the permit, and associated records, that are being deposited on the date indicated.
4. Signature of Permittee and Date. Permittee signature certifies that all paleontological resources and associated records on the list are included in the deposit.	4. Signature of Permittee and Date. Permittee signature certifies that all paleontological specimens and associated records on that list are included in the deposit, and are in the indicated condition. Reclamation will continue to hold the permittee responsible for (1) all undelivered items, and (2) fulfilling any un-met terms and conditions of the use permit associated with preparing the collection for curation that the repository or Reclamation finds the permittee as having failed to fulfill prior to transfer of the materials to the repository. Failure could result in Reclamation refusing to issue future permits to the permittee.	4. Signature of Permittee and Date. Permittee signature certifies that all paleontological resources and associated records on the list are included in the deposit.	4. Signature of Permittee and Date. Permittee signature certifies that all paleontological resources and associated records on the list are included in the deposit.
5. Repository Name and Address. Must be the designated repository named on the permit line 9.	5. Repository Name and Address. Must be the repository named on line 9 of the paleontology use permit or subsequently authorized by the bureau authorized officer in a written modification of the use permit.	5. Repository Name and Address. Must be the designated repository named on the permit line 9.	5. Repository Name and Address. Must be the designated repository named on the permit line 9.
6. Repository Accession Number(s). Accession numbers are assigned by the repository. BLM needs these in order to track and report on the federally-owned collections.	6. Repository Accession Number(s). This is a unique number issued by the repository to the collection at the time it is received. This is not the same as the accession number issued by Reclamation.	6. Repository Accession Number(s). Accession numbers are assigned by the repository. FWS needs these in order to track and report on the federally-owned collections.	6. Repository Accession Number(s). Accession numbers are assigned by the repository. NPS needs these in order to track and report on the federally-owned collections.
7. Name of Repository’s Authorizing Official. Print the name of the repository authorized official.	7. Name of Repository’s Authorizing Official. An authorized repository official must sign this form, thereby documenting receipt of the collection, as represented on the list provided by the permittee. The name of the repository authorized official that is signing on line 8 shall be printed here on line 6. The repository official signing on line 8 must have the authority to accept a collection and obligate the repository to care for the received items. Furthermore, that repository official cannot also have been the permittee, nor have been named in line 8 of the permit application or subsequently performed any key role in implementing permitted actions. This is because a conflict of interest arises if the receiving repository official is also associated with the permitted work and preparation and deposit of the collection at the repository. If there is an association between the personnel named in the permit and the repository, then another official of the repository with no ties to the permitted work must be the repository’s authorizing official.	7. Name of Repository’s Authorizing Official. Print the name of the repository authorized official.	7. Name of Repository’s Authorizing Official. Print the name of the repository authorized official.
8. Title of Repository’s Authorizing Official. The repository official must be authorized to receive collections on behalf of the repository.	8. Title of Repository’s Authorizing Official. The repository official must be authorized to receive collections on behalf of the repository.	8. Title of Repository’s Authorizing Official. The repository official must be authorized to receive collections on behalf of the repository.	8. Title of Repository’s Authorizing Official. The repository official must be authorized to receive collections on behalf of the repository.
9. Signature of Repository Official and Date. The repository official signs to certify authorization to receive Federally-managed paleontological resources and associated records on behalf of the above named repository and that all paleontological resources and associated records listed on the attached inventory have been received and deposited at the repository.	9. Signature of Repository Official and Date. The repository official will sign and date the form, and then submit the signed form, with the itemized list, to the authorized agency official.	9. Signature of Repository Official and Date. The repository official signs to certify authorization to receive Federally-managed paleontological resources and associated records on behalf of the above named repository and that all paleontological resources and associated records listed on the attached inventory have been received and deposited at the repository.	9. Signature of Repository Official and Date. The repository official signs to certify authorization to receive Federally-managed paleontological resources and associated records on behalf of the above named repository and that all paleontological resources and associated records listed on the attached inventory have been received and deposited at the repository in accordance with the agreement between NPS and the repository.