Form DI-9005 Paleontological Permit Report Cover Sheet

DI Form 9005. MM/YYYY OMB Control No. 1093-XXXX

Expires XX/XX/20XX

Department of the Interior

Paleontological Permit Report Cover Sheet

A separate report is required for each active permit.

1. Permittee Name	2. Permit Number	3. Reporting Period
4. Fieldwork or Other Work – was work conducted under this permit during the reporting period? [ ] YES (continue to line 5) [ ] NO (continue to line 7)
5. Deposit of Collections – have all paleontological resources collected under this permit, and their associated data been deposited in the approved repository? [ ] YES [ ] NO [ ] FIELDWORK DONE, BUT NOTHING WAS COLLECTED Attach transmittal documentation, including a list of paleontological resources collected. If some or all of the collections have not been deposited in the approved repository, please identify and give a timetable for deposit.
6. Reporting Information (appended to cover sheet): - Summary of work completed, including field dates, personnel involved, and results. - Copies of published papers and reports that were generated from work under this permit or that acknowledge this permit. - Narrative of future work that is intended to be performed under this permit. - Notable discoveries, including new species discovered or described, and any media reports. - Note any threatened resources about which the agency should be aware. - Paleontological Locality Forms for all new localities discovered or updated forms, including maps and photos. - Note any ways that the bureau may be able to better assist with your work.
7. Permit Status [ ] I REQUEST THAT THIS PERMIT BE RENEWED [ ] I REQUEST THAT THIS PERMIT BE CLOSED
8. 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 Permittee Date

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 understand the work that was conducted under your permit and incorporate the results as appropriate into resource management. 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 5 hours 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

Paleontological Permit Report Cover Sheet

BLM	Reclamation	FWS	NPS
General: The permit report cover sheet is optional. However, use of this form will help ensure that reports are complete. Permit reports must be filed annually, or when a permit is ready to be closed. BLM requires a separate permit report for each permit.	General: Draft reports will be reviewed by the Authorizing Official or their designee to determine if they meet the terms and conditions for reporting defined in the permit.	General: This form is a summary of work completed under the permit and a request for the permit to be renewed or closed. FWS collects this information and makes decisions about permits via direct communication with the permittee. All decisions are documented in writing.	NPS collects the information requested in this form via the IAR, which is required of all permittees (including paleontology). The IAR should be submitted through the NPS Research Permit and Reporting System (RPRS): https://irma.nps.gov/rprs/Home
1. Permittee Name. This is the principle investigator (PI), from line 1a of the paleontology permit.	1. Permittee Name. This is the principle investigator (PI), from line 1a of the paleontology use permit.	1. Permittee Name. This is the principle investigator (PI), from line 1a of the paleontology 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.	2. Permit Number. This is the number that was assigned by the bureau to the paleontology use permit.
3. Reporting Period. BLM requires that permits be reported annually, so the reporting period should be the reporting year.	3. Reporting Period. The period covered by the report or materials attached to the cover sheet.	3. Reporting Period. FWS requires a permit report at the end of the life of the permit, but may require reports more often.
4. Field or Other Work. If any work was conducted continue to question 5. If no work was done under the permit during the reporting period, check this box and return the form to the bureau.	4. Field or Other Work. The dates at which work was performed during the reporting period.	4. Field or Other Work. If any work was conducted continue to question 5. If no work was done under the permit during the reporting period check this box and return the form to the bureau.
5. Deposit of Collections. Attach completed form DI-9008, Repository Receipt for Collections. If some or all of the collections have not been deposited in the approved repository, please explain. This information is necessary so the bureau can track and report on collections.	5. Deposit of Collections. Indicate the date of deposit of collections made under the use permit into the approved repository. Attach transmittal documentation (DI-9008), and a list of paleontological resources collected that indicates deposit status to date.	5. Deposit of Collections. Attach completed form DI-9008, Repository Receipt for Collections. If some or all of the collections have not been deposited in the approved repository, please explain. This information is necessary so the bureau can track and report on collections.
6. Reporting Information. Include the following information in the report: - Summary of work completed, including field dates, personnel involved, and results. - Copies of published papers and reports that acknowledge this permit. - Narrative of future work that is intended to be performed under this permit. - Notable discoveries, including new species discovered or described, and any media reports. - Note any threatened resources about which the bureau should be aware. - Paleontological Locality Forms for all new localities discovered, including maps and photos. - Note any ways that the bureau may be able to better assist with your work.	6. Reporting Information. Briefly summarize the nature and key results of work performed during the reporting period, and the nature of work remaining to be performed under the permit. Provide other information required in the use permit for interim or status reports. Attach copies of locality forms (DI-9004) completed (new or updated site forms).	6. Reporting Information. Include the following information in the report: - Summary of work completed, including field dates, personnel involved, and results.
7. Permit Status. Indicate whether you want the permit to be renewed for another reporting period or if the permit should be closed. Also indicate any minor modifications that you desire, such as changes in field personnel (line 8 of the permit), or minor changes in field methods (line 4 of the permit). Major changes may require a new permit application. If fieldwork is complete, then indicate that the permit can be closed.	7. Permit Status. Indicate the status in performing the work approved in the use permit. If it is not on schedule, indicate why and provide a revised schedule. Reclamation may not accept revision of the schedule; the original schedule remains in effect unless and until Reclamation’s authorized officer provides written approval of a change in the terms and schedule of the use permit.	7. Permit Status. Indicate whether you want the permit to be renewed for another reporting period or if the permit can be closed.
8. Signature of Permittee. By signing the permittee certifies that the information provided in the permit report is true and accurate.	8. Signature of Permittee. By signing the permittee certifies that the information provided in the report is true and accurate.	8. Signature of Permittee. By signing the permittee certifies that the information provided in the report is true and accurate.