Form 10-595 The America the Beautiful – the National Parks and Feder

NPS Form 10-595 (Rev. 12/2016)
National Park Service

OMB Control No. 1024-0252
Expiration Date ##/##/####

AMERICA THE BEAUTIFUL – THE NATIONAL PARKS AND FEDERAL
RECREATIONAL LANDS SENIOR PASS
U.S. Department of the Interior - Bureau of Land Management, Fish and Wildlife Service, Bureau of Reclamation, National Park Service
U.S. Department of Agriculture - Forest Service - U.S. Army Corps of Engineers

About the Senior Pass:
The Senior Pass is a lifetime pass available to United States citizens or permanent residents 62 years of age or older. The
Pass can be used at over 2000 federal recreation sites across the nation, including National Parks, National Wildlife Refuges,
and many National Forest and other federal recreation lands. The Senior Pass admits the Pass owner and any passengers
traveling with him/her in a single non-commercial vehicle at per-vehicle fee areas or the Pass owner and three additional adults
where per-person fees are charged. The Senior Pass may also offer a discount on some expanded amenity fees, such as
camping. Discounts offered by the Pass very widely across the many different types of recreation sites. Pass owners are
encouraged to check with sites they plan to visit before obtaining a Pass to verify that their Pass will be accepted. Anytime a
Pass is used, photo identification will be requested to verify Pass ownership.
How to Obtain a Senior Pass:
The Pass may be obtained two ways, either at a federal recreation site where entrance or standard amenity fees are charged or
through the mail. To obtain a Pass you must have photo identification to verify that you are a U.S. citizen or permanent resident
62 years of age or older, which could include:
A U.S. State or Territory issued Driver’s License, Identification or Birth Certificate
A U.S. Passport or Passport Card
A Permanent Resident Card (Green Card)
Obtaining a Pass Through the Mail
To obtain a Senior Pass through the mail you must complete this application, provide a photocopy of proof of age and
citizenship or residency and pay the processing fee. The cost of obtaining a Senior Pass through the mail is twenty dollars
($20). Ten ($10) for the Senior Pass and ten ($10) for processing the application.
Obtaining a Pass Online
To obtain your pass online you will be required to complete an online order form and upload an electronic version of your photo
identification. The cost of obtaining a Senior Pass online is twenty dollars ($20). Ten ($10) for the Senior Pass and ten ($10) for
processing the application. Go to store.usgs.gov for more information and to place your order.
Obtaining a Pass in Person
If you apply for a Senior Pass at a federal recreation site you do NOT need to fill out this application. When you arrive at
the recreation site, the officer selling the pass will verify your age and that you are a U.S. citizen or permanent resident by
checking your identification. You will then be issued the Pass. The Pass is ten dollars ($10) if obtained in person, there is no
processing fee. Before making a trip to obtain a Pass, be sure to contact the site to ensure that they have passes available.
Replacement Passes:
Lost or stolen Passes cannot be replaced at this time. If your Pass has been lost or stolen you must purchase a new one.
Worn or damaged Passes can be replaced free of charge at any recreation site where Passes are issued, or through the mail by
returning the Pass with this application and paying the ten dollar ($10) processing fee.

NPS Form 10-595 (Rev. 12/2016)
National Park Service

OMB Control No. 1024-0252
Expiration Date ##/##/####

APPLICATION FOR MAIL ORDER SALES OF THE
AMERICA THE BEAUTIFUL – THE NATIONAL PARKS AND FEDERAL
RECREATIONAL LANDS SENIOR PASS
U.S. Department of the Interior - Bureau of Land Management, Fish and Wildlife Service, Bureau of Reclamation, National Park Service
U.S. Department of Agriculture - Forest Service --- U.S. Army Corps of Engineers

Your application for a Senior Pass must include:
Product #209290
1. This completed, signed application form.
2. Photocopy of documentation issued by an authorized U.S. agency that demonstrates U.S. citizenship or permanent
residence and birthdate (driver's license, passport, state issued ID).
3. Payment of the processing fee by either Credit Card, Check or Money Order.
4. For a pass replacement, please submit the original worn pass.

**Do Not Send Original Documents**
Please Print Clearly - Your name should appear as it does on your Photo ID

Full Name

-

Street
City

State

Zip Code

-

Telephone

E-Mail Address

By submitting this application:
I hereby affirm that I am a citizen of or domiciled in the United States, and that I am 62 years old or older.
Signature: ____________________________________________

Date

-

-

Payment
Credit Card

Visa

Master Card

American Express

Discover

Security Code

Exp. Date

Credit Card Number:

Your credit card will be billed $20 at the time of shipment.
Send your completed Application to:
USGS
Attn: Senior Pass
Box 25286
Denver, CO 80225

Questions:
[email protected]
1-888-ASK-USGS
(1-888-275-8747)

Federal Law 18 U.S.C. 1001 makes it a crime in any matter within the jurisdiction of any department or agency of the
United States for any person knowingly and willfully to falsify, conceal, or cover up by any trick, scheme, or device a
material fact; to make any materially false, fictitious, or fraudulent statement or representation; or to make or use
any false writing or document knowing that it contains a materially false, fictitious or fraudulent statement or entry.
Violations of 18 U.S.C. 1001 are punishable by fines of up to $10,000, imprisonment of up to five years, or both.

NPS Form 10-595 (Rev. 12/2016)
National Park Service

OMB Control No. 1024-0252
Expiration Date ##/##/####

NOTICES
PRIVACY ACT STATEMENT
General: The Federal Lands Recreation Enhancement Act of 2004 (REA), 16 U.S.C. 6804 et seq.
Authority: The information collected is required to establish eligibility; process financial transactions to complete Pass purchase
requests; fulfill Passes to individuals (‘‘fulfill’’ and ‘‘fulfillment’’ refer to shipping and handling of Passes), federal recreation sites, and
third parties; and provide associated customer services such as sending renewal notices and providing information about the Pass
program and federal lands. Informational or promotional messages will be sent to individuals and organizations only if they have
affirmatively requested such messages through an ‘‘opt-in’’ mechanism.
Purposes and Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or
information contained in this system may be disclosed outside the National Park Service as a routine use pursuant to 5 U.S.C.
552a(b)(3) to other Federal, state, tribal, territorial, foreign or local government, educational, and other organizations, entities or
individuals for the purpose of verifying eligibility to receive a Pass, prevent duplication, fraud and abuse, or as otherwise required by law
when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records
notice “America the Beautiful—The National Parks and Federal Recreational Lands Pass System, DOI–06”
Effects of Nondisclosure: Voluntary, however, failure to provide the requested information may impede individual from obtaining a
pass from the National Park Service.

PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to collected to determine adequate proof
of residency. The obligation to respond is required to obtain the Interagency Senior Pass. You are not required to respond to this or
any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number. OMB has
approved this collection of information and assigned Control No. 1024-0252.

ESTIMATED BURDEN STATEMENT
The public burden for the collection of information is estimated to be 10 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing the form. Direct comments regarding this burden estimate, or any aspects
of this form, to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Mail Stop 242, Reston,
VA 20192. Please do not send your form to this address.