Form 10-596 The America the Beautiful – the National Parks and Feder

NPS Form 10-596 (Rev. 12/2016)
National Park Service

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

AMERICA THE BEAUTIFUL – THE NATIONAL PARKS AND FEDERAL
RECREATIONAL LANDS ACCESS 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 Access Pass:
The Access Pass is a free, lifetime pass available to United States citizens or permanent residents, regardless of age, that have
a permanent disability. 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 Access 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 Access Pass may also offer a discount on some expanded
amenity fees, such as camping. Discounts offered by the Pass vary 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 an Access 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, 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)
You must also provide documentation that you have a permanent disability, which could include:
•
•

•

A statement signed by a licensed physician attesting that you have a permanent physical, mental, or sensory
impairment that substantially limits one or more major life activities, and stating the nature of the impairment;
OR
A document issued by a Federal agency, such as the U.S. Department of Veterans Administration, which attests that
you have been medically determined to be eligible to receive Federal benefits as a result of blindness or permanent
disability. Other acceptable Federal agency documents include proof of receipt of Social Security Disability Income
(SSDI) or Supplemental Security Income (SSI);
OR
A document issued by a State agency such as a vocational rehabilitation agency, which attests that you have been
medically determined to be eligible to receive vocational rehabilitation agency benefits or services as a result of
medically determined blindness or permanent disability. Showing a State motor vehicle department disability sticker,
license plate or hang tag is not acceptable documentation.

Obtaining a Pass Through the Mail
To obtain an Access Pass through the mail you must complete this application, provide a photocopy of proof of citizenship or
residency, documentation of disability and pay the processing fee. The cost of obtaining an Access Pass through the mail is ten
dollars ($10) for processing the application (the Pass is free).
Obtaining a Pass in Person
If you apply for an Access 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 documentation of disability 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 free 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 10-596 (Rev. 2/2017)
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 ACCESS 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 an Access Pass must include:
Product #209291
1. This completed, signed application form.
2. Photocopy of documentation issued by Social Security Disability, Office of Veterans Affairs and/or a licensed physician
that demonstrates permanent disability.
3. Photocopy of documentation issued by an authorized U.S. agency that demonstrates U.S. citizenship or permanent
residence (driver's license, passport, state issued ID).
4. Payment of the processing fee by Credit Card.
5. 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
State

City

-

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 have been medically determined to have a
permanent physical, mental, or sensory impairment that severely limits one or more major life activities. Major life activities
include functions such as: caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, etc.
(Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC § 705 20)).
Signature: _______________________________________________________

-

Date

-

Payment
Credit Card:

Visa

Master Card

American Express

Discover

Credit Card Number

Date

Security Code

-

Your credit card will be billed $10 at the time of shipment.
Send your completed Application to:
USGS
Attn: Access 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 10-596 (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
disability and residency. The obligation to respond is required to obtain the Interagency Access 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.