Form 7-2540 Bureau of Reclamation Use Authorization Application

7-2540 (02-2016) Bureau of Reclamation
	OMB Control No.: 1006-0003 OMB Expiration Date: XX-XX--2021

USE AUTHORIZATION APPLICATION

Applicants: Use this form to apply for possession or occupancy of, or for extraction or disturbance of natural resources from land, facilities, or waterbodies under the jurisdiction of the Bureau of Reclamation (Reclamation). For examples of uses requiring Reclamation authorization, and for information concerning other uses, see "General Information" on the next page. Fill out the following application completely. Use “N/A” if a question does not apply. If additional space is needed, attach separate pages of information as necessary. Refer to the second page of this form for detailed instructions.
1. Information about the applicant requesting the use:
Applicant or Representative:
Company or Entity Name:
Address:
City, State, and Zip Code:
Telephone Numbers (include area code):					Email add	ress:
Tax ID or Social Security Number (as applicable):
2. Is this request for a new use authorization or a renewal of an existing use authorization? Renewal New
If renewal, issuing office			Date of use authorization
Location of the proposed use: [A map or drawing including legal land description (section, township, range) showing the location of the proposed use is required.] Purpose of proposed use: Description of the proposed use: [Provide full description.]
6. Dates of proposed use [during the following times and dates (specify below)]:
START				E	ND
DATE	TIME		DATE	TIME
(Month, Day, Year)	AM	PM	(Month, Day, Year)		AM	PM
7. Name of Insurance Carrier:
8. Have you, or your organization, forfeited any portion of any previous permit, bond, or surety submitted for use of Federal lands, or is any investigation or legal action pending against you or your organization for use of Federal lands? Yes No [If “Yes”, attach details on separate sheet.]
9. Applicant Certification: I certify that the information given in this application is true, complete, and correct to the best of my knowledge and belief and is given in good faith. I acknowledge that I (we) am (are) required to comply with any conditions or stipulations that are required by the Bureau of Reclamation when the use authorization is issued. The non-refundable application fee is included: Yes No If “No”, reason:
Date			Signature of Applicant
Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

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7-2540 (02-2015) OMB Control No.: 1006-0003

Bureau of Reclamation OMB Expiration Date: XX-XX-2018

USE AUTHORIZATION APPLICATION

GENERAL INFORMATION

1. Examples of uses that may be applied for using FORM 7-2540 (this form). The following uses of Reclamation’s lands, facilities, and waterbodies are commonly requested by using this use authorization application. This list is intended to provide examples of such uses and should not be considered as all inclusive:

Commercial filming and photography; Commercial guiding and outfitting; Commercial or organized sporting events; Grazing, farming, and other agricultural uses;	Organized recreational activities, public gatherings, & other special events;
	Removal of, or exploration for, sand, gravel, and other mineral materials;
	Timber harvesting, or removal of commercial forest products or other vegetative resources; and
	Any other uses deemed appropriate by Reclamation, subject to the exclusions listed in the Code of Federal Regulations (43 CFR 429.4).

2. Uses that may be applied for using Standard Form (SF) 299. Use SF 299 to request a use authorization for the placement, construction, and use of energy, transportation, water, or telecommunication systems and facilities. You may access SF 299 at http://www.gsa.gov/portal/forms/download/117318.

3. The issuance of a use authorization is at Reclamation's discretion. There is no guarantee that Reclamation will approve any application to use Reclamation lands, facilities, or waterbodies. If an initial review determines that your requested use is inappropriate for consideration or likely to interfere with Reclamation project purposes or operations, Reclamation will not grant the use authorization.

4. Administrative costs. If Reclamation finds your proposed use is potentially compatible with Reclamation project purposes or operations, we will advise you of any additional estimated administrative costs in excess of the initial non-refundable $100 application fee, which you will be required to pay before processing of your application continues. Administrative costs include, but are not limited to: use fee determination; compliance with National Environmental Policy Act and the National Historic Preservation Act; and Reclamation’s review, preparation and issuance of the use authorization. Should your requested use be denied at any time during the review process, Reclamation will notify you in writing of the basis for the denial and reimburse any unspent administrative costs.

5. Use Fee (Value of the use authorization). In addition to the administrative costs, applicants will also be required to pay for the value of the use of the lands, facilities, or waterbodies based on the value of the use prior to issuance of the use authorization.

43 CFR 429, Subpart E describes the procedures that will be used to process and recover the value of use authorizations.

GENERAL INSTRUCTIONS

1. Complete the Use Authorization Application. Complete all parts of the use authorization application. If a particular question or response does not apply to the proposed use, please indicate “not applicable” or “N/A”. Attach additional sheets if more space is needed. If you have additional questions, please contact your local Reclamation office. Some uses may require that you provide the name of your insurance carrier. A complete list of offices can be found at the following web site address: http://www.usbr.gov/main/regions.html#list. The use authorization regulations are at: http://www.usbr.gov/lands/429.pdf.

2. Enclose a non-refundable application fee of $100, payable to the Bureau of Reclamation. Submit the application,

non-refundable application fee of $100, and any attachments to the Reclamation office responsible for the location of the proposed use. (Unless previously waived under 43 CFR 429, Subpart F). The non-refundable application fee will cover the estimated minimum administrative costs to Reclamation to review your application. Failure to submit the required application fee and adequate information will cause delays in evaluation of the application. No activity may begin until Reclamations issues a fully executed use authorization document.

SPECIFIC INSTRUCTIONS (by corresponding item number from first page)

3. Location of the proposed use. Submit two copies of all maps or drawings and other information clearly demonstrating the location for the proposed use, including township, range, and section. Under 43 CFR 429.13(a), Reclamation may request additional information needed to process your application, such as legal land descriptions and detailed construction specifications.

5. Description of the proposed use. Examples of additional information to provide, depending upon the use, are as follows: maximum number of anticipated participants/spectators/crew;

• number and types of vehicles to be on site;

• description of props, tents, tractors, trailers, and other equipment;

• description of facilities you intend to provide, such as sanitation facilities, emergency personnel, food services or vendors, or other applicable information (attach plans); and description of your intended use of Reclamation on-site roads or trails;

• maximum number of grazing animals;

• acreage of proposed crop;

• proposed amount of gravel or material to be extracted.

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Paperwork Reduction Act (Act): This information is needed to evaluate use requests such as those listed on this application. Responses are necessary to receive or maintain a benefit; without this information Reclamation may not grant your request. Under the Act, the reporting burden to the public for this form is estimated to average 2 hours per response, including time for reviewing instructions, and completing and reviewing the form. In accordance with the Act, Reclamation may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget control number.

Privacy Act Statement

This information is solicited under the authority of 43 U.S.C. 391 et seq 43 U.S.C. 485. The primary purpose for collecting this information is to manage an inventory of all land, facilities and waterbodies within its jurisdiction, and administer land and realty actions, such as use authorization management, land settlement records, sales, transfers, disposals, mineral location entries, mining claims, oil and gas applications, real property and right-of-way acquisition, real property interest applications, and status of land interests held for project purposes. This information may be disclosed to agencies, organizations or persons as authorized by the routine uses that can be found in the published system of records notices INTERIOR/WBR-17, Lands - Leases, Sales, Rentals, and Transfers; and INTERIOR/WBR-32, Special Use Applications, Licenses, and Permits. Providing the information requested on this form is voluntary, however, failure to provide all or part of the information may prevent, delay, or deny the request to grant a use authorization.