Form 10-932 Application for Special Use Permit - Commercial Filming/

NPS Form 10-932 (Rev. 08/2019)
National Park Service

OMB Control No. 1024-0026
Expiration Date XX/XX/20XX

APPLICATION FOR SPECIAL USE PERMIT
COMMERCIAL FILMING / STILL PHOTOGRAPHY
(Long Form)
[PARK NAME]
[Street Address]
[City, State, Zip Code]
[Phone Number for Park Permits POC]

Please supply the information requested below. Attach additional sheets, if necessary, to provide required information. A
nonrefundable processing fee of [insert amount] must accompany this application unless the requested use is an exercise of a
First Amendment right. You must allow sufficient time for the park to process your request; check with the park for guidelines.
You will be notified of the status of the application and the necessary steps to secure your final permit. Your permit may require
the payment of cost recovery charges and proof of liability insurance naming the United States of America an additional insured.
* Enter either a social security number OR a tax ID number; we do not require both.
Applicant Name
Company/Organization Name
Social Security Number*

Tax Identification Number*

Street Address

Street Address

City

State

Zip Code

Country

City

State

Telephone Number

Contact Name

Cell Phone Number

Telephone Number

Fax Number

Fax Number

Email Address

Email Address
PROJECT INFORMATION
Telephone Number

Project Name
Location Manager

Zip Code

Country

Cell Phone Number

Email Address

Type of Project
Video/Motion Picture/Movie

Still Photography

Detailed Description of Onsite Activities (attach additional pages, if necessary)

LOCATION SCHEDULE

* number in this column should include all individuals present at the location

Date

Location

Start Time

End time

Interior/
Exterior

Activity: Set-Up/Film/
Non-Filming/Breakdown

RECORDS RETENTION: TEMPORARY. Destroy/delete 3 years after closure. (NPS Records Schedule, Resource Management and
Lands (Item 1D) (N1-79-08-1))

Number of
Cast/Crew*

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NPS Form 10-932 (Rev. 08/2019)
National Park Service

OMB Control No. 1024-0026
Expiration Date XX/XX/20XX

TALENT
Talent comprises anyone in front of the camera and includes, but is not limited to, actors, hosts, correspondents, presenters,
park visitors, cooperators, volunteers, National Park Service and concessioner staff, etc.
Do you intend to utilize talent?
Yes
No If “Yes”, provide a full description below of who they are and how they will be
utilized. (attach additional pages, if necessary)

EQUIPMENT
Description of equipment, backdrops, sets, props (attach additional pages, if necessary). Please note if any of the following will
be included: weapons, animals, minors, nudity.

ELECTRICAL REQUIREMENTS
Description of electrical requirements (attach additional pages, if necessary).

Generators? If “Yes”, provide quantity and size.

Yes

Quantity

No

LIGHTING REQUIREMENTS
Lighting?
Yes
No (If “Yes”, explain below)
Reflectors Only?
Description of lighting requirements (attach additional pages, if necessary).

ROAD USE
Will you require the use of roads?
Yes
No If “Yes”, please explain:
Do you require road closures?
Yes
No
If “Yes”, please provide the following information (attach additional pages, if necessary)
Starting
Ending
Starting Time
Ending Time
Date
Date
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM

Types of Shots:

Yes

Size

No

Location

AM
PM
AM
PM
AM
PM
AM
PM
AM
PM

Driving

Drive-by

Drive-ups and away

Other (explain):

Towing

Wet down road

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NPS Form 10-932 (Rev. 08/2019)
National Park Service

OMB Control No. 1024-0026
Expiration Date XX/XX/20XX

CAMERA EQUIPMENT

Camera/Equipment
Location:
(Check all that apply)

Road shoulder

Road median

Other (explain):

Types of Equipment:
(Check all that apply)

Hand

Tripod

Dolly

Dolly w/track footage

Arm footage

Crane or jib arm

Portable crane
Car mount
OPERATIONAL INFORMATION

Camera car, shot maker, or process trailer

NUMBER OF VEHICLES
NOTE: Large or oversized vehicles may not be able to be accommodated or additional steps may need to be taken to ensure
that no damage to park resource occurs.
Cars, SUVs, or light pick-up trucks
Vehicles greater than a 10,000 lbs. (class 3 or higher)
BASE CAMP LOCATION (attach diagrams)
SPECIAL ACTIVITIES (attach additional pages, if necessary)
INVOLVEMENT OF MINORS
Will children be involved?

Yes

LIVESTOCK OR TRAINED ANIMALS
Will livestock or trained animals be used?
Type

Quantity

No If “Yes”, provide number of children and age range.

Quantity

Age Range

Yes
No If “Yes”, provide the following:
Manner of
Staging/Coral Requirements
Transportation

AIRCRAFT
NOTE: All aircraft use over park lands should be listed. Landings must be specifically requested and approved as a condition of
your permit.
Will aircraft be used?
Yes
No If “Yes”, explain below (attach additional pages, if necessary)

SPECIAL EFFECTS (including weapons, pyrotechnics, etc.) (attach additional pages, if necessary)

Effects Technician’s Name

Contact Phone Number

License # (if applicable)

Permit # (if applicable)

STUNTS
Will stunts be used?

Yes

Email Address

No If “Yes”, explain below (attach additional pages, if necessary)

Stunt Coordinator
OTHER OR HAZARDOUS ACTIVITIES
Any other unusual or hazardous activities?

Contact Phone Number

Yes

Email Address

No If “Yes”, explain below (attach additional pages, if necessary)

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NPS Form 10-932 (Rev. 08/2019)
National Park Service

OMB Control No. 1024-0026
Expiration Date XX/XX/20XX

OPERATIONAL INFORMATION
Have you physically visited the requested area?

Yes

No

When answering “Yes” to any of the following questions, provide additional information using additional pages, as necessary
Do you have, or are you applying for, a permit with another Federal, State or local agency for this activity?
Have you had previous permits from the National Park Service?
Have you ever been denied a permit or had a permit revoked by a Federal agency?
Have you forfeited a bond or other security for filming on Federal lands?
Are there any pending Federal investigations against you which involve a commercial filming activity?

Yes
Yes
Yes
Yes
Yes

No
No
No
No
No

Do you plan to advertise or issue a press release before the event?
Do you anticipate any security concerns? If yes, explain (attach additional sheet).

Yes
Yes

No
No

NOTE: You are encouraged to attach additional pages with information useful in evaluating your permit request
including: story boards or scripts, set construction, parking plan, security plans, sanitary facilities, crowd control,
emergency medical plan, off-road activity, trail use, use of any building and site clean-up.
PROJECT ADMINISTRATION
Are you applying for this permit on behalf of another person or company?
Yes
No
If “Yes”, provide a full description (including contact information) of all other individuals/companies involved with this project
(attach additional pages, as necessary)

CONTACTS
Person on Location Responsible for Adherence to All Terms and Conditions of Permit:
Name
Title
Telephone Number

Cell Phone Number

Email Address

Person on Location Responsible for Coordinating Activities With the NPS:
Name
Title
Telephone Number

Cell Phone Number

Email Address

Company Point-of-contact for Follow-up Information and Billing:
Name
Title
Telephone Number

Cell Phone Number

Email Address

The applicant by his or her signature certifies that all the information given is complete and correct, and that no false or misleading information
or false statements have been given. All estimates are reliable to the best of my knowledge and I have the full authority to represent the
applicant/production company and the project described above.

Printed Name

Title

Company Name

Signature

Date

INTERNAL AGENCY USE ONLY
Project Number/BILL

Date Processed

Permit Number

Prepared By

Organization Name

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NPS Form 10-932 (Rev. 08/2019)
National Park Service

OMB Control No. 1024-0026
Expiration Date XX/XX/20XX

NOTICES
This is an application only, and does not serve as permission to conduct any special activity in the park. The information provided will
be used to determine whether a permit will be issued. Send the completed application along with the application fee in the form of a [park
to select payment methods accepted: cashier’s check, money order or personal check made payable to the National Park Service] to
[input name/park office] at the park address found on the first page of this application.
If your request is approved, a permit containing applicable terms and conditions will be sent you. The permit must be signed by the
responsible person and returned to the park for final approval by the Park Superintendent before the permitted activity may begin.
Customers Making Payment by Personal Check
When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund
transfer from your account or to process the payment as a check transaction. When we use information from your check to make an
electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not
receive your check back from your financial institution.
Privacy Act Statement
Authority: 16 U.S.C. 1, National Park Service Organic Act; 16 U.S.C. 3, Rules and regulations of national parks, reservations, and
monuments; timber; leases, 16 U.S.C. 3a, Recovery of costs associated with special use permits; and 16 U.S.C. 460i–6d, Commercial
Filming.
Purpose: The purposes of the system are (1) to provide a park superintendent with information to approve or deny requests for activities
that provide a benefit to an individual, group or organization, rather than the public at large; and (2) to assist park staff to manage the
activity to ensure that the permitted activity does not interfere with the enjoyment of the park by visitors and that the natural and cultural
resources of the park are protected.
Routine 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, territorial, local, tribal, or foreign agencies and other authorized organizations and individuals based on an authorized
routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of
records notice for this system.
Disclosure: Voluntary, however, failure to provide the requested information may impede individual from obtaining a permit from the
National Park Service.
Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b): Your Social Security
Number (SSN) is needed to identify records unique to you. Applicants are required to provide their social security or taxpayer identification
number for activities subject to collection of fees and charges by the National Park Service. Failure to disclose your SSN may prevent or
delay the processing of your application. The authority for soliciting your SSN is 31 U.S.C. 7701. The information gathered through the
use of the SSN will be used only as necessary for processing this application and collecting and reporting any delinquent financial
obligations. Use of the social security number will be carried out in accordance with established regulations and published System of
Records Notices Special Use Permits –Interior, NPS—1 (79 FR 9272)..
Paperwork Reduction Act Statement
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to provide the park managers the information
needed to decide whether or not to allow the requested use. All applicable parts of the form must be completed in order for your request
to be considered. 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. 1024-0026.
Estimated Burden Statement
Public reporting burden for this form is estimated to average 30 minutes per response including the time it takes to read, gather and
maintain data, review instructions and complete the form. Direct comments regarding this burden estimate or any aspects of this form to
the Information Collection Clearance Officer, National Park Service, 1201 Oakridge Drive, Fort Collins, CO 80525. Please do not send
your form to this address.

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