Form 4130-3a Grazing Application

Form 4130-3a
(June 2015)

FORM APPROVED
OMB NO. OMB NO. 1004-0041
Expires: October 31, 2017

State: ID
Office: LLIDB01000
Preference Code: 03
AUTHORIZATION: 1100046

GRAZING APPLICATION
IF CHANGED RETURN BY: September 25, 2017
GEORGE AND MARTHA WASHINGTON
11111 NORTH DENVER ROAD
DENVER CO 80226

BUREAU OF LAND MANAGEMENT
FOUR RIVERS FIELD OFFICE
3948 DEVELOPMENT AVE
BOISE ID 83705-5339

INSTRUCTIONS: PLEASE REVIEW THE GRAZING SCHEDULE(S) BELOW, which list(s) the upcoming grazing use for which you will be billed unless
you request changes that are subsequently approved by the BLM.

Please contact us with any questions at 208-384-3300.

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e

Use this form to request changes in upcoming grazing use for BLM approval. BLM may approve changes that are within the terms and conditions of your
term GRAZING PERMIT. To request changes, edit the schedule(s) below to clearly show your requested grazing use (livestock number, grazing dates,
etc.); sign and date; and file the application at this office by September 25, 2017. Application submitted after September 25, 2017, may result in a service
charge for reissuing a grazing bill.

ALLOTMENT

am

TERMS AND CONDITIONS

PASTURE

LIVESTOCK
NUMBER KIND

PERIOD
BEGIN END

%PL
USE TYPE USE

AUMS

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SCHEDULE NUMBER: 2
BIG LITTLE CREEK

SCHEDULE NUMBER: 2

06- WEST CREEK

100 CATTLE

11/01/17

01/15/18

100 ACTIVE

Ex

ID00813

LIVESTOCK GRAZING WITHIN THE BIG LITTLE ALLOTMENT SHALL BE IN ACCORDANCE WITH THE FIELD MANAGER'S FINAL DECISION
DATED NOVEMBER 11,2011.
SALT AND MINERAL BLOCKS SHALL NOT BE PLACED WITHIN 1/4/ MILE OF SPRINGS, STREAMS OR MEADOWS.
YOUR CERTIFIED ACTUAL USE REPORT BY PASTURE IS DUE WITHIN 15 DAYS OF THE END OF THE AUTHORIZED GRAZING PERIOD.

OFFICE NOTIFICATIONS:

DATE PRINTED: 06/19/2017

PAGE 1 OF 4

250

GRAZING APPLICATION

AUTHORIZATION - 1100046

ALLOTMENT SUMMARY
TEMP
ACTIVE SUSPENDED SUSPENDED PERMITTED
AUMS
USE
AUMS
AUMS

ALLOTMENT

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ID00813

BIG LITTLE CREEK

264

264

Ex

am

pl
e

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DATE PRINTED: 06/19/2017

PAGE 2 OF 4

GRAZING APPLICATION

AUTHORIZATION - 1100046

TERMS AND CONDITIONS APPLICABLE TO ALL PERMITS AND LEASES
1. Grazing permit or lease terms and conditions and the fees charged for grazing use are established in accordance with the provisions of the grazing
regulations now or hereafter approved by the Secretary of the Interior.
2. They are subject to cancellation, in whole or in part, at any time because of:
a. Noncompliance by the permittee/lessee with rules and regulations.
b. Loss of control by the permittee/lessee of all or a part of the property upon which it is based.
c. A transfer of grazing preference by the permittee/lessee to another party.
d. A decrease in the lands administered by the Bureau of Land Management within the allotment(s) described.
e. Repeated willful unauthorized grazing use.
f. Loss of qualifications to hold a permit or lease.
3. They are subject to the terms and conditions of allotment management plans if such plans have been prepared. Allotment management plans MUST be
incorporated in permits or leases when completed.
4. Those holding permits or leases MUST own or control and be responsible for the management of livestock authorized to graze.
5. The authorized officer may require counting and/or additional or special marking or tagging of the livestock authorized to graze.

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e

6. The permittee's/lessee's grazing case file is available for public inspection as required by the Freedom of Information Act.
7. Grazing permits or leases are subject to the nondiscrimination clauses set forth in Executive Order 11246 of September 24, 1964, as amended. A copy
of this order may be obtained from the authorized officer.
8. Livestock grazing use that is different from that authorized by a permit or lease MUST be applied for prior to the grazing period and MUST be filed with
and approved by the authorized officer before grazing use can be made.

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9. Billing notices are issued which specify fees due. Billing notices, when paid, become a part of the grazing permit or lease. Grazing use cannot be
authorized during any period of delinquency in the payment of amounts due, including settlement for unauthorized use.
10. The holder of this authorization must notify the authorized officer immediately upon the discovery of human remains, funerary objects, sacred objects,
or objects of cultural patrimony (cultural items), stop the activity in the area of the discovery and make a reasonable effort to protect the remains and/or
cultural items.

Ex

11. Grazing fee payments are due on the date specified on the billing notice and MUST be paid in full within 15 days of the due date, except as otherwise
provided in the grazing permit or lease. If payment is not made within that time frame, a late fee (the greater of $25 or 10 percent of the amount owed but
not more than $250) will be assessed.
12. Members of Congress may not enter into a grazing permit or lease. 41 USC 6306 (2014). Further, no officer, agent, or employee of the Department of
the Interior, other than members of Advisory committees appointed in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 1) and
Sections 309 of the Federal Land Policy and Management Act of 1976 (42 U.S.C. 1701 et. seq.) shall be admitted to any share or part in a permit or lease
for grazing or derive any benefit to arise from a permit or lease for grazing.

STOCK IDENTIFICATION (BRANDS, EARMARKS, ETC.):

___________________________________________________________________________________
___________________________________________________________________________________
REASON FOR NON-USE:

___________________________________________________________________________________
___________________________________________________________________________________
OPERATOR SIGNATURE:

_________________________________________________________ DATE: ________________
BLM AUTHORIZED OFFICER:

_________________________________________________________ DATE: ________________
Title 18, U.S.C., Section 1001 makes it a crime for any person knowingly and willfully to make any department or agency of the United States any false,
fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

DATE PRINTED: 06/19/2017

PAGE 3 OF 4

GRAZING APPLICATION

AUTHORIZATION - 1100046

NOTICES
The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with information requested by this form.
AUTHORITY: 43 U.S.C. 315b, 315m, 1181d, 1732, 1752, and 1903, and 43 CFR part 4100.
PRINCIPAL PURPOSE: The information you provide forms the basis for BLM's determination of whether the changes you request are within the terms
and conditions of your grazing permit or lease.
ROUTINE USES: In accordance with the Bureau of Land Management's (BLM) System of Records Notice published in the Federal Register on December
29, 2010 [Bureau of Land Management's Range Management System-Interior, LLM-2; Notice To Amend an Existing System of Records; Privacy Act of
1974; as Amended], names and addresses provided by the applicant on this form will be publically available in reports on the BLM public website.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is required to obtain or retain a benefit. Failure to submit all of the
requested information or to complete this form may result in delay or the rejection and/or denial of your application.
The Paperwork Reduction Act requires us to inform you that, if you elect to return this form: BLM uses the information on this form to determine if your
requested use of BLM-managed lands is: (1) within your authorized level of use; (2) consistent with the other terms and conditions of your permit or lease,
and (3) consistent with established multiple-use objectives. BLM will also use this information to consider if existing terms and conditions should be
modified or new terms and conditions should be established. Response to this request is required to obtain or retain a benefit. You do not have to respond
to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number.

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e

BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 10 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any
other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0041), 1849 C Street, NW, Room 2134LM, Bureau
Information Collection Clearance Officer (WO-630), Washington, D.C. 20240.

DATE PRINTED: 06/19/2017

PAGE 4 OF 4

Form 4130-3a
(June 2015)

FORM APPROVED
OMB NO. OMB NO. 1004-0041
Expires: October 31, 2017

State: ID
Office: LLIDB01000
Preference Code: 03
AUTHORIZATION: 1100046

GRAZING APPLICATION
IF CHANGED RETURN BY: September 25, 2017
GEORGE AND MARTHA WASHINGTON
11111 NORTH DENVER ROAD
DENVER CO 80226

BUREAU OF LAND MANAGEMENT
FOUR RIVERS FIELD OFFICE
3948 DEVELOPMENT AVE
BOISE ID 83705-5339

INSTRUCTIONS: PLEASE REVIEW THE GRAZING SCHEDULE(S) BELOW, which list(s) the upcoming grazing use for which you will be billed unless
you request changes that are subsequently approved by the BLM.

Please contact us with any questions at 208-384-3300.

pl
e

Use this form to request changes in upcoming grazing use for BLM approval. BLM may approve changes that are within the terms and conditions of your
term GRAZING PERMIT. To request changes, edit the schedule(s) below to clearly show your requested grazing use (livestock number, grazing dates,
etc.); sign and date; and file the application at this office by September 25, 2017. Application submitted after September 25, 2017, may result in a service
charge for reissuing a grazing bill.

ALLOTMENT

am

TERMS AND CONDITIONS

PASTURE

LIVESTOCK
NUMBER KIND

PERIOD
BEGIN END

%PL
USE TYPE USE

AUMS

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SCHEDULE NUMBER: 2
BIG LITTLE CREEK

SCHEDULE NUMBER: 2

06- WEST CREEK

100 CATTLE

11/01/17

01/15/18

100 ACTIVE

Ex

ID00813

LIVESTOCK GRAZING WITHIN THE BIG LITTLE ALLOTMENT SHALL BE IN ACCORDANCE WITH THE FIELD MANAGER'S FINAL DECISION
DATED NOVEMBER 11,2011.
SALT AND MINERAL BLOCKS SHALL NOT BE PLACED WITHIN 1/4/ MILE OF SPRINGS, STREAMS OR MEADOWS.
YOUR CERTIFIED ACTUAL USE REPORT BY PASTURE IS DUE WITHIN 15 DAYS OF THE END OF THE AUTHORIZED GRAZING PERIOD.

OFFICE NOTIFICATIONS:

DATE PRINTED: 06/19/2017

PAGE 1 OF 4

250

GRAZING APPLICATION

AUTHORIZATION - 1100046

ALLOTMENT SUMMARY
TEMP
ACTIVE SUSPENDED SUSPENDED PERMITTED
AUMS
USE
AUMS
AUMS

ALLOTMENT

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ID00813

BIG LITTLE CREEK

264

264

Ex

am

pl
e

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DATE PRINTED: 06/19/2017

PAGE 2 OF 4

GRAZING APPLICATION

AUTHORIZATION - 1100046

TERMS AND CONDITIONS APPLICABLE TO ALL PERMITS AND LEASES
1. Grazing permit or lease terms and conditions and the fees charged for grazing use are established in accordance with the provisions of the grazing
regulations now or hereafter approved by the Secretary of the Interior.
2. They are subject to cancellation, in whole or in part, at any time because of:
a. Noncompliance by the permittee/lessee with rules and regulations.
b. Loss of control by the permittee/lessee of all or a part of the property upon which it is based.
c. A transfer of grazing preference by the permittee/lessee to another party.
d. A decrease in the lands administered by the Bureau of Land Management within the allotment(s) described.
e. Repeated willful unauthorized grazing use.
f. Loss of qualifications to hold a permit or lease.
3. They are subject to the terms and conditions of allotment management plans if such plans have been prepared. Allotment management plans MUST be
incorporated in permits or leases when completed.
4. Those holding permits or leases MUST own or control and be responsible for the management of livestock authorized to graze.
5. The authorized officer may require counting and/or additional or special marking or tagging of the livestock authorized to graze.

pl
e

6. The permittee's/lessee's grazing case file is available for public inspection as required by the Freedom of Information Act.
7. Grazing permits or leases are subject to the nondiscrimination clauses set forth in Executive Order 11246 of September 24, 1964, as amended. A copy
of this order may be obtained from the authorized officer.
8. Livestock grazing use that is different from that authorized by a permit or lease MUST be applied for prior to the grazing period and MUST be filed with
and approved by the authorized officer before grazing use can be made.

am

9. Billing notices are issued which specify fees due. Billing notices, when paid, become a part of the grazing permit or lease. Grazing use cannot be
authorized during any period of delinquency in the payment of amounts due, including settlement for unauthorized use.
10. The holder of this authorization must notify the authorized officer immediately upon the discovery of human remains, funerary objects, sacred objects,
or objects of cultural patrimony (cultural items), stop the activity in the area of the discovery and make a reasonable effort to protect the remains and/or
cultural items.

Ex

11. Grazing fee payments are due on the date specified on the billing notice and MUST be paid in full within 15 days of the due date, except as otherwise
provided in the grazing permit or lease. If payment is not made within that time frame, a late fee (the greater of $25 or 10 percent of the amount owed but
not more than $250) will be assessed.
12. Members of Congress may not enter into a grazing permit or lease. 41 USC 6306 (2014). Further, no officer, agent, or employee of the Department of
the Interior, other than members of Advisory committees appointed in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 1) and
Sections 309 of the Federal Land Policy and Management Act of 1976 (42 U.S.C. 1701 et. seq.) shall be admitted to any share or part in a permit or lease
for grazing or derive any benefit to arise from a permit or lease for grazing.

STOCK IDENTIFICATION (BRANDS, EARMARKS, ETC.):

___________________________________________________________________________________
___________________________________________________________________________________
REASON FOR NON-USE:

___________________________________________________________________________________
___________________________________________________________________________________
OPERATOR SIGNATURE:

_________________________________________________________ DATE: ________________
BLM AUTHORIZED OFFICER:

_________________________________________________________ DATE: ________________
Title 18, U.S.C., Section 1001 makes it a crime for any person knowingly and willfully to make any department or agency of the United States any false,
fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

DATE PRINTED: 06/19/2017

PAGE 3 OF 4

GRAZING APPLICATION

AUTHORIZATION - 1100046

NOTICES
The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with information requested by this form.
AUTHORITY: 43 U.S.C. 315b, 315m, 1181d, 1732, 1752, and 1903, and 43 CFR part 4100.
PRINCIPAL PURPOSE: The information you provide forms the basis for BLM's determination of whether the changes you request are within the terms
and conditions of your grazing permit or lease.
ROUTINE USES: In accordance with the Bureau of Land Management's (BLM) System of Records Notice published in the Federal Register on December
29, 2010 [Bureau of Land Management's Range Management System-Interior, LLM-2; Notice To Amend an Existing System of Records; Privacy Act of
1974; as Amended], names and addresses provided by the applicant on this form will be publically available in reports on the BLM public website.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is required to obtain or retain a benefit. Failure to submit all of the
requested information or to complete this form may result in delay or the rejection and/or denial of your application.
The Paperwork Reduction Act requires us to inform you that, if you elect to return this form: BLM uses the information on this form to determine if your
requested use of BLM-managed lands is: (1) within your authorized level of use; (2) consistent with the other terms and conditions of your permit or lease,
and (3) consistent with established multiple-use objectives. BLM will also use this information to consider if existing terms and conditions should be
modified or new terms and conditions should be established. Response to this request is required to obtain or retain a benefit. You do not have to respond
to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number.

Ex

am

pl
e

BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 10 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any
other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0041), 1849 C Street, NW, Room 2134LM, Bureau
Information Collection Clearance Officer (WO-630), Washington, D.C. 20240.

DATE PRINTED: 06/19/2017

PAGE 4 OF 4