7-2536 Limited Recipient Identification Sheet

7-2536 (07-17)
Bureau of Reclamation

OMB Control No.: 1006-0023
OMB Expiration Date: (Month and Day), 2020

LIMITED RECIPIENT IDENTIFICATION SHEET
For Determining if Your Entity is a Limited Recipient for Reclamation Reform Act of 1982 (RRA) Purposes
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: ____________________________ District Name: _______________________________________________
Entity name: ___________________________________________________________________________________________
TO BE COMPLETED BY ENTITY
(Please refer to the instructions provided on the other side of this form.)
1. Entity name: _________________________________________________________
2. Entity address: _______________________________________________________
_______________________________________________________
Note: If your entity is a public entity or has a section 501 exemption from the Internal Revenue Service, STOP and contact the
appropriate Reclamation office for additional instructions.
3. Number of acres held (directly or indirectly owned or leased) in this district: ____________
4. State or country where entity is established or registered: ______________________
5. Did this entity receive Reclamation irrigation water on or before October 1, 1981?
YES

NO

If “YES,” provide the date the entity first received Reclamation irrigation water and the name of the district where that water was
received: Date __________________________
District: ___________________________________________________
6. Does this entity hold land in any other district(s) subject to the acreage limitation provisions?

YES

NO

If “YES,” list the district(s) where land is held and the number of acres held in the district(s). If you are unsure of whether
another district is subject to the acreage limitation provisions of Federal reclamation law, contact your appropriate Reclamation
office. Use attachments if necessary.
District Name
Number of Acres

7. Does this entity wholly own any subsidiaries that hold land in a district subject to the acreage limitation provisions or is this
YES
NO
entity wholly owned by another entity?
If ”YES,” list the subsidiaries or the parent entity, or attach your organizational structure:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
8. Does this entity ultimately benefit (directly or indirectly) more than 25 natural persons?
Note: Refer to the other side of this form for further guidance on completion of this item.

YES

NO

* If you answered “NO” to item 8 above, attach a separate sheet that lists (1) the name of each part owner, and (2) the percentage of interest
each part owner holds in this entity.
* If you answered “YES” above, the entity may be a limited recipient. RRA forms must be completed for any entity that ultimately benefits
more than 25 natural persons and holds (directly or indirectly owns or leases) more than 40 acres westwide (i.e., in the 17 western states).
If the entity meets both of those criteria, ask your district office for the appropriate RRA form(s) with instructions and an RRA
Form 7-21INFO. Complete the appropriate RRA form(s) and submit it to the district office for a determination of your entity's acreage
limitation status and entitlements.
* If you answered “YES” above but the entity does not hold more than 40 acres westwide, while the entity is a limited recipient, the
RRA forms requirements do not apply. If you have questions, contact the Reclamation office that sent you this sheet.

Please attest to the following:
I (we) attest that the information provided herein is true, accurate, and complete to the best of my (our) knowledge. Based on
the information provided on this sheet, Reclamation may request additional information.
Print name:
_________________________________________________________________________
Signature:
______________________________________________ Date: ____________________
Address:
__________________________________________________________________________________
Relationship to entity: ________________________________________ Telephone number: ____________________
E-mail address (optional): ___________________________________________________________________________
See reverse side for instructions and Paperwork Reduction Act of 1995 and Privacy Act of 1974 system of records information.

ENTITY COPY

Paperwork Reduction Act
This information is being collected to establish landholder compliance with Federal reclamation law. Response to this request is
mandatory in accordance with Public Law 97-293 and 43 CFR 426.18. Public reporting burden for this form is estimated to
average 5 minutes per response. An agency 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 (OMB) control number.
Direct comments regarding the burden estimated or any other aspect of these forms to Manager, Reclamation Law
Administration Division, Code 84-55000, U.S. Bureau of Reclamation, PO Box 25007, Denver CO 80225.

INSTRUCTIONS FOR COMPLETION
GENERAL Instructions
• When Reclamation has identified an entity that may be a limited recipient, Reclamation will determine if the “Limited Recipient
Identification Sheet” (Sheet) should be completed by the entity. Reclamation will send this Sheet directly to the entity.
• Press firmly when writing to ensure that all copies are legible.
• Visit www.usbr.gov/rra for more information.
RECLAMATION Instructions
• “For Reclamation Use Only” block: Complete all information.
• For recordkeeping purposes, retain the top half-sheet copy (“Originator Copy”) of the Sheet at the time of issuance.
• When the entity has completed and returned the Sheet to Reclamation:
o Ensure the Sheet is complete.
o Retain the “Reclamation Copy.”
o Provide the “District Copy” to the appropriate district office.
ENTITY Instructions
• Numbers 1 through 4: Enter the requested information.
• Number 5: Answer the question provided. Enter the date the entity first received Reclamation irrigation water anywhere in the
17 western states, and the name of the district in which that water was received. The answer is “NO” if the entity did not exist
prior to October 1, 1981.
• Number 6: Answer the question provided. Identify land the entity directly or indirectly owns and leases in any other district that
is subject to the acreage limitation provisions.
• Number 7: Answer the question provided. If the entity has any wholly owned subsidiaries (i.e., subsidiaries that are 100% owned
by this entity) and the wholly owned subsidiary directly or indirectly owns or leases land that is subject to the acreage limitation
provisions, list the wholly owned subsidiaries. If this entity is owned by another entity, list the entity (parent entity) that owns this
entity.
• Number 8: Count all natural persons listed as a part owner (or shareholder, stockholder, etc.) for this entity and for any entity that
wholly or partially owns this entity. Once you have (a) counted more than 25 natural persons, or (b) evaluated all associated
entities for part owners (or shareholders, stockholders, etc.), stop and answer this YES/NO question based on the count you have
just completed. Count each natural person only once. (The term “natural person” means a living human being. For acreage
limitation purposes, this includes shareholders specifically named on stock certificates, partners identified by a partnership
agreement, tenants specifically named in landownership documents, parties attributed with the land held in trust, etc.) If you
answered “NO,” this entity is not a limited recipient. Attach a separate sheet that lists (1) the name of each part owner, and (2) the
percentage of interest each listed part owner holds in this entity. The total interest must equal 100 percent.
• Complete the attestation section.
• Retain the “Entity Copy”
• Return the “Reclamation Copy” and the “District Copy” to the Reclamation office that issued this Sheet.
Refer questions to the Reclamation office that provided this Sheet.
This report is required by Public Law 97-293. Failure to complete this form can result in the determination that your entity
is ineligible to receive Reclamation irrigation water. Information obtained in this form is protected by the Privacy Act of 1974,
system of records notice INTERIOR/WBR-31, and will be used to administer the acreage limitation provisions of Federal
reclamation law. The Secretary of the Interior or the district may require additional information in order to administer these laws.

7-2536 (07-17)
Bureau of Reclamation

OMB Control No.: 1006-0023
OMB Expiration Date: (Month and Day), 2020

LIMITED RECIPIENT IDENTIFICATION SHEET
For Determining if Your Entity is a Limited Recipient for Reclamation Reform Act of 1982 (RRA) Purposes
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: ____________________________ District Name: _______________________________________________
Entity name: ___________________________________________________________________________________________

Paperwork Reduction Act
This information is being collected to establish landholder compliance with Federal reclamation law. Response to this
request is mandatory in accordance with Public Law 97-293 and 43 CFR 426.18. Public reporting burden for this form is
estimated to average 5 minutes per response. An agency 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 (OMB) control
number. Direct comments regarding the burden estimated or any other aspect of these forms to Manager, Reclamation
Law Administration Division, Code 84-55000, U.S. Bureau of Reclamation, PO Box 25007, Denver CO 80225.

ORIGINATOR COPY