7-2578 Religious or Charitable Organization Identification Shee

7-2578 (07-17)
Bureau of Reclamation

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

RELIGIOUS OR CHARITABLE ORGANIZATION IDENTIFICATION SHEET
For Determining if Your Organization is Eligible for Special Application of the
Acreage Limitation Provisions Under Section 219 of the Reclamation Reform Act of 1982 (RRA)
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: __________________________________________________
District name: ____________________________________________________
Religious or Charitable Organization name:

____________________________

TO BE COMPLETED BY RELIGIOUS OR CHARITABLE ORGANIZATION
(Please refer to the instructions provided on the other side of this form.)
1. Religious or charitable organization name: _________________________________
2. Organization address: _________________________________________________
_________________________________________________
3. Number of acres held (directly or indirectly owned or leased) in this district: ____________
4. Does your organization 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

5. Does your organization have tax exempt status under section 501 of the Internal Revenue Code?

YES

6. If you answered “YES” to number 5 above, skip this item and proceed to number 7 on page 2.
If you answered “NO” to number 5 above, answer the following question:
Did your organization receive Reclamation irrigation water on or before October 1, 1981?

YES

NO

If “NO,” skip number 7 on page 2 and proceed to the attestation section.
If “YES,” provide the date your organization first received Reclamation irrigation water and the name of the
district where that water was received, then skip number 7 on page 2 and proceed to the attestation section:

Date _____________________________

District: _____________________________________________

ORGANIZATION COPY

Page 1 of 2

NO

7-2578 (07-17)
Bureau of Reclamation

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

7. If you answered “YES” to number 5, answer all of the following questions AND provide the documentation requested in 7(d):
(a) Is any part of your organization’s agricultural produce or the proceeds of the sales of such produce used for other than
charitable purposes?
YES
NO
If “YES,” explain how the produce and proceeds are used:

(b) Is any land held by your organization operated or leased by a party other than your organization, a subdivision of the
organization, or a more central organization of the same affiliation?
YES
NO
If “YES,” explain who operates or leases the land.

(c) Does any part of your organization’s net earnings accrue to the benefit of any private shareholder or individual?

YES

NO

If “YES,” explain who benefits from the organization’s net earnings.

(d) You must also provide documentation confirming your tax exempt status with this completed identification sheet.
Acceptable forms of proof include, but are not limited to:

•
•
•

Your organization’s tax exemption letter from the IRS,
Your central organization’s IRS group exemption letter, or
Your organization’s most recent Federal income tax return.

ATTESTATION SECTION
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.
I (we) understand that:
• Based on the information provided on this sheet, Reclamation may request additional information.
• If I completed number 6 on page 1, my organization may not be eligible for special application of the acreage
limitation provisions under section 219 of the RRA and may be determined to be a limited recipient.
• If I completed number 7, the documentation requested in 7(d) must be attached to this form.
Print name:

____________________________________________________________

Signature:

____________________________________________________________

Date:

____________________________________________________________

Address:

____________________________________________________________

Relationship to organization: __________________________________________________
Telephone number: _________________________________________________________
E-mail address (optionaI): ____________________________________________________
See reverse side for instructions and Paperwork Reduction Act of 1995 and Privacy Act of 1974 system of records information.

ORGANIZATION COPY

Page 2 of 2

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 15 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 organization that may be eligible for special application of the acreage limitation provisions
under section 219 of the RRA, Reclamation will determine if the “Religious or Charitable Organization Identification Sheet”
(Sheet) should be completed by the organization. Reclamation will send this Sheet directly to the organization.
• 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 organization 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.
ORGANIZATION Instructions
• Numbers 1 through 3: Enter the requested information.
• Number 4: Answer the question provided. If “YES,” enter the requested information.
• Number 5: Answer the question provided. .
• Number 6: Proceed to number 7 if the answer to number 5 is “YES.” Answer the question provided if the answer to number 5 is
“NO.” Enter the requested information if the answer to this item (number 6) is “YES.” Proceed to the attestation section as
indicated.
• Number 7: Provide the requested information if the answer to number 5 is “YES.” The documentation requested in 7(d) must
accompany this completed identification sheet.
• Complete the attestation section.
• Retain the “Organization 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 organization
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.

7-2578 (07-17)
Bureau of Reclamation

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

RELIGIOUS OR CHARITABLE ORGANIZATION IDENTIFICATION SHEET
For Determining if Your Organization is Eligible for Special Application of the
Acreage Limitation Provisions Under Section 219 of the Reclamation Reform Act of 1982 (RRA)
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: __________________________________________________
District name: ____________________________________________________
Religious or Charitable Organization 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 15 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