Fs-2700-1 Monitoring Or Inspection Report For Special Use Authoriz

FS-2700-1 (v.07/2012)

OMB No. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE

Forest Service

MONITORING OR INSPECTION REPORT FOR SPECIAL USE AUTHORIZATIONS

Authority: Forest Service Manual 2716.5

Holder’s Name: ____________________________________________________________________

Name of authorized site or development: _________________________________________________

Authorization ID: ___________ Issue Date: ________________ Expiration Date: _______________

Authorization Form: ________________ Authority: _______________________ Use Code: ______

Holder Contact Information (name of representative, telephone number, and e-mail address): __________________________________________________________________________________

__________________________________________________________________________________

Purpose of Monitoring or Inspection (see FSM 2716.51 or specify other purpose): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Does the activity(s) monitored or inspected comply with the authorization’s terms and conditions? Yes or No (explain):

__________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If the inspection is on site, describe in detail the condition of the authorized area or improvements:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Specify in detail actions that are necessary to correct any unsatisfactory conditions: __________________________________________________________________________________

__________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________

________________________ ________________________________

Date Monitored or Inspected Name of Monitor or Inspector

________________________ ________________________________

Date Monitoring or Inspection Title

Discussed With Holder

________________________ ________________________________

Date Report Sent to Holder Name of Authorized Officer

________________________________

Title

INSTUCTIONS

Use this form to document monitoring of compliance with special use authorizations and inspections of the area or improvements authorized by special use authorizations in accordance with FSM 2716. Insert additional lines as needed. Identify the authorization involved in the monitoring or inspection, the purpose of the monitoring or inspection, the name of the monitor or inspector, and the date of the monitoring or inspection. Identify any deficiencies encountered; consider attaching a map or photograph to enhance identification. Discuss any deficiencies with the holder, and note the date of the discussion. Corrective actions may be identified and scheduled in the operating plan with the authorized officer’s concurrence. Keep the report in the case file, and provide a copy to the holder.

Failure to correct deficiencies identified and scheduled must be documented in a notice of noncompliance to the holder. The notice of noncompliance must specify the items of noncompliance and their factual and legal basis. In addition, the notice must identify the timeframe for correcting the noncompliance and the consequences for failure to correct it within that timeframe. Send the notice by certified mail or hand deliver it.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0082. The time required to complete this information collection is estimated to average 0.25 hour per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s Target Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, DC 20250-9410, or call toll free at (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 522) govern the confidentiality to be provided for information received by the Forest Service.