FS-2200-002 Application for Temporary Grazing or Livestock Use Permi

USDA Forest Service FS-2200-002 (v08-2018)

OMB No. 0596-0003 (Exp. 9/30/2018)

Application for Temporary Grazing or Livestock Use Permit

(Reference FSM 2230 and FSH 2209.13)

NOTE: The information requested on this form is voluntary; however, all the data requested is necessary if you wish to be considered as a qualified applicant for a grazing permit. The data is requested under authority of 5 USC 301, 36 CFR 222.3.

Section A (To be completed by Applicant)

I,

     

of

     

(Name of Applicant)

(Mailing Address including Zip Code)

do hereby apply for a permit to graze livestock (not to exceed one year) on National Forest System lands or other lands under Forest Service control as follows:

LIVESTOCK

PERIOD OF USE

Number

Kind

Class

From

To

GRAZING ALLOTMENT

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

It is fully understood and agreed that a grazing permit, if issued and accepted pursuant to this application, may be cancelled, in whole or in part, after written notice for: (a) failure to comply with the terms and conditions in the grazing permit, regulations of the Secretary of Agriculture on which the permit is based, or annual operating or other instructions of Authorized Officers issued pursuant to the permit; (b) knowingly and willfully making a false statement or representation in this application; (c) conviction for failure to comply with Federal laws or regulations or State and local laws relating to livestock control and to protection of air, water, soil and vegetation, fish and wildlife, and other environmental values when exercising the grazing use authorized by the permit; or (d) because the National Forest System lands or other lands under Forest Service control described in the permit are no longer available for grazing. It is also fully understood and agreed that a grazing permit, if issued pursuant to this application, may be modified to conform to current situations brought about by changes in law, regulations, executive orders, allotment management plans, land management planning, or other management needs. A permit issued pursuant to this application may also be modified because of resource conditions or permittee request.

The following statements and representations constitute a part of this application for a temporary grazing or livestock use permit:

1. I own or lease(Circle one) and seek grazing authorization for       head of cattle,      head of horses, and/or       head of sheep branded and earmarked as follows:

SHEEP BRAND

The type of use for which this application is submitted is: (Check all boxes that apply) Temporary Grazing: Grazing use NOT TO EXCEED ONE YEAR (As described under 36 CFR 222.3 and FSH 2209.13.) Breeding Animals: If the sires used to service permitted livestock are not owned by the permittee. Crossing National Forest System Lands: For non-permitted livestock going to or from private land, to other federal lands, or to market, and where transportation in another manner is not practical or available. Vegetation Management: To maintain or change vegetation for benefits such as fuel breaks or fire hazard reduction, noxious weed control, removal of competing vegetation to improve wildlife habitat, site preparation, or reduction of competition for timber regeneration. Approved Research or Administrative Use: (As described under 36 CFR 222.3 and FSH 2209.13)      

On-and-Off Provisions: (Complete if applicable) I hereby request that the following provisions be made part of my grazing permits: That I be authorized to graze a total of

     

head of

     

under an on-and-off provision on the

     

grazing allotment.

The land I control together with adjacent National Forest System lands and other lands under Forest Service control form a natural grazing unit.

The land I offer under this provision consists of

     

acres I own and

     

acres I lease or have the right to use, more

particularly described as follows:

     

Signature of Applicant      

Title      

Date      

Section B (To be completed by Recommending Officer)

The number, kind, and class of livestock, period of use, and grazing allotment on which the livestock are recommended to graze are as entered below.

LIVESTOCK

PERIOD OF USE

Number

Kind

Class

From

To

GRAZING ALLOTMENT

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

On-and-Off Provisions: Provides for a total of ________ head of ____________ to be grazed under an on-and-off provision. Attach Part 3 to the Temporary Permit.

Remarks:

Signature of Recommending Officer      

Name (print)      

Title      

Date      

Burden Statement

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 0596-0003. The time required to complete this information collection is estimated to average 20 minutes per response, 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, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Instructions for Completion of Form FS-2200-002, Application for Temporary Grazing

or Livestock Use Permit

(Reference FSM 2230 and FSH 2209.13)

Section A

Applicant – Enter Name of entity who is applying for a permit.

Address – Enter address of entity who is applying for a permit.

Livestock Number– Enter the number of animals being applied for.

Livestock Kind – Enter the appropriate livestock kind.

Livestock Class – Enter the appropriate livestock class.

Period of Use. (From/To) – Enter dates (mm/dd) of the period being applied for.

Grazing Allotment(s) – Enter the complete name of the allotment(s) the applied for use would occur on.

1. Head of Cattle – Enter the number of Cattle owned and seeking authorization for.

Head of Horses – Enter the number of Horses owned and seeking authorization for.

Head of Sheep – Enter the number of Sheep owned and seeking authorization for.

Brand and Earmark

Draw on the right and or left ear the earmark used.

Draw on the right and/or left cow the brand used.

Draw on the right and/or left horse the brand used

Draw in the block the sheep brand used.

2. Check the appropriate box for the type of permit applying for.

3. On-and-Off Provisions

No. of Head – Enter the total number of animals applying for with on/off provisions.

Cattle/Horses/Sheep – Enter the livestock kind applying for with on/off provisions.

Grazing Allotment(s) – Enter the complete name of the allotment(s) the applied for use would occur on.

No. of Owned Acres – Enter the number of acres that are owned to be used as part of this permit.

No. of Leased Acres – Enter the number of acres that are leased to be used as part of this permit.

Description – Enter the legal description of the owned and leased property. NOTE: attach copy of the proof to graze on leased land to the application.

Signature of Applicant – Enter the complete full name of the permit holder applying for the Permit.

Title – Enter the title of the person applying for the permit.

Date – Enter the date of signature.

Section B

Livestock Number– Enter the number of animals being applied for.

Livestock Kind – Enter the appropriate livestock kind.

Livestock Class – Enter the appropriate livestock class.

Period of Use. (From/To) – Enter dates (mm/dd) of the period being applied for.

Grazing Allotment(s) – Enter the complete name of the allotment(s) the applied for use would occur on.

On-and-Off Provisions No. of Head – Enter the total number of animals applying for with on/off provisions.

On-and-Off Provisions Cattle/Horses/Sheep – Enter the livestock kind applying for with on/off provisions.

Remarks - Enter any pertinent Remarks.

Signature of Recommending Officer – Enter the official signature of the Recommending official

Name (Print) – Print the name of the recommending official.

Title – Enter the official Title of the recommending official

Date – Enter the date that the recommendation was submitted.

Previous versions of this form are obsolete Page 7 of 7