FS-2700-1 (09/2020)

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. Response to this collection of information is mandatory. The authority to collect the information is the Organic Administration Act,
16 U.S.C. 551. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA’s TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

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