Form DI-9002 Paleontological Permit Application

DI Form 9002 (Rev. 02/2022) OMB Control No. 1093-0008

U.S. Department of the Interior Expires XX/XX/20XX

Paleontology Permit Application

1a. Applicant name	1b. Applicant institutional affiliation
2. Professional contact information	3. Field contact information
4. Description of applicant qualifications
5. Location of proposed work
6. Description, scope, need for, and methodology of proposed work
7. Dates of proposed work Start: End:
8. Individuals who will be responsible for supervising or conducting work
9. Name, location, and contact information of the proposed repository
10. Anticipated costs and responsible parties
11. I certify under penalty of perjury that the information furnished is true and correct. Knowingly making a false statement may subject the declarant to the penalty provided by 18 U.S.C. 1001 and 16 U.S.C. 3372(d). Signature of Applicant Date

Instructions

Paleontology Permit Application

General: Use this form to apply for authorization to collect paleontological resources on Bureau of Land Management, Bureau of Reclamation, and U.S. Fish and Wildlife Service lands. For proposed collection on National Park Service (NPS) lands, request a NPS scientific permit application through the NPS Research Permit and Reporting System (RPRS) at https://irma.nps.gov/rprs/Home.

1a. Applicant name. The name of the individual applying for the permit.

1b. Applicant institutional affiliation. The employing or sponsoring organization with which the applicant is professionally associated.

2. Professional contact information. Include Online Researcher Catalog Identification Number (ORCID), work mailing address, work email, work fax and phone numbers, and any other information that is necessary for the Federal land manager to contact the applicant/permittee.

3. Field contact information. Any work phone, email, or social media address that will allow the Federal land manager to contact the applicant/permittee while conducting fieldwork.

4. Description of applicant qualifications. Attach a curriculum vitae or resume for the applicant and all other persons who will oversee work under the permit, if it is approved. Include a list of the applicant’s past permits, if any, and record of compliance or non-compliance. These attachments should demonstrate that the applicant possesses the qualifications required by 43 CFR § 49.110.

5. Location of proposed work. Provide a State, County, map coordinate (UTM, NAD 83) and also Section/Township/Range within the appropriate ¼ ¼. In addition, provide a readable copy of a 1:24,000 scale USGS topographic map that has not been altered or photo-reduced, marked to show proposed work location(s). Include supporting information as appropriate.

6. Description, scope, need for, and methodology of proposed work. Give the proposed work a brief title (for example: excavation of dinosaur remains from the Hell Creek Formation in the Charles M. Russell National Wildlife Refuge). Describe (1) the purpose and need for the proposed work (research goals and how the proposed collection would further paleontological knowledge or public education); (2) the scope of work or research plan (planned activities, field and analytical methods and description of needed access to field areas, names of key personnel and their assigned roles and responsibilities for field, analytical, and reporting efforts, with a summary of their prior experience and/or training that qualifies them to perform these duties); (3) duration of the proposed work (requested schedule for fieldwork, analysis, preparation, delivery of collected materials to the proposed repository, and report submittal); (4) logistical information (maximum number in field party and maximum number of vehicles, means to access sites, intent to house crews on Federal land, site preparatory work that could affect land resources; (5) nature and extent of proposed specimen collection, collection methods, any intent to perform consumptive use of collected specimens and why it is required to achieve defined research objectives, name and location of laboratory facilities where analytical work will be performed, and planned actions to prepare specimens for curation; (6) any existing collections known to have come from this area; and (7) any additional information that will help the federal land manager identify the extent, nature, and potential impacts of the proposal. Include contract statement of work if applicable for this project.

7. Dates of proposed work. Include the proposed starting and projected end date of work for this project.

8. Individuals who will be responsible for supervising or conducting work. For each individual named on line 8 attach a curriculum vitae or resume that provides a summary of education, training, and experience in the kind of work proposed, and in the role proposed.

9. Name, location, and contact information of the proposed repository. Provide the name and address of the facility that agrees to receive the collection made under the permit if granted, and name, phone number, and email address of the facility’s point of contact.

10. Anticipated costs and responsible parties. Describe the anticipated costs of the permitted activities, including preparation and initial curation, and identify the persons or organizations that will be responsible for these costs if the permit is granted. Responsibility for costs must be agreed upon before any collection takes place. Including bonding information, if required by the bureau.

11. Signature of applicant. By signing this application, the applicant certifies that the information provided is true and accurate. If a bureau finds that the applicant has intentionally provided misleading or false information, or has failed to disclose facts about past performance, or otherwise failed to provide a complete and truthful application about proposed actions and their ability to perform, it is a basis for denial of a permit.

NOTICES

Privacy Act Statement

Authority: 16 U.S.C. 470aaa.aaa-11, Paleontological Resources Preservation Act of 2009.

Purpose: The primary use of the records maintained in the system is to manage, protect, and preserve paleontological resources on Federal lands under the jurisdiction of the Department of the Interior. Information will be used to issue permits for the collection of paleontological resources and facilitate the management of activities under these permits.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, records or information may be shared with partners and curators who have physical custody of Federally-owned collections of paleontological resources to manage the collections, permitted researchers to share relevant information from previous discoveries and scientific investigations, and other Federal agencies and non-Federal entities as necessary to maintain accurate and complete permit records as authorized under the Privacy Act and in the routine uses outlined in the system of records notice INTERIOR/DOI-20, Paleontological Resources Preservation System.

Disclosure: Providing information is voluntary; however, not providing the requested information may hinder the approval of the requested permit.

Paperwork Reduction Act Statement

In accordance with the Paperwork Reduction Act (44 U.S.C. 3501, et seq.), we collect the necessary information, under the applicable laws, to evaluate your qualifications, decide whether to issue a permit, and decide whether to approve the proposed repository for deposit of any collections. Your response is required to obtain or retain a benefit. Failure to provide all requested information may be sufficient cause to deny the request. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1093-0008.

Estimated Burden Statement

We estimate it will take you about 4 hours to complete this application, including time to maintain records, gather information, and complete the form. You may send comments on the burden estimate or any other aspect of this form to the Departmental Information Collection Clearance Officer, Office of the Chief Information Officer, 1849 C Street NW, Washington, DC 20240, or via email at [email protected]. Please do not send your completed form to this email address.

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