Form DI-9006 Paleontology Permit Report

DI Form 9006 (Rev. 02/2022) OMB Control No. 1093-0008

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

Paleontology Permit REPORT

The information fields below must be included in the reports that are prepared in accordance with Paleontology Permits issued under 43 CFR Part 49.

1. Permit Number:

2. Permittee Name:

3. Permittee Institutional Affiliation:

4. Date of Report:

5. Reporting Period:

6. Report Title:

7. Purpose of Permit (check one):

Consulting Work on Behalf of a Project Proponent / Operator (if this box is checked, fill out lines 7a-7d, then continue to line 8)

Scientific Research, Educational Program, or Other (if this box is checked, proceed directly to line 8)

7a. Name of Project Proponent / Operator for whom consulting work was conducted:

7b. Name of Project for which consulting work was conducted:

7c. Report Number:

7d. Hours Spent on Fieldwork:

8. Location of Work:

9. Description of Work

• Summary of work completed, including field dates, personnel involved, and results.

• Copies of, or links to, published papers and reports that were generated from work under this permit or that acknowledge this permit.

• Narrative of future work that is intended to be performed under this permit.

• Notable discoveries, including new species discovered or described, and any media reports.

• Any threatened resources about which the agency should be aware.

• Paleontology Locality Records (DI Form 9004), for all new localities discovered or updated, including maps and photos.

• Repository Receipt of Collections (Paleontology) (DI Form 9007), for any collections that have been made.

10. Permit Status. (Identify if you want this permit to be modified, renewed, or closed.

11. I certify under penalty of perjury that the information furnished is true and accurate. 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 Permittee: Date:

Instructions

Paleontology Permit Report

General: Permit reports summarize the work completed under the permit and may also contain requests for the permit to be modified, renewed, or closed. Permit reports must be filed as specified in the permit terms and conditions. A separate report is required for each permit.

1. Permit Number. The permit number is assigned by the bureau (line 1a of DI Form 9003, Paleontology Permit). All correspondence between the bureau and permittee should reference this permit number.

2. Permittee Name. The individual who obtained the permit (line 1a of DI Form 9003, Paleontology Permit) is responsible for all reports that are submitted under this permit.

3. Permittee Institutional Affiliation. The business, university, or other entity with whom the permittee is affiliated (line 1b of the DI Form 9003, Paleontology Permit).

4. Date of Report. This is the date that the report is submitted to the bureau.

5. Reporting Period. The calendar dates covered by the report.

6. Report Title. The report title is normally assigned by the permittee in order to identify the work that is described in the report.

7. Purpose of Permit. Check the appropriate box. If the permit was issued for scientific, educational, or other purposes, continue with line 8. If the permit was issued for consulting, continue with lines 7a through 7d before proceeding to line 8.

7a. Name of Project Proponent/Operator for whom consulting work was conducted. Please identify the proponent/operator, bureau unit, or other party that is sponsoring (or paying for) the report.

7b. Project Name. Normally assigned by the permittee or project proponent, the project name identifies the activity or action that is being supported by the paleontological assessment described in this report.

7c. Report Number. If the author assigns a unique number, enter it here.

7d. Hours Spent on Fieldwork. Indicate how many person hours were spent conducting paleontological fieldwork or survey in support of this report. This does NOT include time spent preparing for field work, commuting to field areas, or preparing reports.

8. Location of Work. Identify on a map (NAD 83) the area where work was conducted. This may be identified in Latitude/Longitude, UTM, or the Public Land Survey System (Township, Range, Section). 1:24,000 scale topographic maps should not be photo-reduced.

9. Description of Work. This should describe the results of the work that was completed under this permit. Include Paleontology Locality Records (DI Form 9004) for all new discoveries, and a Repository Receipt of Collections (Paleontology) (DI Form 9007), for all collections that have been made. If a part or all of the collections have not been deposited in the approved repository, provide a timetable for the deposit.

10. Permit Status. Indicate whether the permit should be modified or renewed for another reporting period or if the permit should be closed.

11. Signature of Permittee. By signing and dating this form, the permittee certifies that the information provided in the report is true and accurate.

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 5 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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