Form 3-2573 Easement Acquisition – Initial Landowner Inquiry Form

Form 3-2573 (Rev. 08/2023)
U.S. Department of the Interior

OMB Control No. 1018-####
Expires ##/##/20##

EASEMENT ACQUISITION
INITIAL LANDOWNER INQUIRY FORM
U.S. Fish and Wildlife Service

Name:

Date:

Address:

Phone Number(s):

Easement Type (circle one or both):

Wetland

Grassland

Legal Description(s) of Land Being Considered:

Ownership Type (circle all that apply):
Individual
LLC
Partnership
Comments:

Trust

Contract for Deed

Other

Cover Type(s) (e.g., native prairie, cropland, etc.) & Land Use (e.g., pasture, CRP, crop production,
etc.)

Known/Potential Future Development – examples may include wind, gravel, farmstead expansion,
buildings, feedlots, etc. (circle one): Yes
No
(If Yes, further discussions with wetland manager or station lead acquisition biologist may be
required)
Comments:

Explain Easement Provisions (check each item to indicate it was discussed):

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Form 3-2573 (Rev. 08/2023)
U.S. Department of the Interior

OMB Control No. 1018-####
Expires ##/##/20##

FOR MORE SPECIFIC SCENARIOS AND THINGS NOT COVERED IN THIS CHECKLIST, REFER
DISCUSSION TO MANAGER
All Easements:
______
______
______
______
______
______
______

Are perpetual
Subject to existing rights-of-way and other outstanding or reserved rights
Easement is acquired subject to subsurface mineral rights (oil, gas, and coal)
Weed control is the landowner’s responsibility
The landowner retains all trespass rights
Up to 12 months for payment to be made after contract is signed
Should not need to pay income tax on easement payment – Speak to your tax preparer

Grassland Easements:
______ No breaking of grassland - digging, plowing, disking, or other destruction of the
vegetative cover is prohibited
______ Haying/mowing is allowed in accordance with easement contract after July 15th
______ Grassland can be grazed without restriction in accordance with easement contract
______ No breaking of native prairie for any reason
______ No planting or maintenance of trees or food plots
______ Must also have a wetland easement if wetlands are present
______ CRP enrolled prior to grassland easement is not eligible for CRP contract renewal (refer
to NRCS representative with further questions)
Wetland Easements:
______
______
______
______
______

Wetland easements restrict draining, burning, filling and leveling
Wetland can be grazed without restriction
Wetland can be farmed/hayed when naturally dry
All wetlands within a grassland easement must be protected
Drained wetland basins will need to be restored

Are you interested in obtaining a free, no obligation easement offer?
(circle one)
Yes
No
If yes, request permission to use an ATV or Truck to conduct a field evaluation.
Permission to access property granted? (circle one)

Yes

No

______________________________
Ground check completed by:

___________________________
Date

______________________________
Evaluation completed by:

___________________________
Date

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Form 3-2573 (Rev. 08/2023)
U.S. Department of the Interior

OMB Control No. 1018-####
Expires ##/##/20##

NOTICES
PRIVACY ACT STATEMENT
Authority: The Migratory Bird Hunting and Conservation Stamp Act (16 U.S.C. 718d(b)(3)) and the Safe,
Accountable, Flexible, Efficient Transportation Equity Act (P.L. 109-59, section 1119).
Purpose: FWS will use the information collected to enter into grassland easements with private landowners.
Routine Uses: This information may be disclosed in accordance with the Freedom of Information Act, the Privacy
Act of 1974, and the routine uses listed in System of Records Notice (SORN) FWS-11 Real Property Records, 71 FR
68635 (November 27, 2006); modification published 88 FR 16277 (March 16, 2023).
Disclosure: Furnishing this information is voluntary; however, failure to furnish all the requested information may
prevent FWS from considering your application for the Grassland Easement Program.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501 et seq.), the U.S. Fish and Wildlife Service collects
information from landowners who willingly enter into grassland easements, and to respond to requests made
under the Freedom of Information Act and the Privacy Act of 1974. Information requested in this form required to
obtain or retain a benefit. Failure to provide all requested information may be sufficient cause for the U.S. Fish
and Wildlife Service to deny the request. 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
currently valid OMB control number. OMB has approved this collection of information and assigned Control No.
1018-####.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average:
Individuals/Households Respondents: 1 hour for reporting and 1 hour for recordkeeping, and
Private Sector Respondents: 1 hour for reporting and 1 hour for recordkeeping.
These burden estimates include time for reviewing instructions, gathering and maintaining data and completing
and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the
Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg
Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your
completed form to this address.
FREEDOM OF INFORMATION ACT
Information provided to the Service is generally subject to release to the public under the Freedom of Information
Act (FOIA). Certain information, however, may be subject to withholding if the Service determines that the
information is a trade secret and/or commercial or financial information that is privileged or confidential. To the
extent you are submitting business information that falls into one of these categories, you must clearly mark this
information as "Business Confidential" in order for the Service to assess the applicability of FOIA Exemption 4. Any
information provided by you that is not marked as “Business Confidential” will be considered releasable to the
public under the FOIA [43 CFR 2.26 – 2.33].

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