10-932 Application for Special Use Permit - Commercial Filming/

Special Park Use Applications, portions of 36 CFR 1-7, 13, 20, and 34

NPS 10-932 Application for CFSP (Long Form) OMB Renewal 2023

OMB: 1024-0026

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NPS Form 10-932 (Name Change) OMB Control No. 1024-0026

National Park Service Expiration Date 11/30/2023

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APPLICATION FOR SPECIAL USE PERMIT FILMING, STILL PHOTOGRAPHY, AND AUDIO RECORDING (Long Form)


[PARK NAME]

[Street Address]

[City, State, Zip Code]

[Phone Number for Park Permits POC]

NPS Logo


Please supply the information requested below. Attach additional sheets, if necessary, to provide required information. A non-refundable application fee of [insert amount] must accompany this application. You must allow sufficient time for the park to process your request; check with the park for guidelines. You will be notified of the status of the application and the necessary steps to secure your final permit. Your permit may require the payment of location fees, cost recovery charges, and proof of liability insurance naming the United States of America an additional insured. Applications may not be submitted more than one year before the proposed activity including time required for set up.


* Enter either a Social Security Number OR a tax ID number; we do not require both.

Applicant Information

Company/Organization Information

Applicant Name:

Company/Organization Name:

Social Security Number*:

Tax Identification Number*:

Street Address:


Street Address:

City:


City:

State:


State:

Zip Code:


Zip Code:

Country:


Country:

Telephone Number:


Telephone Number:

Cell Phone Number:

Contact Name:

Fax Number:


Fax Number:

Email Address:


Email Address:

Project Information

Project Name



Location Manager



Telephone



Cell



Email Address



Type of Project

Still Photography Filming Audio Recording



Detailed Description of Onsite Activities (attach additional pages if needed)




Location Schedule

Date

Location

Start Time

End Time

Interior / Exterior

Activity (e.g., Set-up, Breakdown)

# of Cast and Crew*

















































* Number in this column should include all individuals present at the location

Talent

Talent comprises anyone in front of the camera and includes, but is not limited to: models, hosts, correspondents, presenters, park visitors, cooperators, volunteers, National Park Service and concessioner staff, etc.


Do you intend to use talent?

Yes (If yes, write a full description below of who they are and how they’ll be used. Attach additional pages if necessary).

No




Equipment

Description of equipment, backdrops, sets, props (attach additional pages, if necessary). Please note if any of the following will be included: weapons, animals, minors, nudity.


Electrical Requirements

Description of electrical requirements (attach additional pages, if necessary).

Generators

Are you using generators?

Quantity (if using)

Size (if using)

Yes

No





Lighting Requirements

Are you using lighting?

Reflectors only?

Description of lighting requirements (attach additional pages if necessary)

Yes

No



Yes

No



Road Use

Will you require the use of roads?

Do you require road closures?

Yes (If yes, please explain below)

No



Yes (If yes, please explain below)

No


Road Use Schedule

Starting Date

Ending Date

Starting Time (include AM or PM)

Ending Time (include AM or PM)

Location
































Road Use Shots

Driving

Drive-by

Towing

Wet down road

Drive-ups and away

Other (please explain):


Camera Equipment

Camera / equipment location (check all that apply)


Road shoulder

Road median

Other (explain):




Types of equipment (check all that apply)


Hand

Dolly with track footage

Portable crane

Tripod

Arm footage

Car mount

Dolly

Crane or jib arm

Camera car, shot maker, or process trailer




Operational Information

Large or oversized vehicles may not be able to be accommodated or additional steps may need to be taken to ensure that no damage to park resource occurs.

Number of cars, SUVs, or light pick-up trucks

Number of vehicles greater than 10,000 lbs (class 3 or higher)

Base camp location (attach diagrams)

Special activities (attach additional pages, if necessary)






Involvement of Minors

Yes (If yes, provide the information requested below)

No

Quantity of minors

Age range










Livestock or Trained Animals

Yes (If yes, provide the information requested below)

No

Type of livestock

Quantity of livestock

Manner of transportation

Staging/coral requirements

















Aircraft

NOTE: All aircraft use (including “drones” or Uncrewed Aircraft Systems) over park lands should be listed. Landings and take offs must be specifically requested and approved as a condition of your permit.


Will aircraft be used?


Yes, aircraft will be used (If yes, explain)

No, aircraft won’t be used

Explanation of use



Special Effects

Including weapons, pyrotechnics, etc. Attach additional pages, if necessary.

Description of special effects to be used



Effects technician’s name



Technician phone



Technician email



License # (if applicable)



Permit # (if applicable)



Stunts

Will stunts be used?


Yes, stunts will be used (If yes, explain)

No, stunts won’t be used

Explanation of stunts



Stunt coordinator’s name



Coordinator phone



Coordinator email



Other Hazardous Activities

Any other unusual or hazardous activities?


Yes (If yes, explain)

No

Explanation of activities




Activity Questions
Activity Questions

When answering “Yes” to any of the following questions, provide additional information using additional pages, as necessary


Have you visited the requested area? Yes No


Do you have, or are you applying for, a permit with another Federal, state or local agency for this activity? Yes No

Have you obtained a permit from the National Park Service in the past?

(If yes, provide a list of permit dates and locations on a separate page.) Yes No


Have you ever been denied a permit or had a permit revoked by a Federal agency? Yes No

Have you forfeited a bond or other security for on Federal lands? Yes No


Do you plan to advertise or issue a press release before the event? Yes No


Is there any reason to believe there will be attempts to disrupt, protest or prevent your event? Yes No

(If yes, please explain on a separate page.)


Are there any pending Federal Investigations against you which involve a commercial filming activity Yes No


NOTE: You are encouraged to attach additional pages with information useful in evaluating your permit request including: story boards or scripts, set construction, parking plan, security plans, sanitary facilities, crowd control, emergency medical plan, off-road activity, trail use, use of any building and site clean-up.

Project Administration

Are you applying for this permit on behalf of another person or company?


Yes (If yes, explain)

No

If yes, provide a full description (including contact information) of all other individuals / companies involved with this project. Attach additional pages, as necessary.



Contacts

Role

Name

Title

Telephone

Cell

Email address

Person on Location Responsible for Adherence to All Terms and Conditions of Permit







Person on Location Responsible for Coordinating Activities With the NPS







Company Point-of-contact for Follow-up Information and Billing









The applicant by his or her signature certifies that all the information given is complete and correct, and that no false or misleading information or false statements have been given.


Name



Title



Company Name



Date



Signature





























NOTICES


IMPORTANT NOTICE TO APPLICANT

This application does not serve as permission to conduct any special use activity in the park. The information provided will be used to evaluate whether a permit will be issued. All applicable parts of the form must be completed. Incomplete applications will not be evaluated. Send the completed application, along with the application fee in the form of a [park to select payment methods accepted: cash, cashier’s check, money order, personal check]. Checks made payable to the National Park Service and all funds must be in US Dollars to [input name/park office and address]. Fees may also be paid online by credit card or electronic funds transfer at pay.gov. The application must be signed and dated in order for the application to be considered complete.



Purposes The purposes of this application are (1) to provide a National Park Service (NPS) park superintendent with information to approve or deny requests for activities that provide a benefit to an individual, group, or organization, rather than the public at large; and (2) to help NPS staff manage the activity to ensure that the permitted activity does not interfere with the enjoyment of the park by visitors and that the natural and cultural resources of the park are protected.



Routine Uses: In addition to those disclosures generally permitted under Title 5 U.S.C. § 552(a)(b) of the Privacy Act, records or information contained in this system may be disclosed outside the NPS as a routine use pursuant to Title 5 U.S.C. § 552(a)(b)(3) to other Federal, State, territorial, local, tribal, or foreign agencies and other authorized organizations and individuals based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system 

Effects of Nondisclosure: Failure to provide the requested information may impede your ability to obtain a permit from the NPS. The U.S. Criminal Code, Title 18 U.S.C. § 1001, provides that knowingly falsifying or concealing a material fact is a felony that may result in fines of up to $10,000 or 5 years in prison, or both. Deliberately and materially making false or fraudulent statements on this form will be grounds for denying you a Special Use Permit.


If your request is approved, a permit containing applicable terms and conditions will be sent to you. The permit must be signed by the responsible person and returned to the park for final approval by the Park Superintendent before the permitted activity may begin.


CUSTOMERS MAKING PAYMENT BY PERSONAL CHECK


When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution.


PAPERWORK REDUCTION ACT STATEMENT


We are collecting this information subject to the Paperwork Reduction Act (Title 44 U.S.C. § 3501) to provide the Park Superintendent information needed to evaluate whether a permit will be issued for the requested use. You are not required to respond to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number. The authority to collect information on the attached form is derived from Title 31 U.S.C. § 7701. Taxpayer identifying number, Title 54 U.S.C. § 100101, Promotion and regulation; Title 54 U.S.C. § 100751, Regulations; Title 54 U.S.C. § 103104, Recovery of costs associated with special use permits; and Title 54 U.S.C § 100905 Commercial filming.


ESTIMATED BURDEN STATEMENT


Public reporting burden for this form is estimated to average 30 minutes per response including the time it takes to read, gather and maintain data, review instructions, and complete the form. Direct comments regarding this burden estimate, or any aspects of this form, to the Information Collection Clearance Officer, National Park Service, 13461 Sunrise Valley Drive Reston, Virginia 20192. Please do not send your application to this address.

PRIVACY ACT STATEMENT


General: This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 21, 1984, for individuals completing this application. All information collected using this form will be safeguarded in accordance with established regulations and published notices of System of Records, NPS


Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b): The collection of your SSN or TIN is necessary to allow the NPS to collect fees under Title 54 U.S.C.§ 103104 and Title 54 U.S.C. §100905. Your SSN or TIN will only be used as necessary to: (1) process this application, (2) collect any associated permit fees, and (3) collect and report any delinquent financial obligations. Failure to disclose your SSN or TIN when required may prevent or delay the processing of your application and issuing the associated permit. Use of your SSN or TIN will be carried out in accordance with established regulations and published notices of system of records, NPS-1







INTERNAL AGENCY USE ONLY


Project Number/BILL:


Date Processed:


Permit Number:


Prepared By:


Organization Name:




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RECORDS RETENTION: Unapproved (3 years).  Maintain Approved applications with related permit and associated records based on appropriate item(s) in NPS Records Schedule 1, Resources Management and Lands, (N1-79-08-1)

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleApplication for Still Photography, Long Form (Form 10-932)
Authordhaas
File Modified0000-00-00
File Created2024-07-26

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