Form 1120-19 Bureau of Land Management Resource Advisory Council Appl

FORM APPROVED
OMB Control No. 1004-0204
Expires: 04/30/2025

Form 1120-019

(July 2024)

UNITED STATES

DEPARTMENT OF THE INTERIOR

BUREAU OF LAND MANAGEMENT

RESOURCE ADVISORY COUNCIL APPLICATION

Resource Advisory Councils (RAC) were established by the Federal Land Policy and Management Act (43 U.S.C. 1739), as citizen advisory groups to the Bureau of Land Management (BLM). These citizen-based groups provide an opportunity for individuals from all backgrounds and interests to have a voice in the management of America's public lands, and to help improve their health and productivity. RAC recommendations address all public land issues, including land use planning, recreation, noxious weeds, and wild horse and burro herd management areas, to name just a few.

Members are appointed by the Secretary of the Interior to serve 3-year terms and may be re-appointed. Each RAC consists of 10 to 15 members from diverse interests in local communities, including ranchers, environmental groups, tribes, State and local government officials, academics, and other public land users. An individual may not serve concurrently on more than one RAC. Council members must reside in the states within the geographic jurisdiction of the RAC.

RAC members serve without salary but are reimbursed for travel and per diem expenses at current rates for government employees. To be eligible for appointment to a RAC, a person must be qualified through education, training, knowledge, or experience. A RAC generally meets two-to-four times annually, or as needed to accomplish RAC business.

RAC members are generally expected to do the following:

• Attend meetings and field trips that have been scheduled in advance and participate in public discussion of issues during the meeting.

• Provide advice to the BLM officials on an informal basis, regarding issues that arise between formal meetings.

• Maintain up-to-date knowledge of issues affecting the RAC's geographic area.

• Provide BLM officials with opinions and advice that represents the point-of-view of the category represented by the RAC member, the member's experience and knowledge about the issue, and their reflection on data presented to the RAC by the public, BLM staff, or other sources.

• Provide feedback from the RAC meetings and interaction with the BLM staff and managers to specific interest groups. Provide the BLM with input and overview from interest groups.

The RACs have been successful in bringing diverse and often competing interests to the table to deal with matters of mutual concern. This inclusive approach has shown great promise as a means to successfully deal with long-standing issues of public land management. The RACs have demonstrated that consensus- driven recommendations often lead to sustainable outcomes that benefit natural resources and often enjoy a high level of public support.

RESOURCE ADVISORY COUNCIL APPLICATION

All Fields Required
Attach additional pages if necessary

Name of Committee to be considered for: ___________________________________________

First Name: _________________________________

Full Middle Name: ____________________________________

Last Name: _______________________________

Date of Birth: _____________________________________

Email Address: _____________________________________________________________

Home Address

Street: __________________________________________________________________

City: ___________________________ State: ________________ Zip: ________________

Mailing Address (if different from home):

Street: _______________________________________________________________

City: ___________________________ State: ________________ Zip: ________________

Describe related or relevant education or training in the specific area of interest you seek to represent:

Describe related or relevant work experience in the specific area of interest you seek to represent:

Describe previous advisory committee experience or relevant civic and professional activities:

Describe your experience working on a team or with disparate groups:

Why are you interested in serving on this advisory council?

Indicate the specific area(s) of interest you seek to represent:

Category 1:
	I hold a Federal grazing permit within the committee's area of jurisdiction.
	I represent transportation or rights-of-way interests.
	I represent developed outdoor recreation, off-highway vehicle users, or commercial recreation activities.
	I represent the commercial timber industry.
	I represent energy and mineral development interests.
Category 2:
	I represent a nationally or regionally recognized environmental organization.
	I represent dispersed recreation interests.
	I represent archaeological and historical interests.
	I represent wild horse and burro interest groups.
Category 3:
	I hold State, county, or local elected office.
	I am an employee of a State agency responsible for management of natural resources, land, or water.
	I represent an Indian tribe within or adjacent to the Committee's area of jurisdiction.
	I am an academician involved in natural resource management or the natural sciences.
	I represent the affected public-at-large.

Indicate any BLM permit, leases, or licenses that you hold personally or are held by your employer:

Are you a federally registered lobbyist? ___ Yes ___ No

Is at least one letter of recommendation attached or has a letter been sent on your behalf by the interest group or organization that you wish to represent? ___ Yes ___ No

Signature: ______________________________________ Date: ________________

NOTE: Although applications are submitted to the BLM office within the RAC's area of jurisdiction, appointments are ultimately conferred by the Secretary of the Interior. Applications will be reviewed and nomination packages will be completed at the local level. Governors of affected States will be consulted during this process. Recommendations will be endorsed by the appropriate BLM State Director and forwarded to the BLM Washington Office. Following the BLM Director's endorsement, recommendations will be forwarded to the Department of the Interior for background checks, ethics, and other reviews before presentation to the Secretary. The time between submission of application and receipt of member appointment letter may take 4-5 months.

The Privacy Act and the regulation at 43 CFR 2.48 (d) require that you be furnished the following information in connection with information required by this form.

AUTHORITY: The authority to request this information is contained in 5 U.S.C. Ch. 10, the Federal Advisory Committee Act; 5 U.S.C. 1739, the Federal Land Policy and Management Act; and 43 CFR Subpart 1784, Bureau of Land Management advisory committee regulations.

PURPOSE: The information will be used by the appointment officer to determine the qualifications such as education, training, and experience of candidates related to qualifications to serve on a Resource Advisory Council of the Bureau of Land Management.

ROUTINE USES: This information will be maintained in the Interior Volunteer Service File System (Interior/DOI-05) and is subject to routine uses of that system of records. These routine uses can be found at 66 FR 28536.

DISCLOSURES: Failure to submit this information will inhibit full consideration of a prospective advisory council member's qualifications and could result in non-selection. If you are appointed as an advisor, the information will be retained by the appointing official as long as you serve. Otherwise, it will be destroyed 2 years after termination of your membership or returned (if requested) following announcement of the Council appointments.

THE PAPERWORK REDUCTION ACT requires us to inform you that:

This collection is in accordance with the clearance requirements of 5 U.S.C. 3507. Completion of this form is required to obtain or retain a benefit. You do not have to respond to this or any other Federal agency-sponsored information collection and no Federal agency may conduct or sponsor such a collection, unless it displays a valid OMB control number. The information is used to determine qualifications, suitability, and availability for service on resource advisory councils.

Failure to submit this information will inhibit full consideration of a prospective advisory council member's qualifications and could result in non-selection.

BURDEN HOURS STATEMENT: The estimated public reporting burden for this form is 4 hours per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-0204), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Washington, D.C. 20240.

(Form 1120-019, Page 9 of 9)