Form FS-2700-1 Monitoring Report for Special Use Authorizations

FS-2700-1 (XX/202X)

OMB No. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE

Forest Service

MONITORING REPORT FOR SPECIAL USE AUTHORIZATIONS

Authority: Forest Service Manual 2716.5

Holder’s Name: ____________________________________________________________________

Name of authorized site or development: _________________________________________________

Authorization ID: ___________ Issue Date: ________________ Expiration Date: _______________

Authorization Form: ________________ Authority: _______________________ Use Code: ______

Holder Contact Information (name of representative, telephone number, and e-mail address): __________________________________________________________________________________

__________________________________________________________________________________

Purpose of Monitoring or Inspection (see FSM 2716.51 or specify other purpose): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Does the activity(s) monitored or inspected comply with the authorization’s terms and conditions? Yes or No (explain):

__________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If the inspection is on site, describe in detail the condition of the authorized area or improvements:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Specify in detail actions that are necessary to correct any unsatisfactory conditions: __________________________________________________________________________________

__________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________

________________________ ________________________________

Date Monitored or Inspected Name of Monitor or Inspector

________________________ ________________________________

Date Monitoring or Inspection Title

Discussed with Holder

________________________ ________________________________

Date Report Sent to Holder Name of Authorized Officer

________________________________

Title

INSTRUCTIONS

Use this form to document monitoring of compliance with special use authorizations and inspections of the area or improvements authorized by special use authorizations in accordance with FSM 2716. Insert additional lines as needed. Identify the authorization involved in the monitoring or inspection, the purpose of the monitoring or inspection, the name of the monitor or inspector, and the date of the monitoring or inspection. Identify any deficiencies encountered; consider attaching a map or photograph to enhance identification. Discuss any deficiencies with the holder and note the date of the discussion. Corrective actions may be identified and scheduled in the operating plan with the authorized officer’s concurrence. Keep the report in the case file and provide a copy to the holder.

Failure to correct deficiencies identified and scheduled must be documented in a notice of noncompliance to the holder. The notice of noncompliance must specify the items of noncompliance and their factual and legal basis. In addition, the notice must identify the timeframe for correcting the noncompliance and the consequences for failure to correct it within that timeframe. Send the notice by certified mail or hand deliver it.

PAPERWORK REDUCTION ACT STATEMENT

According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to, an information collection request unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection request is 0596-0082. Response to this information collection request is required to obtain or retain benefits, specifically, a special use authorization. The authority for this information collection request is Organic Administration Act, 16 U.S.C. 551. The time required to complete this information collection request is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, collecting and maintaining the data needed, and completing and reviewing the information collection request. Send comments regarding this burden estimate or any other aspect of this information collection request, including suggestions for reducing the burden, to Forest Service Information Collections Officer, [email protected], with OMB control number 0596-0082 in the subject line.

PRIVACY ACT STATEMENT

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the information on this form.

Purpose:  The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the Director of Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request information.

Authority:  Collection of this information solicited on this form is authorized by Organic Administration Act, 16 U.S.C. 551.

Routine Uses:  The information collected will be used by Forest Service officials to ensure that your use of National Forest System lands is administered in accordance with applicable statutes, regulations, and directives. The information collected from you is retained in the Special Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special Uses Program, generate bills for collection of land use fees for your authorization, monitor compliance with your special use authorization, and other matters pertaining to administration of your special use authorization. SUDS is a component of the Forest Service’s Natural Resources Manager database (NRM). A complete list of the routine uses of NRM can be found in the system of records notice associated with this form, FS-24.

Disclosure:  The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.

NONDISCRIMINATION STATEMENT

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs).  Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA’s TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all the information requested in the form.  To request a copy of the complaint form, call (866) 632-9992.  Submit the completed form or letter to USDA by (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. 

USDA is an equal opportunity provider, employer, and lender.

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