Form FS-2700-19 Annual Land Use Fee Calculation for Concession Permits

USDA - Forest Service FS-2700-19 (XX/202X)

OMB No. 0596-0082

USDA – FOREST SERVICE FEE CALCULATION FOR CONCESSION PERMITS

A. PERMITTEE (Name and address):

B. SUDS IDENTITY CODE

     

     

C. PERIOD:

D. FEE CALCULATION SALES:

E. GROSS FIXED ASSETS (GFA):

     

$

     

$

     

SOURCE OF SALES

SALES FOR FEE CALCULATION

BREAK EVEN POINT (SALES TO GFA)

RATE BASE

BALANCE OF SALES RATE

AMOUNTS

%

%

%

%

1

II

III

IV

V

VI

VII

VIII

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

     

$

     

     

     

     

     

     

     

     

Total

$

     

     

     

     

     

ITEMS

RATE %

SALES

FEE

1. COMPOSITE BREAK/EVEN POINT

     

2 COMPOSITE RATE BASE

     

3. COMPUTATION OF BASIC FEE a – on sales below break/even

     

$

     

$

     

b – on sales from break/even to twice break/even

     

c – on sales greater than twice break/even

     

4. TOTALS (Sales and Basic Fee)

$

     

$

5. WEIGHTED AVERAGE FEE RATE

     

6. SLOPE TRANSPORT FEET

%

     

X

     

=

(SALES AND BASIC FEE)

7. SURCHARGE (if any)

$

     

X

     

=

$

(TOTAL BASIC FEE)

(SURCHARGE RATE)

8. COMMISSIONS AND OTHER INCOME

$

     

X

     

=

$

(COMMISSIONS)

(WEIGHTED AVG. FEE RATE)

9. FRANCHISE PAYMENTS

$

     

X

     

=

$

(FRANCHISE PAYMENTS)

(FRANCHISE RATE)

10. FEE EARNED (G/t payments to be billed separately)

$

11. MINIMUM FEE PAID ------------------------------------------------------------------------------------------------------------------------------►

$

12. TOTAL FEE DUE -----------------------------------------------------------------------------------------------------------------------------------►

$

13. PAYMENT TO DATE including credits -------------------------------------------------------------------------------------------------------►

$

14. BALANCE DUE CREDIT (Check One) ------------------------------------------------------------------------------------------►

$

PREPARED BY:

DATE

CHECKED BY:

DATE

Previous edition is obsolete.

(See Reverse for instructions)

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 the Organic Administration Act,16 U.S.C. 551. The time required to complete this information collection request is estimated to average 1 hour 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 the 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.

INSTRUCTIONS

1. Fill out blocks A-E at top of form.

2. Fill in Sources of Sales, Breakeven Points (column III); Rate Bases (column v), and Balance of Sales Rates (column VII) from permit fee clauses.

3. From permittee’s report of sales, determine dollar amount of sales for each kind of business and enter in column I.

4. Determine the percentage that the sales for each kind of business is of total sales. Enter these percentages in column II rounded off to the nearest whole percent.

5. Multiply column III by column II and enter the result in column IV without decimals. Show a total for the column at the bottom. Point off two places. This is the composite breakeven point. Round it off to the nearest whole percent, dropping any amount less than 0.5 percent, and enter it on line 1 under Rate.

6. Multiply column V by column II and enter the products in column VI without decimals. Show a total for the column at the bottom. Point off four places. This is the composite rate base. Round it off to the nearest hundredth of a percent and enter it on line 2 under Rate.

7. Enter 50% of line 2 rate on line 3a under Rate rounded off to the nearest hundredth of a percent. Enter 150% of line 2 rate on line 3b under Rate rounded off to the nearest hundredth of a percent. (Note: line 3b minus 3a must always equal line 2.)

8. Multiply the entry in block E by the percentage on line 1. If the result is greater than the entry in block D, enter the block D amount on line 3a under Sales. If the result is less than block D, enter the result on line 3a under Sales.

9. Subtract entry on line 3a under Sales from total sales block D. If the difference between line 3a entry and block D is equal to or less than line 3a, post the difference to line 3b under Sales. If the difference is greater than line 3a, post an amount equal to line 3a entry to line 3b. Post any balance of sales over line 3a and 3b total to line 3c under Sales. Total the results and post on line 4. Line 4 total sales must equal the block D entry.

10. If an entry is made under Sales on line 3c, multiply column VII by column II and enter the result in column VIII without decimals. Show a total for the column at the bottom. Point off four places. This is the composite balance of sales rate. Round it off to the nearest hundredth of a percent and enter it on line 3c under Rate.

11. Multiple line 3a Sales by line 3a Rate and post the result to line 3a, Fee. Follow the same procedure for lines 3b and 3c as appropriate. Post basic fee to line 4.

12. Divide line 4 Sales into line 4 Fee and post weighted average fee rate, rounded off to the nearest hundredth of a percent, to line 5 under Rate.

13. If surcharge applies, enter basic fee and surcharge percentage on line 6. Multiply and enter surcharge on line 7 under Fee.

14. Post commissions and other income to line 8. Multiply by weighted average fee rate line 5. Post the result on line 8 under Fee.

15. Post franchise payment to line 9, multiply by percentage due to the government. Post fee due on line 9 under Fee.

16. Add fees on line 4, 6, 7, 8, and 9 and post total to line 10 under Fee.

17. Enter minimum fee paid on line 11 under Fee.

18. 18. On line 12, enter entry from line 10 or 11, whichever is larger.

19. On line 13, enter payments made to date, including credit from previous year.

20. On line 14, enter the difference between line 12 and 13 and check off the appropriate word.

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