Form FS-2700-4i, Append FS-2700-4i, Append Special Use Permit for Outfitting and Guiding, Appendix

Authorization ID: #AUTH_ID#
Contact Name: #HOLDER_ID#
Expiration Date: #EXPIRATION_DATE#

U.S. DEPARTMENT OF AGRICULTURE
FOREST SERVICE

FS-2700-4i (XX/XXXX)
OMB No. 0596-0082
FS-2700-4i, Appendix H

SPECIAL USE PERMIT FOR OUTFITTING AND GUIDING
APPENDIX H
ANNUAL STEWARDSHIP ACT FEE OFFSET AGREEMENT
AUTHORITY:
Section 7 of the National Forest System Trails Stewardship Act, 16 U.S.C. 583k-5

This annual Stewardship Act fee offset agreement (agreement) is made by #HOLDER_NAME# of
#HOLDER_ADD_LINE_1#, (the holder) and the U.S. Department of Agriculture, U.S. Forest Service,
______________[name of] National Forest (the Forest Service), under section 7 of the National Forest System Trails
Stewardship Act, 16 U.S.C. 583k-5, and the special use permit for outfitting and guiding issued to the holder on date (the
permit).
1. Amount of Land Use Fee Subject to Offset. The total estimated annual land use fee is ___________[amount].
_________ percent of that land use fee may be offset by the cost of construction, improvement, or government
maintenance performed by the holder of National Forest System trails, trailheads, and developed sites that support public
use, as itemized below in accordance with this agreement. Projects to be performed by the holder shall be completed by
the date specified and within the holder’s fiscal year for the year the fee is due. The Forest Service may modify the projects
and dates as necessary, after consultation with the holder.
2. Projects and Project Costs Covered by This Agreement. The actual cost of each project that is satisfactorily completed
as determined by the Forest Service may be offset against the holder’s land use fee. Due dates and cost estimates for
completion of each project are enumerated below. Examples of allowable costs include salaries and wages, materials and
supplies, and subcontracts that are direct costs of an itemized project. The total cost for projects to be performed under this
agreement shall not exceed the annual land use fee. The holder shall perform the following work under this agreement:
Description of Fee Offset Work
(specify whether it is construction,
improvement, or government
maintenance)

Completion Estimated
Actual
Actual Cost
Due Date
Cost
Completion
Date

3. Davis-Bacon Act, Minimum Wage, and Paid Sick Leave Requirements. Government maintenance, reconditioning,
renovation, and improvement conducted under this agreement and costing over $2,000 is subject to the Davis-Bacon Act,
40 U.S.C. 3141 et seq., and its implementing regulations, including the Davis-Bacon Act clause at 29 CFR 5.5; Executive
Order 14026, Increasing the Minimum Wage for Federal Contractors, and its implementing regulations, including the
federal contractor minimum wage clause at 29 CFR Part 23, Appendix A; and Executive Order 13706, Establishing Paid
Sick Leave for Federal Contractors, and its implementing regulations, including the federal contractor paid sick leave

clause at 29 CFR Part 13, Appendix A. These regulatory requirements are incorporated by reference into this agreement
as if fully set forth in this agreement.

4. Documentation of Project Costs. Upon a determination by the Forest Service that a project has been satisfactorily
completed by the holder, the holder shall submit documentation of its actual cost to the Forest Service and shall certify,
using form FS-2700-4i, Appendix I, that the representations in that documentation are accurate and complete. The
certification shall be signed and dated, __________ and shall state that failure to sign the certification shall vitiate the fee
offset claim. The Forest Service shall verify that documentation before giving any credit against the holder’s land use fee
and reserves the right not to grant any land use fee offset if any representations in the documentation are inaccurate or
incomplete.

Signed:
__________________________________________________________________________________________________
HOLDER NAME, PRECEDED BY NAME AND TITLE
SIGNATURE
DATE
OF PERSON SIGNING ON BEHALF OF HOLDER,
IF HOLDER IS AN ENTITY

Signed:
#OFFICER_NAME#
#OFFICER_TITLE#
__________________________________________________________________________________________________
NAME AND TITLE OF AUTHORIZED OFFICER
SIGNATURE
DATE

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
Section 7 of the National Forest System Trails Stewardship Act, 16 U.S.C. 583k-5. The time required to complete this information
collection request is estimated to average 2 hours 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 Section 7 of the National Forest System Trails
Stewardship Act, 16 U.S.C. 583k-5

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.