Form FS-2800-0023 Significant Cave Nomination Worksheet

SIGNIFICANT CAVE
NOMINATION WORKSHEET
(Reference FSM 2880)

FS- 2800-0023 (Rev. 04/2023)
OMB# 0596-0244
Exp. 12/31/2024

To Be Filled Out By the Person or Organization Submitting this Nomination

Name_______________________________________________________________
Address____________________________/________________/________________
Street
City
State & Zip
Telephone # (____) ______________ Email_____________________ Date __________
(MM/DD/YYYY)

Person to contact for additional Information:

Name____________________________ Telephone (____)_________________
Nomination Information

Cave Name_______________________________
Location: State: __________ Meridian: __________ Town: _____ Range: _____ Section: _________
Abbreviation Ex. DC

OR GPS Coordinates:
Lat.__________________ Long._______________________ Format.__________________
Position Error/ # of Satellites______________________________
Coordinate System_____________________________________
OR Verbal description:

* Topographic Map Enclosed: Yes

No

*Cave Map Enclosed: Yes

No

Administering Federal Agency: _______________________________________________
Local field office where cave is located: _________________________________________
* Information marked with an (*) is considered confidential under (section 5, Federal Cave Resources Protection Act,
1988) and is not subject to public disclosure under the Freedom of Information Act (Section 552 of Title 5 U.S. Code).

A cave must meet one or more of the following criteria to be eligible for designation as a significant
cave. If you select "yes" for one or more of these criteria, please explain why in the remarks section. If
desired, you may attach additional materials that will support your conclusions.
YES
NO
Biota: The cave provides seasonal or year-long habitat for organisms or
animals; contains species or subspecies of flora or fauna native to caves; are sensitive to disruption;
or are found on State or Federal sensitive, threatened, or endangered species lists.
File Code: 2880

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FS-2800-0023 (REV. 12/2021)

Remarks:

YES
NO
Cultural: The cave contains historic properties or archaeological resources
or other features that are included in, or eligible for, inclusion in the National Register
of Historic Places because of its research importance for history or prehistory, its
historical associations, or other historical or traditional significance.
Remarks:

YES
NO
Geologic/Mineralogic/Paleontologic: The cave possesses one or more of the
following features:
(1) Geologic or mineralogic features that are fragile, or that exhibit interesting formation
processes, or that are otherwise useful for study.
(2) Deposits, sediments, or features useful for evaluating past events.
(3) Paleontological resources with potential to contribute useful educational and
scientific information.
Remarks:

YES
NO
Hydrologic: The cave is a part of a hydrologic system or contains water that is
important to humans, biota, or development of cave resources.
Remarks:

YES
NO
scenic values.
Remarks:

File Code: 2880

Recreational: The cave provides or could provide recreational opportunities or

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FS-2800-0023 (REV. 12/2021)

YES
NO
Educational or Scientific: The cave offers opportunities for educational or scientific
use; the cave is virtually in a pristine state, lacking evidence of contemporary human
disturbance or impact; or the length, volume, total depth, pit depth, height, or similar measurements
are notable.
Remarks:

YES
NO
Specially Designated Area: All caves located within special management areas,
such as Special Geologic Areas, Research Natural Areas, or National Monuments that are
designated wholly or in part due to the cave resources found therein are determined to be
significant.
Remarks:

Additional Comments:

Attach Sketch
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, a collection of information unless it displays a valid Office
of Budget and Management (OMB) control number. The valid OMB control number for this information collection is 0596-0244. Response to this collection of information is voluntary. The authority for
this information collection request is the The Federal Caves Resources Protection Act of 1988 and 36CFR § 290.5 cites The time required to complete this information collection is estimated to average
11 hours per response, including the time for reviewing instructions, searching existing data sources, gathering 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 USDA Forest Service Information
Collections Officer, [email protected], with OMB control number 0596-0244 in the subject line.
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 of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your 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.
The Privacy Act of 1974, 5 U.S.C. 552a and the Freedom of Information Act ,5 U.S.C. 552 govern the confidentiality to be provided for information received by the Forest Service.

File Code: 2880

For technical questions and Section 508 accommodation, please contact [email protected]

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