Donor Certification Form

OMB 1090-0009

The Department of the Interior and its bureaus (Department or DOI) has various authorities that permit the acceptance of donations or gifts in furtherance of resource conservation projects and other programs. Before accepting a donation, DOI must first evaluate whether or not the circumstances of the donation maintain the integrity of the Department's programs and operations, the impartiality of the Department, and public confidence in the Department. Prior to enacting the Donations Policy, DOI conducted a risk analysis in which $25,000 was determined to be the threshold above which there was a greater risk of possible legal or ethical questions associated with donations. Therefore, for donations valued at $25,000 or more, donors are requested to complete a DI-3680 Donor Certification form (DI-3680 form) to provide information clarifying business and legal interactions with the Department and consistency with the Donations Policy prior to acceptance.

The latest form for Donor Certification Form expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DI-3680 State, Local or Tribal Government Form
Form DI-3680 Businesses and Organizations Form
Form DI-3680 Individuals and Households Form
2021 DI-3680 Supporting Statement fin 11-29-21.docx Supporting Statement A
2021 DI 3680 Supporting Stmt Authorities Table final 9-24-21.docx Supplementary Document
PUBLISHED 30 DAY NOTICE 1090-0009 - 86 FR 67719 - 11292021.pdf Supplementary Document
1090-0009 Published 60 Day Notice - 86 FR 34036 - 06282021.pdf Supplementary Document
54 U.S.C. § 101101.pdf Supplementary Document
54 U.S.C. 200103(i).pdf Supplementary Document
54 U.S.C. § 307107.pdf Supplementary Document
54 U.S.C. § 102503(b).pdf Supplementary Document
54 U.S.C. § 101111.pdf Supplementary Document
43 U.S.C. § 1473.pdf Supplementary Document
25 U.S.C. § 2006(f)(1).pdf Supplementary Document
16 U.S.C. § 3192(i).pdf Supplementary Document
USCODE-2013-title25 458ddd.pdf Supplementary Document
USCODE-2013-title16 3196.pdf Supplementary Document
USCODE-2013-title16 3192.pdf Supplementary Document
USCODE-2013-title30-chap25 1231.pdf Supplementary Document
USCODE-2013-title43 1473.pdf Supplementary Document
USCODE-2013-title43 36a-c.pdf Supplementary Document
USCODE-2013-title16 3701.pdf Supplementary Document
USCODE-2013-title16 3741.pdf Supplementary Document
USCODE-2013-title16 661.pdf Supplementary Document
USCODE-2013-title43 395.pdf Supplementary Document
USCODE-2013-title43 1701.pdf Supplementary Document
USCODE-2013-title25 500c.pdf Supplementary Document
USCODE-2013-title16 4601-4608.pdf Supplementary Document
374 DM 6.htm Supplementary Document
18 USC 201.pdf Supplementary Document
9 Stat. at L. 395-7.pdf Supplementary Document
State, Local or Tribal Government Form
Businesses and Organizations Form
Individuals and Households Form

All Historical Document Collections

202111-1090-001 Approved with change	Extension without change of a currently approved collection	2021-11-29
201809-1090-001 Approved without change	Extension without change of a currently approved collection	2018-10-23
201509-1090-001 Approved without change	Extension without change of a currently approved collection	2015-09-30
201205-1090-001 Approved without change	Extension without change of a currently approved collection	2012-07-17
200812-1090-001 Approved without change	New collection (Request for a new OMB Control Number)	2009-04-24

OMB Details

Individuals and Households

Federal Enterprise Architecture: General Government - Central Property Management

Form DI-3680

Donor Certification Form

Fillable Printable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.