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NOTICES <br />The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with the information <br />requested by this form. <br />AUTHORITY: 30 U.S.C. 181 - 287 and 30 U.S.C. 351 - 359 permit collection of the information requested by this form. <br />PRINCIPAL PURPOSE: The BLM will use the information you provide to process your application and determine if you are eligible <br />to hold a coal lease on public lands. <br />ROUTINE USES: The BLM will only disclose this information in accordance with the provisions at 43 CFR 2.56(b) and (c). <br />EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain or retain a benefit. <br />Failure to submit all of the requested information or to complete this form may result in delay or preclude the BLM's acceptance of your <br />application for a coal lease. <br />The Paperwork Reduction Act requires us to inform you that: <br />The BLM collects this information to evaluate and authorize proposed exploration and mining operations on public lands. <br />Submission of the requested information is necessary to obtain or retain a benefit. <br />You do not have to respond to this or any other Federal agency - sponsored information collection unless it displays a currently valid <br />OMB control number. <br />BURDEN HOURS STATEMENT: The public reporting burden for this form is estimated to average 25 hours per response when the <br />form is used under the authority of 43 subpart 3422 (Lease Sales), or 800 hours per response when the form is used under the authority <br />of 43 subpart 3430 (Preference Right Leases). The estimated burdens include the time for reviewing instructions, gathering and <br />maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any other <br />aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004- 0073), Bureau Information Collection <br />Clearance Officer (WO -630), 1849 C Street. Mail Stop 401 LS, Washington, DC 20240. <br />(Form 3400 -12. page 4) <br />N <br />c� <br />1-t. <br />J '►7 . <br />C' <br />