Laserfiche WebLink
Is USDA, Forest Service OkfB 0596-0'-17 <br />FS -1500-i5 <br />5 <br />Q. AUTHORIZED REPRESENTATIVES. By signature below. each party certifies <br />that the individuals listed in this document as representatives of the individual <br />parties are authorized to act in their respective areas for matters related to this <br />MOU. <br />In witness whereof, the parties hereto have executed chis MOU as of the last date <br />written below. <br />GIN -NY BRAN, ON, Division Director Date <br />State of Colorado, Division of Reclamation Mining <br />and Safety <br />-SCOTT G. APMENTROUT, Forest Supervisor <br />U.S. Forest Service, Grand Mesa, Uncompahgre and <br />Gunnison National Forests <br />Date <br />The authority and format of this agreement have been reviewed and approved for <br />signature. <br />?2 41'0_ �L k/V1"te't_ .._ '? /// � <br />Merna Fehlmann Date <br />U.S. Forest Service Grants Management Specialist <br />Burden Statement <br />According to the Paperwork Reduction Act of 1995, an agency may n of conduct or sponsor, and a person is not required to respond to a collection of <br />information unless it displays a valid OMB control number, The valid OMB control number for this information collection is 0596-0217. The time <br />required to complete this information collection is estimated to average 3 hours per response, including the time for reviewing instructions, searching <br />existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. <br />The U.S. Departmelt of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, <br />disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information. political beliefs, <br />reprisal, or because all or part of an individual's income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons <br />with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's <br />TARGET Center at 202-720-2600 (voice and TDD). <br />To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or <br />call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877.8339 (TDD) or (868) 377.8842 <br />(relay voice). USDA is an equal opportunity provider and employer. <br />Page 6 of 6 <br />