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<br />Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly or willfully to make to <br />any deparhnent or agency of the United States any false, fictitious or fraudulent statements or <br />representations as to any matter within its jurisdiction, subject to a fine of up to $10,000 and <br />imprisonment up to 5 yeazs. <br />NOTICE <br />The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 <br />et seq.) requires us to inform you that: <br />BLM is collecting this information to process your application and effect a binding contract. <br />BLM will use this information to identify and communicate with applicants. <br />You must respond to this request to get a benefit. A federal agency may not conductor sponsor, and <br />you are not required to respond to, an information collection which does not have a currently valid <br />OMB control number. <br />AUTHORITY: 30 U.S.C. 601 e! seq,; 43 CFR 3600 <br />PRINCIPAL PURPOSE: BLM uses [his information to identify the parties entering into contracts for disposing of mineral <br />materials. <br />ROUTINE USES: BLM will transfer information from the record or the record itself to appropriate fedttal, state, local, or <br />foreign agencies, when relevant to criminal, civil, or regulatory investigations or prosecutions. <br />EFFECT OF NOT PROVIDING INFORMATION: If you do not provide this information to BLM, we will not be able to <br />process your application for a contract. <br />BLM estimates the public reporting burden for this form at an average of 30 minutes per response, including the time For <br />reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the <br />burden estimate or any other aspect of this form to U.S. Deparment of the Interior, Bureau of Land Management, Bureau <br />Cleazance Officer, (1004-0103), 1849 C St., NW., Mail Stop 401 LS, Washington, D.C. 20240. <br />