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NOTICES <br />NOTE.;: This applies to the Department of the Interior/Bureau of Land Management (BLM). <br />The Privacy Act of 1974 provides that you be furnished with the following information in connection with the <br />information provided by this application for an authorization. <br />AUTHORITY 16 U.S.C. 310 and 5 U.S.C. 301. <br />PRINCIPAL PURPOSE: The primary uses of the records are to facilitate the (1) processing of claims or <br />applications; (2) recordation of adjudicative actions; and (3) indexing of documentation in case files supporting <br />administrative actions. <br />ROUTINE USES: BLM and the Department of the Interior (DOI) may disclose your information on this form: (l) to <br />appropriate Federal agencies when concurrence or supporting information is required prior to granting or acquiring a <br />right or interest in lands or resources; (2) to members or the public who have a need for the information that is <br />maintained by BLM for public record; (3) to the U.S. Department of Justice, court, or other adjudicative body when <br />DOI determines the information is necessary and relevant to litigation; (4) to appropriate Federal, State, local, or <br />foreign agencies responsible for investigating, prosecuting violation, enforcing, or implementing this statute, <br />regulation, or order; and (5) to a congressional office when you request the assistance of the Member of Congress in <br />writing. <br />EFFECT OF NOT PROVIDING THE INFORMATION: Disclosing this information is necessary to receive or <br />maintain a benefit. Not disclosing it may result in rejecting the application. <br />The Paperwork Reduction Act of 1995 requires us to inform you that: <br />The Federal agencies collect this information from applicants requesting right-of-way, permit, license, lease, or <br />certifications for the use of Federal Lands. <br />Federal agencies use this information to evaluate your proposal. <br />No Federal agency may request or sponsor and you are not required to respond to a request for information which <br />does not contain a currently valid OMB Control Number. <br />BURDEN HOURS STATEMENT: The public burden for this form is estimated at 25 hours per response including <br />the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct <br />comments regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau <br />of Land Management (10040189), Bureau Information Collection Clearance Officer (WO-630) 1849 C Street, <br />N.W., Mail Stop 401 LS, Washington, D.C. 20240. <br />A. reproducible copy of this form may be obtained from the Bureau of Land Management, Land and Realty Group, <br />1620 L Street, N.W., Ram. 1000 LS, Washington, D.C. 20036. <br />(SF - 299, page S)