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NOTICES <br />The Privacy Act of 1974 and the regulations in 43 CFR 2.48(d) provide that you be furnished with the following information required by this application: <br />AUTHORITY: 30 U.S.C. 601, 602; and 43 U.S.C. 1201 <br />PRINCIPAL PURPOSE: BLM uses the information to maintain an inventory of vegetal and mineral information and to adjudicate your rights to <br />vegetal and mineral resources. <br />ROUTINE USES: BLM will disclose the information on this form pursuant to the regulations in 43 CFR 2.56. <br />EFFECT OF NOT PROVIDING THIS INFORMATION: If you do not furnish all the information required by this form, your application may be rejected. <br />The Paperwork Reduction Act of 1995 requires us to inform you that: <br />The BLM collects this information to evaluate the amount and condition of vegetal and mineral materials on public lands and will be used to maintain <br />depletion records. <br />Response to this request is required to obtain a benefit. <br />The BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored information collection unless it displays <br />a currently valid OMB control number. <br />BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 2 hours per response, including the time for reviewing <br />instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect <br />of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0001), Bureau Information Collection Clearance Officer (WO-630), <br />1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240. <br />iV - - - <br />r C. <br />s ?'1 <br />X <br />(Form 5510-I, page 2)