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The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) require that you be furnished the following information in connection with <br />information required by this application. <br />AUTHORITY: 30 U.S.C. 22 et seq.; 43 U.S.C. 1732(b) and 1782(c); 31 U.S.C. 9301 et seq.; 43 CFR 3802 and 43 CFR 3809. <br />PRINCIPAL PURPOSE: Information is being used to establish financial responsibility for surface disturbance on public lands. <br />ROUTINE USES: BLM will only disclose the information according to the regulations at 43 CFR 2.56(d). <br />EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is necessary to obtain or retain a benefit. Failure to <br />disclose this information may result in BLM's rejection of your application. <br />The Paperwork Reduction Act of 1995 requires us to inform you that: <br />The BLM collects this information to grant the right to conduct exploration and mining activities on public lands. <br />Response to this request is required to obtain or retain 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 <br />unless it displays a currently valid OMB control number. <br />BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 8 hours per response, including the <br />time for 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. Department of the Interior, Bureau of Land Management (1004 - 0194), Bureau <br />Information Collection CIearance Officer (WO -630), 1849 C Street, N.W., Room 2134LM, Washington, D.C. 20240. <br />NOTICES <br />(Form 3809-5, page 2) <br />