FS-2700-5a Term Special Use Permit for Recreation Residences

Authorization ID: #AUTH_ID#
Contact ID: #HOLDER_ID#
Expiration Date: #EXPIRATION_DATE#
Use Code: #USE_CODE#

FS-2700-5a (XX/202X)
OMB No. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE
FOREST SERVICE
TERM SPECIAL USE PERMIT FOR RECREATION RESIDENCES

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AUTHORITY:
Act of March 4, 1915, 16 U.S.C. 497

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#HOLDER_NAME#, #HOLDER_ADD_LINE_1#, #HOLDER_ADD_LINE_2#, #HOLDER_ADD_LINE_3#,
(the holder) #HOLDER_CITY#, #HOLDER_STATE# #HOLDER_ZIP# [is/are] authorized to occupy a
recreation residence on National Forest System (NFS) lands for personal, noncommercial recreational
use on the #NAME# National Forest, subject to the terms of this permit and its appendices. A legal
description of the NFS lands covered by this permit (the permit area) is described as follows:
1. Lot #REC_RES_LOT_NUMBER# of the #REC_RES_TRACT_NAME# tract, a plat of which is on file
in the office of the Forest Supervisor;
or

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2. #TOWNSHIP_SECT_RANGE# #FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#,
SECOND_DIVISION# #SECOND_DIV_NAME_NUMBER#, #THIRD_DIVISION#
#THIRD_DIV_NAME_NUMBER#, as shown on the attached map, which is incorporated as Appendix A.
This and any other appendices are hereby incorporated into this permit.

The following appurtenant private improvements, whether on or off the lot, are authorized in addition to
the recreation residence:
#PURPOSE #

I. GENERAL TERMS
A. AUTHORITY. This permit is issued pursuant to the Act of March 4, 1915, the Term Permit Act,
16 U.S.C. 497; 36 CFR Part 251, Subpart B, as amended; Forest Service Manual 1920, 1950, 2340,
2720, and 5410; and Forest Service Handbook (FSH) 2709.11, Chapters 10-50; FSH 2709.14,
Chapter 20; and FSH 5409.12, Chapter 60.
B. AUTHORIZED OFFICER. The authorized officer for this permit is the Forest Supervisor, a District
Ranger, or the Station, Institute, or Area Director with delegated authority pursuant to Forest Service
Manual 2700.
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C. AUTHORIZED USE. This permit authorizes only noncommercial recreational use by the holder’s
immediate family and the holder’s non-paying guests, other than incidental rental that has prior written
approval from the authorized officer pursuant to clause VII.A.
D. OCCUPANCY BY A TRUST BENEFICIARY’S IMMEDIATE FAMILY. If this permit is issued to a
living trust and the grantor’s immediate family will not be occupying the recreation residence, the trustee
shall notify the which trust beneficiary’s immediate family will be occupying the recreation residence. The
permanent address of this immediate family shall be provided to the Forest Service. The trustee shall
update the identification and permanent address of this immediate family as necessary. The trustee
warrants that the trustee has the authority to bind the trust to the terms of this permit. The trust is liable
for compliance with all the terms of this permit.
E. TERM. This permit shall expire at midnight on #EXPIRATION_DATE#. Expiration of this permit shall
not require notice, a decision document, or any environmental analysis or other documentation.

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F. CHANGE IN ADDRESS, OWNERSHIP OF THE RECREATION RESIDENCE, OR THE TRUSTEE.
The holder, the holder’s executor or personal representative, or the trustee shall immediately notify the
authorized officer of a change in the holder’s or grantor’s permanent address or a change in the
ownership of the recreation residence authorized by this permit. If the permit is issued to a trust, the
trustee shall immediately notify the authorized officer of a change in the trustee or revocation or
termination of the trust.
G. AMENDMENT. This permit may be amended in whole or in part by the Forest Service when,
at the discretion of the authorized officer, such action is deemed necessary or desirable to
incorporate new terms that may be required by law, regulation, the applicable land management
plan, or projects and activities implementing the land management plan pursuant to 36 CFR Part
218. Any amendments to this permit under this clause must be in writing and must be signed and
dated by the authorized officer.
H. COMPLIANCE WITH LAWS, REGULATIONS, AND OTHER LEGAL REQUIREMENTS. In
exercising the privileges granted by this permit, the holder shall comply with all present and future federal
laws and regulations and all present and future state, county, and municipal laws, regulations, and other
legal requirements that apply to the permit area, to the extent they do not conflict with federal law,
regulations, or policy. The Forest Service assumes no responsibility for enforcing laws, regulations, and
other legal requirements that fall under the jurisdiction of other governmental entities.

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I. NON-EXCLUSIVE USE. The use and occupancy authorized by this permit are not exclusive. The
Forest Service reserves the right of access to the permit area, including a continuing right of physical
entry to the permit area for inspection, monitoring, or any other purpose consistent with any right or
obligation of the United States under any law or regulation. The Forest Service reserves the right to allow
others to use the permit area in any way that is not inconsistent with the holder’s rights and privileges
under this permit, after consultation with all parties involved.
II. IMPROVEMENTS
A. LIMITATIONS ON USE. This permit authorizes only occupancy of a recreation residence. Nothing in
this permit gives or implies permission to build or maintain any structure or improvement or to conduct
any activity, unless specifically authorized by this permit. Any use not specifically authorized by this
permit must be proposed in accordance with 36 CFR 251.54 or 251.61. Approval of such a proposed use
through issuance of a new permit or permit amendment is at the sole discretion of the authorized officer.
Improvements requiring specific approval shall include but are not limited to signs, fences, name plates,
mailboxes, newspaper boxes, boathouses, docks, pipelines, antennas, water and sewer facilities,
retaining walls, driveways, parking areas, and storage sheds.
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B. DRAWINGS. All drawings and revisions to drawings for development, layout, construction,
reconstruction or alteration of improvements on the authorized lot must be prepared by a licensed
engineer, architect, or landscape architect, or other qualified professional acceptable to the authorized
officer. These drawings and drawing revisions must have written approval from the authorized officer
before they are implemented. The authorized officer may require the holder to furnish as-built drawings,
maps, or surveys upon completion of the work.
C. RELOCATION. This permit is issued with the express understanding that should future location of
federally owned improvements or road rights-of-way require relocation of the holder’s improvements, the
relocation will be conducted by and at the expense of the holder within a reasonable period specified by
the authorized officer.
III. OPERATIONS

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A. OPERATING PLAN. The holder shall prepare an operating plan and any operating plan revisions in
consultation with the authorized officer or the authorized officer’s designated representative. The
operating plan shall cover all activities authorized by this permit. The operating plan shall outline steps
the holder will take to protect public health and safety and the environment and shall include sufficient
detail and standards to enable the Forest Service to monitor the holder’s activities for compliance with the
terms of this permit. The operating plan shall be submitted by the holder and approved in writing by the
authorized officer or the authorized officer’s designated representative prior to commencement of
authorized activities and shall be attached to this permit as an appendix. Any operating plan revisions
shall be submitted by the holder and approved in writing by the authorized officer or the authorized
officer’s designated representative before they are implemented. The operating plan shall, at a minimum,
address requirements for the following:
1. Maintenance of vegetation, tree planting, and removal of dangerous trees and other unsafe
conditions.
2. Maintenance of the authorized improvements.

3. Size, placement and description of authorized signs.
4. Removal of garbage.
5. Fire protection.

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6. Identification of the person responsible for implementing the operating plan, if other than the holder,
and a list of the name, address, and telephone numbers of persons to contact in the event of an
emergency.
7. Process and logistics for receiving approval from the authorized officer.

The operating plan shall be revised as necessary when changes to the authorized use are approved by
the authorized officer.

B. MINIMUM OCCUPANCY AND PROHIBITION ON USE AS PRIMARY PLACE OF RESIDENCE. The
recreation residence authorized by this permit shall not be used as a full-time residence. Use of
permitted improvements as a principal place of residence is prohibited and shall be grounds for
revocation of this permit.
C. MAINTENANCE OF IMPROVEMENTS. The holder shall maintain the authorized improvements and
permit area to standards of repair, orderliness, neatness, sanitation, and safety acceptable to the
authorized officer and consistent with other provisions of this permit. Standards are subject to periodic
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change by the authorized officer when deemed necessary to meet statutory, regulatory, or policy
requirements or to protect NFS resources.
D. INSPECTION OF THE PERMIT AREA. The holder is responsible for inspecting the permit area
(using Form FS-2700-6b, Recreation Residence Self-Inspection Report), authorized rights-of-way, and
adjoining areas for dangerous trees, hanging limbs, and other evidence of hazardous conditions that
could affect the authorized improvements or pose a risk to public safety. After obtaining written approval
from the authorized officer, the holder shall remove these hazards at the holder’s expense.
E. USE OF NFS ROADS AND NFS TRAILS. The holder’s use of NFS roads and NFS trails shall
comply with applicable requirements in 36 CFR Part 212, Subpart A; 36 CFR Part 261, Subpart A; and
orders issued under 36 CFR Part 261, Subpart B. Motor vehicle use shall be consistent with designations
made under 36 CFR Part 212, Subpart B, unless specifically provided otherwise in the operating plan.
Over-snow vehicle use shall be consistent with designations made under 36 CFR Part 212, Subpart C,
unless specifically provided otherwise in the operating plan.

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F. MONITORING BY THE FOREST SERVICE. The Forest Service shall monitor the holder's operations
and reserves the right to inspect the permit area and authorized facilities and improvements at any time
for compliance with the terms of this permit. The holder shall comply with inspection requirements
deemed appropriate by the authorized officer. The obligations of the holder under this permit are not
contingent upon any duty of the Forest Service to inspect the permit area or authorized facilities or
improvements. A failure by the Forest Service or other governmental officials to inspect is not a defense
to noncompliance with any of the terms of this permit.
G. CUTTING, DISPOSAL, AND PLANTING OF VEGETATION. This permit does not authorize the
cutting of trees, brush, shrubs, and other plants (“vegetation”). Vegetation may be cut, destroyed, or
trimmed only after the authorized officer or the authorized officer’s designated agent has approved in
writing and marked or otherwise identified what may be cut, destroyed, or trimmed. The holder shall
notify the authorized officer when approved cutting, destruction, or trimming of vegetation has been
completed. The Forest Service shall determine in advance of felling the method of disposal of trees felled
in the permit area that meet utilization standards. Disposal may be by sale or without charge per 36 CFR
Part 223, as may be most advantageous to the United States. Debris from felling that does not meet
utilization standards shall also be disposed of according to methods determined by the Forest Service.
Planting of vegetation in the permit area must have prior written approval from the authorized officer.
IV. RIGHTS AND LIABILITIES

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A. LEGAL EFFECT OF THE PERMIT. This permit, which is revocable and terminable, is not a contract
or a lease, but rather a federal license. The benefits and requirements conferred by this authorization are
reviewable solely under the procedures set forth in 36 CFR Part 214 and 5 U.S.C. 704. This permit does
not constitute a contract for purposes of the Contract Disputes Act, 41 U.S.C. 601. The permit is not real
property, does not convey any interest in real property, and may not be used as collateral for a loan.

B. VALID EXISTING RIGHTS. This permit is subject to all valid existing rights. Valid existing rights
include those derived from mining and mineral leasing laws of the United States. The United States is not
liable to the holder for the exercise of any such right.
C. ABSENCE OF THIRD-PARTY BENEFICIARY RIGHTS. The signatories of this permit do not intend
to confer any rights on any third party as a beneficiary under this permit.

D. WATER RIGHTS AND WATER FACILITIES
1. Water Rights. This permit does not confer any water rights on the holder. The term “water rights”
includes all authorizations, such as certificates, reservations, decrees, or permits, for water use issued
under state, local, or other law. Any necessary water rights must be acquired by the holder in accordance
with state law and the terms of this permit. After this permit is issued, all water rights obtained by the
holder for facilities that divert or pump water from sources located on NFS lands for use on NFS lands,
whether authorized or unauthorized, are for the benefit of the United States and shall be acquired in the
name of the United States. Any expenses for acquiring water rights shall be the responsibility of the
holder and not the responsibility of the United States.

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2. Water Facilities. No ditch, reservoir, well, spring, seepage, or other facility to pump, divert, store, or
convey water (hereinafter “water facilities”) for which the point of diversion, storage, or withdrawal is on
NFS lands may be initiated, developed, certified, or adjudicated by the holder without prior written
approval from the authorized officer. The authorization of any water facilities in the permit area is granted
to allow use of water only in connection with the recreation residence authorized by this permit. If the use
of any water facilities in connection with this recreation residence ceases, the authorization to use any
associated water facilities also ceases. The United States reserves the right to place any conditions on
installation, operation, maintenance, and removal of water facilities that are necessary to protect public
property, public safety, and natural resources on NFS lands in compliance with applicable law. Any
change in the beneficial use of or location of use from a water facility without prior written approval from
the authorized officer shall result in termination of the authorization of that facility.

3. Water Rights Acquired in the Name of the Holder.

(a) Identification of Water Rights. The holder has obtained the following water rights for use under this
permit in the holder’s name:

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State ID #: _______________________________

Owner: __________________________________

Purpose of Use: ___________________________
Decree, License, or Certificate: _______________
Point of Diversion: ______________________

(b) Revocation or Termination. Upon revocation or termination of this permit, the holder shall transfer the
water rights enumerated in paragraph 3(a) to the succeeding permit holder for use only in connection with
the recreation residence authorized by this permit provided that if that recreation residence is not
reauthorized, the holder shall promptly petition in accordance with state law to remove from NFS lands
the point of diversion and water use associated with the water rights or shall relinquish the water rights to
the state where they are located.

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(c) Abandonment. Upon abandonment of the recreation residence authorized by this permit, any of the
water rights enumerated in paragraph 3(a) that remain in the name of the holder at the time of
abandonment shall be deemed to have been transferred to the United States to hold for the benefit of any
succeeding permit holder for use only in connection with that recreation residence; provided that if that
recreation residence is not reauthorized, the United States shall retain the water rights or relinquish them
to the state where they are located.
(d) Waiver. The holder waives any claims against the United States for compensation for any water
rights that are transferred, removed, or relinquished as a result of revocation or termination of this permit
or abandonment of the use authorized by this permit, or for compensation in connection with imposition of
any conditions on installation, operation, maintenance, and removal of water facilities associated with
water rights enumerated in paragraph 3(a).

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E. NO WARRANTY OF ACCESS, SITE SUITABILITY, OR SERVICES. This permit authorizes the use
and occupancy of NFS lands by the holder for the purposes identified in this permit. The Forest Service
does not make any express or implied warranty of access to the permit area, of the suitability of the
permit area for the authorized uses, or for the furnishing of road or trail maintenance, water, fire protection
services, search and rescue services, or any other services by a government agency, utility, association,
or individual.

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F. RISK OF LOSS. The holder assumes all risk of loss to the authorized improvements and all risk of
loss of use and occupancy of the permit area, in whole or in part, due to public health and safety or
environmental hazards. Loss to the authorized improvements and of use and occupancy of the permit
area may result from but is not limited to theft, vandalism, fire and any fire-fighting activities (including
prescribed burns), environmental contamination, avalanches, rising waters, winds, falling limbs or trees,
and other forces of nature. If any authorized improvements are destroyed or substantially damaged, the
authorized officer shall conduct an analysis to determine whether the improvements can be safely
occupied in the future and whether rebuilding should be allowed. If rebuilding is not allowed, this permit
shall terminate. If the authorized officer determines that the permit area cannot be safely occupied due to
a public health or safety or environmental hazard, this permit shall terminate. Termination under this
clause shall not give rise to any claim for damages, including lost profits and the value of the
improvements, by the holder against the Forest Service.
G. DAMAGE TO UNITED STATES PROPERTY. The holder has an affirmative duty to protect from
damage the land, property, and other interests of the United States that are associated with the use and
occupancy authorized by this permit. Damage includes but is not limited to destruction of or damage to
NFS lands, fire suppression costs, and destruction of or damage to federally owned improvements.

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1. The holder shall be liable for all injury, loss, or damage, including fire suppression costs, prevention
and control of the spread of invasive species, and the costs of rehabilitation or restoration of natural
resources, resulting from the holder’s use and occupancy of the permit area. Compensation shall include
but is not limited to the value of resources damaged or destroyed, the costs of restoration, cleanup, or
other mitigation, fire suppression or other types of abatement costs, and all associated administrative,
legal (including attorney's fees), and other costs. Such costs may be deducted from a performance bond
required under clause IV.K.

2. The holder shall be liable for damage to all roads and trails of the United States caused by use of the
holder or the holder’s heirs, assignees, agents, employees, contractors, or renters to the same extent as
provided under clause IV.G.1, except that liability shall not include reasonable and ordinary wear and
tear.
H. HEALTH AND SAFETY. The holder shall take all measures necessary to protect the health and
safety of all persons affected by the use and occupancy authorized by this permit. The holder shall
promptly abate as completely as possible and in compliance with all applicable laws and regulations any
physical or mechanical procedure, activity, event, or condition existing or occurring in connection with the
authorized use and occupancy during the term of this permit that causes or threatens to cause a hazard
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to the health or safety of the public or the holder’s employees, agents, or contractors. The holder shall as
soon as practicable notify the authorized officer of all serious accidents that occur in connection with
these procedures, activities, events, or conditions. The Forest Service has no duty under the terms of
this permit to inspect the permit area or operations of the holder for hazardous conditions or compliance
with health and safety standards.
I. ENVIRONMENTAL PROTECTION

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1. Compliance with Environmental Laws. The holder shall in connection with the use and occupancy
authorized by this permit comply with all applicable federal, state, and local environmental laws and
regulations, including but not limited to those established pursuant to the Comprehensive Environmental
Response, Compensation, and Liability Act (CERCLA), as amended, 42 U.S.C. 9601 et seq., the
Resource Conservation and Recovery Act, as amended, 42 U.S.C. 6901 et seq., the Federal Water
Pollution Control Act, as amended, 33 U.S.C. 1251 et seq., the Oil Pollution Act, as amended, 33 U.S.C.
2701 et seq., the Clean Air Act, as amended, 42 U.S.C. 7401 et seq., the Toxic Substances Control Act,
as amended, 15 U.S.C. 2601 et seq., the Federal Insecticide, Fungicide, and Rodenticide Act, as
amended, 7 U.S.C. 136 et seq., and the Safe Drinking Water Act, as amended, 42 U.S.C. 300f et seq.

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2. Definition of Hazardous Material. For purposes of clause IV.I and section V, "hazardous material"
shall mean (a) any hazardous substance under section 101(14) of CERCLA, 42 U.S.C. 9601(14); (b) any
pollutant or contaminant under section 101(33) of CERCLA, 42 U.S.C. 9601(33); (c) any petroleum
product or its derivative, including fuel oil, and waste oils; and (d) any hazardous substance, extremely
hazardous substance, toxic substance, hazardous waste, ignitable, reactive or corrosive materials,
pollutant, contaminant, element, compound, mixture, solution or substance that may pose a present or
potential hazard to human health or the environment under any applicable environmental laws.
3. Oil Discharges and Release of Hazardous Materials. The holder shall immediately notify all
appropriate response authorities, including the National Response Center and the authorized officer or
the authorized officer designated representative, of any oil discharge or of the release of a hazardous
material in the permit area in an amount greater than or equal to its reportable quantity, in accordance
with 33 CFR Part 153 and 40 CFR Part 302. For the purposes of this requirement, “oil” is defined by
section 311(a)(1) of the Clean Water Act, 33 U.S.C. 1321(a)(1). The holder shall immediately notify the
authorized officer or the authorized officer’s designated representative of any release or threatened
release of any hazardous material in or near the permit area which may be harmful to public health or
welfare or which may adversely affect natural resources on federal lands.

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4. Remediation of Release of Hazardous Materials. The holder shall remediate any release, threat of
release, or discharge of hazardous materials that occurs in connection with the holder’s activities in the
permit area, including activities conducted by the holder's agents, employees, contractors, or renters and
regardless of whether those activities are authorized under this permit. The holder shall perform
remediation in accordance with applicable law immediately upon discovery of the release, threat of
release, or discharge of hazardous materials. The holder shall perform the remediation to the satisfaction
of the authorized officer and at no expense to the United States. Upon revocation or termination of this
permit, the holder shall deliver the site to the Forest Service in compliance with all applicable laws and
regulations and free and clear of contamination.

J. INDEMNIFICATION. The holder shall indemnify, defend, and hold harmless the United States for any
costs, damages, claims, liabilities, and judgments arising from past, present, and future acts or omissions
of the holder in connection with the use and occupancy authorized by this permit. This indemnification
and hold harmless provision includes but is not limited to acts and omissions of the holder or the holder’s
family, guests, invitees, heirs, assignees, agents, employees, contractors, or renters in connection with
the use and occupancy authorized by this permit which result in (1) violations of any laws and regulations
which are now or which may become applicable; (2) judgments, claims, demands, penalties, or fees
assessed against the United States; (3) costs, expenses, and damages incurred by the United States; or
(4) the release or threatened release of any hazardous material into the environment. The authorized
officer may prescribe terms that allow the holder to replace, repair, restore, or otherwise undertake
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necessary curative actions to mitigate damages in combination with or as an alternative to monetary
indemnification.
K. BONDING. The authorized officer may require the holder to furnish a surety bond or other security
for any of the obligations imposed by the terms of this permit or any applicable law, regulation, or order.

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1. As a further guarantee of compliance with the terms of this permit, the holder shall deliver and
maintain a surety bond or other acceptable security, such as cash deposited and maintained in a federal
depository or negotiable securities of the United States, in the amount of #AMOUNT# for [specify
obligations covered, e.g., to secure the holder’s obligation to restore the permit area after construction or
upon revocation or termination of the permit without issuance of a new permit]. The authorized officer
may periodically evaluate the adequacy of the bond or other security and increase or decrease the
amount as appropriate. If the bond or other security becomes unsatisfactory to the authorized officer, the
holder shall within 30 days of demand furnish a new bond or other security issued by a surety that is
solvent and satisfactory to the authorized officer. If the holder fails to meet any of the requirements
secured under this clause, money deposited pursuant to this clause shall be retained by the United States
to the extent necessary to satisfy the obligations secured under this clause, without prejudice to any other
rights and remedies of the United States.

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2. The bond shall be released or other security returned 30 days after (a) the authorized officer certifies
that the obligations covered by the bond or other security are met and (b) the holder establishes to the
satisfaction of the authorized officer that all claims for labor and material for the secured obligations have
been paid or released.
3. The holder may be required to obtain additional bonding or security prior to undertaking additional
construction or alteration not covered by the bond or other security or when the authorized improvements
are to be removed and the permit area restored.

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L. FLOOD DAMAGE. The lands covered by this permit are in a floodplain or floodway. This permit is
issued with the specific understanding that if the authorized improvements are substantially damaged and
made uninhabitable by a flood, this permit shall terminate, and the remaining improvements shall be
removed within 90 days. If damage to the improvements is not substantial, they may be repaired and
allowed to remain if they can be flood-proofed without affecting flows in the floodplain or floodway. No
expansion of existing improvements or new improvements will be allowed in the floodplain or floodway.
No claim shall be made against the United States for loss, damage, or termination of the permit due to a
flood.
V. RESOURCE PROTECTION

A. WATER POLLUTION. No waste or by-product shall be discharged into water in connection with the
use and occupancy authorized by this permit except in full compliance with all applicable federal, state,
and local environmental and other laws. Storage facilities for materials capable of causing water
pollution, if accidentally discharged, shall be located so as to prevent any spillage into waters or channels
leading into water except in full compliance with all applicable federal, state, and local environmental and
other laws.

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B. SCENIC VALUES. The holder shall protect the scenic values of the permit area and the adjacent
land to the greatest extent possible during construction, operation, and maintenance of the authorized
improvements.
C. VANDALISM. The holder shall take reasonable measures to prevent and discourage vandalism and
disorderly conduct and when necessary shall contact the appropriate law enforcement officer to address
these problems.
D. PESTICIDE USE
1. Authorized Officer Concurrence. Pesticides may not be used outside of buildings in the permit area to
control pests, including undesirable woody and herbaceous vegetation (including aquatic plants), insects,
birds, rodents, or fish without prior written concurrence of the authorized officer. Only those products
registered or otherwise authorized by the U.S. Environmental Protection Agency and appropriate State
authority for the specific purpose planned shall be authorized for use within areas on NFS lands.

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2. Pesticide-Use Proposal. Requests for concurrence of any planned uses of pesticides shall be
provided in advance using the Pesticide-Use Proposal (form FS-2100-2). Annually the holder shall, on
the due date established by the authorized officer, submit requests for any new, or continued, pesticide
usage. The Pesticide-Use Proposal shall cover a 12-month period of planned use. The Pesticide-Use
Proposal shall be submitted at least 60 days in advance of pesticide application. Information essential for
review shall be provided in the form specified. Exceptions to this schedule may be allowed, subject to
emergency request and approval, only when unexpected outbreaks of pests require control measures
which were not anticipated at the time a Pesticide-Use Proposal was submitted.
3. Safety Plan. Before applying pesticides in the permit area, the holder shall submit to the authorized
officer a safety plan that includes, at a minimum, a precise statement of the treatment objectives; a
description of the equipment, materials, and supplies to be used, including pesticide formulation,
quantities, and application methods; a description of the lines of responsibility for project planning, project
monitoring, and after-action review; a description of any necessary interagency coordination; a copy of
the current Pesticide-Use Proposal for the permit; a description of the process by which treatment
effectiveness will be determined; and a spill plan, communications plan, security plan, and when required
by applicable local requirements, a provision for prior notification to sensitive individuals.
4. Reporting. By September 30th annually, the holder shall submit to the authorized officer a written
report of each pesticide application project completed during the previous 12-month period. The report
shall contain information pertaining to the pesticide application projects as requested by the authorized
officer.

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5. Labeling, Laws, and Regulations. Label instructions and all applicable laws and regulations shall be
strictly followed in the application of pesticides and disposal of excess materials and containers. No
pesticide waste, excess materials, or containers shall be disposed of in any area administered by the
Forest Service.
E. ARCHAEOLOGICAL AND PALEONTOLOGICAL DISCOVERIES. The holder shall immediately
notify the authorized officer of any antiquities or other objects of historic or scientific interest, including but
not limited to historic or prehistoric ruins, fossils, or artifacts discovered in connection with the use and
occupancy authorized by this permit. The holder shall leave these discoveries intact and in place until
otherwise directed by the authorized officer.
F. NATIVE AMERICAN GRAVES PROTECTION AND REPATRIATION (NAGPRA). In accordance
with 25 U.S.C. 3002(d) and 43 CFR 10.4, if the holder inadvertently discovers human remains, funerary
objects, sacred objects, or objects of cultural patrimony on NFS lands, the holder shall immediately cease
work in the area of the discovery and shall leave the discoveries intact and in place. The holder shall
follow the applicable NAGPRA protocols for the undertaking provided in the NAGPRA plan of action or
the NAGPRA comprehensive agreement; if there are no such agreed-upon protocols, the holder shall as
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soon as practicable notify the authorized officer of the discovery and shall follow up with written
confirmation of the discovery. The activity that resulted in the inadvertent discovery may not resume until
30 days after the authorized officer certifies receipt of the written confirmation, if resumption of the activity
is otherwise lawful, or at any time if a NAGPRA plan of action has been executed by the Forest Service
following tribal consultation and any preconditions have been met.
G. PROTECTION OF THREATENED, ENDANGERED, AND SENSITIVE SPECIES AND THEIR
HABITAT

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1. Threatened and Endangered Species and Their Habitat. The location of sites within the permit area
needing special measures for protection of plants or animals listed as threatened or endangered under
the Endangered Species Act,16 U.S.C. 531 et seq., as amended, or within designated critical habitat shall
be shown on a map in an appendix to this permit and may be shown on the ground. The holder shall take
any protective and mitigation measures specified by the authorized officer as necessary and appropriate
to avoid or reduce effects on listed species or critical habitat affected by the authorized use and
occupancy. Discovery by the holder or the Forest Service of other sites within the permit area containing
threatened or endangered species or designated critical habitat not shown on the map in the appendix
shall be promptly reported to the other party and shall be added to the map.

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2. Sensitive Species and Species of Conservation Concern and Their Habitat. The location of sites
within the permit area needing special measures for protection of plants or animals designated by the
Regional Forester as sensitive species or as species of conservation concern pursuant to FSM 2670 shall
be shown on a map in an appendix to this permit and may be shown on the ground. The holder shall take
any protective and mitigation measures specified by the authorized officer as necessary and appropriate
to avoid or reduce effects on sensitive species or species of conservation concern or their habitat affected
by the authorized use and occupancy. Discovery by the holder or the Forest Service of other sites within
the authorized area containing sensitive species or species of conservation concern designated pursuant
to FSM 2670 or their habitat not shown on the map in the appendix shall be promptly reported to the other
party and shall be added to the map.
H. WATER WELLS AND ASSOCIATED PIPELINES

1. Other Jurisdictional Requirements. Clause IV.D governs water rights and water facilities. The holder
shall obtain all required state and local water permits, licenses, registrations, certificates, or rights and
shall provide a copy of them to the authorized officer. For new wells, this information shall be provided
prior to disturbing NFS lands for the purpose of water use or development.

D

2. Well Construction or Development. For new or reconstruction of existing wells, the holder shall
prepare a well construction and development plan and submit it to the authorized officer for approval.
The well development and construction plan must have prior written approval from the authorized officer
before well construction or development is initiated. The holder shall follow applicable federal, state, and
local standards for design, construction, and development of new wells or reconstruction of existing wells.
If such standards do not exist, the holder shall follow applicable standards issued by the American
Society for Testing and Materials (ASTM), American Water Works Association (AWWA), or National
Ground Water Association (NGWA). The construction and development plan must identify all potential
sources for any proposed water injection during well construction or development. Only non-chlorinated,
potable water may be injected during construction or development of wells to be used for monitoring or
water withdrawal. Copies of all documentation for drilling, constructing, or developing wells, including all
drilling, boring, and well construction logs, shall be provided to the authorized officer within 60 days of
completion of work.

3. Well Decommissioning. The holder shall properly decommission and abandon all wells that are no
longer needed or maintained in accordance with applicable federal, state, and local standards for water
well abandonment. If such standards do not exist, the holder shall follow applicable standards issued by
the ASTM, AWWA, or NGWA. At least 30 days prior to initiation of well decommissioning, the holder shall
submit a well decommissioning plan to the authorized officer. The well decommissioning plan shall have
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written approval from the authorized officer before well decommissioning is initiated. All documentation of
well decommissioning shall be provided to the authorized officer within 60 days of completion of the work.
I. FEDERAL SURVEY MONUMENTS, CORNERS, and BOUNDARY MARKERS. The holder shall
protect in place all federal survey monuments, corners, and boundary markers in the permit area. If any
federal survey monuments, corners, or boundary markers in the permit area are destroyed or modified,
the holder shall ensure that they are reestablished or corrected in accordance with (1) the Manual of
Instructions for the Survey of the Public Land of the United States; (2) the applicable county surveyor’s
specifications; and (3) the specifications of the Forest Service, as applicable. The holder shall ensure
that any official survey records that were affected due to the destruction or modification of any federal
survey monuments, corners, or boundary markers are amended in accordance with applicable law.
Nothing in this clause shall relieve the holder of liability for the willful destruction or modification of any
federal survey monuments, corners, or boundary markers as provided in 18 U.S.C. 1858.
VI. CABIN USER FEES AND DEBT COLLECTION

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A. CABIN USER FEE. The annual cabin user fee shall be based on the recreation residence’s fee tier
assignment. The recreation residence authorized by this permit has been assigned to Tier _____ with a
current-year annual cabin user fee of ______. The cabin user fee is due within 30 days of the date of
billing. The cabin user fee shall be adjusted annually based on changes in the Implicit Price Deflator for
the Gross Domestic Product, published by the Bureau of Economic Analysis of the United States
Department of Commerce, applied on a 5-year rolling average. Assignment to a fee tier is not subject to
appeal pursuant to 36 CFR Part 214.
B. CABIN USER FEE PAYMENTS

1. Crediting of Payments. Payments shall be credited on the date received by the deposit facility, except
that if a payment is received on a non-workday, the payment shall not be credited until the next workday.
2. Disputed Cabin User Fees. Cabin user fees are due and payable by the due date. Disputed cabin
user fees, other than cabin user fees recalculated pursuant to an audit, must be paid in full. Adjustments
will be made if dictated by an administrative appeal decision, a court decision, or settlement terms.
3. Late Payments

D

(a) Interest. Pursuant to 31 U.S.C. 3717 et seq., interest shall be charged on any cabin user fee not paid
within 30 days from the date it became due. The rate of interest assessed shall be the higher of the
Prompt Payment Act rate or the rate of the current value of funds to the United States Treasury (i.e., the
Treasury tax and loan account rate), as prescribed and published annually or quarterly by the Secretary
of the Treasury in the Federal Register and the Treasury Fiscal Requirements Manual Bulletins. Interest
on the principal shall accrue from the date the cabin user fee is due.
(b) Administrative Costs. If the account becomes delinquent, administrative costs to cover processing
and handling the delinquency shall be assessed.
(c) Penalties. Pursuant to 31 U.S.C. 3717(e)(2), a penalty of 6% per year shall be assessed on the total
amount of any debt, including interest and administrative costs, that is more than 90 days delinquent.
The penalty shall accrue from the same date on which interest charges begin to accrue.
(d) Termination for Nonpayment. This permit shall terminate if the holder fails to pay the cabin user fee,
interest, or any other charges within 90 calendar days of the due date. The holder shall remain
responsible for the delinquent charges.
4. Administrative Offset and Credit Reporting. Delinquent cabin user fees and other charges associated
with this permit shall be subject to all rights and remedies afforded the United States pursuant to 31

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U.S.C. 3711 et seq. and its implementing regulations. Delinquencies are subject to any or all of the
following:
(a) Administrative offset of payments due the holder from the Forest Service.
(b) If in excess of 120 days, referral to the United States Department of the Treasury for appropriate
collection action as provided by 31 U.S.C. 3711(g)(1) and its implementing regulations.
(c) Offset by the Secretary of the Treasury of any amount due the holder, as provided by 31 U.S.C.
3720A et seq.
(d) Disclosure to consumer or commercial credit reporting agencies.
VII. RENTAL, NON-TRANSFERABILITY, AND SALE

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A. INCIDENTAL RENTAL. With prior written approval from the authorized officer, the holder may rent
the recreation residence authorized by this permit for a limited number of short, specific periods for
recreational purposes, provided the rental does not change the character or use of the authorized
improvements from noncommercial to commercial. The rental agreement must be in writing and must
provide that the holder remains responsible for compliance with all the terms of this permit. A copy of the
rental agreement shall be provided to the authorized officer.

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B. NONTRANSFERABILITY. This permit is not transferable. A purchaser or transferee of the
recreation residence authorized by this permit must apply for and obtain a new permit from the Forest
Service. A transfer fee shall be charged to the holder per clause VII.D.
C. PROSPECTIVE PURCHASERS AND TRANSFEREES. When the holder is contemplating a sale of
the recreation residence authorized by this permit, the holder shall notify the authorized officer and
provide a copy of this permit to the prospective purchaser or transferee. The holder shall not represent
that the Forest Service will issue a new permit to the prospective purchaser or transferee. Any purchaser
or transferee must apply for and obtain a new permit from the Forest Service. A new permit may be
issued only to an individual, a married couple, or a living trust.

D

D. TRANSFER FEE. The holder shall pay a fee of $1,200, adjusted for inflation, for the issuance of a
new recreation residence permit due to a change of ownership of the recreation residence authorized by
this permit. The transfer fee shall be adjusted annually based on changes in the Implicit Price Deflator for
the Gross Domestic Product, published by the Bureau of Economic Analysis of the United States
Department of Commerce, applied on a 5-year rolling average.
VIII. REVOCATION, SUSPENSION, AND TERMINATION
A. REVOCATION AND SUSPENSION
1. The authorized officer may revoke or suspend this permit in whole or in part:
(a) For noncompliance with federal, state or local law;
(b) For noncompliance with the terms of this permit;
(c) For abandonment or other failure of the holder to exercise the privileges granted; or
(d) In the discretion of the authorized officer, for specific and compelling reasons in the public interest.
2. The authorized officer may revoke this permit at the request of the holder. Revocation at the request
of the holder must be agreed to in writing by the authorized officer. As a condition of revocation of this
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permit at the request of the holder, the authorized officer has discretion to impose any terms deemed
appropriate as provided for in this permit.
3. Prior to revocation or suspension, other than revocation at the request of the holder under clause
VIII.A.2 and immediate suspension under clause VIII.C, the authorized officer shall give the holder written
notice of the grounds for revocation or suspension and a reasonable period, not to exceed 90 days, to
cure any noncompliance.

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B. REVOCATION FOR SPECIFIC AND COMPELLING REASONS IN THE PUBLIC INTEREST. The
authorized officer may revoke this permit during its term if the Forest Service determines based on a land
management planning decision that the use and occupancy authorized by this permit should be changed
for specific and compelling reasons in the public interest, other than a determination under clause IV.F
that the authorized improvements or the permit area cannot be safely occupied. Prior to revoking the
permit under this clause, the authorized officer shall give the holder 90 days written notice, provided that
the authorized officer may prescribe a shorter notice period if justified by the public interest. The Forest
Service shall then have the right to remove or relocate the authorized improvements, to require the holder
to remove or relocate them, or to purchase them. Removal or relocation by the Forest Service of the
authorized improvements shall be accepted by the holder in full satisfaction of all claims against the
United States under this clause. If the Forest Service requires the holder to remove or relocate the
authorized improvements or purchases them, the Forest Service shall be obligated to pay the lesser of (1)
the cost of removal or relocation of the authorized improvements or (2) the value of the authorized
improvements as determined by the Forest Service through an appraisal of their replacement cost, less
an allowance for depreciation of all types. If that amount is fixed by agreement between the authorized
officer and the holder, that amount shall be accepted by the holder in full satisfaction of all claims against
the United States under this clause. If agreement is not reached, the authorized officer shall determine
the amount to be paid, which shall be set forth in the revocation decision. A payment made pursuant to
this clause is subject to the availability of appropriations. Nothing in this permit implies that Congress will
appropriate funds to cover a deficiency in appropriations.
C. IMMEDIATE SUSPENSION. The authorized officer may immediately suspend this permit in whole or
in part when necessary to protect public health or safety or the environment. The suspension decision
shall be in writing. The holder may request an on-site review with the authorized officer’s superior of the
adverse conditions prompting the suspension. The authorized officer superior shall grant this request
within 48 hours. Following the on-site review, the authorized officer’s superior shall promptly affirm,
modify, or cancel the suspension.

D

D. APPEALS AND REMEDIES. Written decisions made by the authorized officer relating to
administration of this permit are subject to appeal pursuant to 36 CFR Part 214, as amended. Revocation
or suspension of this permit shall not give rise to any claim for damages by the holder against the Forest
Service, other than as provided in clause VIII.B.

E. TERMINATION. This permit shall terminate when by its terms a fixed or agreed upon condition,
event, or time occurs without any action by the authorized officer. Examples include but are not limited to
expiration of the permit by its terms on a specified date and termination upon a change in ownership and
issuance of a new permit to another party for the recreation residence authorized by this permit.
Termination of this permit is not subject to administrative appeal and shall not give rise to any claim for
damages by the holder against the Forest Service.

1. Termination upon Change in Ownership. If the holder through voluntary sale, transfer, change in
trustee, revocation of a trust, termination of a trust after the grantor’s death, enforcement of contract,
foreclosure, divorce, or other legal proceeding ceases to be the owner of the authorized improvements,
this permit shall terminate upon issuance of a new permit to another party for the recreation residence
authorized by this permit. If the person who acquires title to the improvements is qualified to be a holder
under applicable regulations and Forest Service directives, that person shall be granted a new permit for
the remainder of the term of this permit.
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2. Termination of a Permit Issued to a Married Couple or an Individual upon their Death
(a) Married Couple. If the holder of this permit is a married couple and one spouse dies, this permit shall
remain in effect, without amendment, in the name of the surviving spouse.
(b) Individual or Surviving Spouse. If the holder of this permit is an individual or a surviving spouse and
the holder dies, this permit shall terminate. Pending settlement of the holder’s estate, an annual
renewable permit, using form FS-2700-4, shall be issued to the executor or personal representative of the
holder's estate. Upon settlement of the estate, the authorized officer shall issue a new permit, updated as
necessary to reflect Forest Service policy changes, to a qualified heir or devisee for the remainder of the
term of this permit. To qualify, an heir or a devisee must be one individual 21 years of age or older or a
married couple and must have title to the recreation residence authorized by this permit as shown by a
court order, bill of sale, recorded will, or other legally sufficient documentation.
3. Termination of a Permit Issued to a Living Trust Upon the Death of the Trustee or Trustees

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(a) Married Couple as the Trustees. If the holder of this permit is a living trust with a married couple as
the trustees and one spouse dies, this permit shall remain in effect, without amendment, in the name of
the surviving spouse as the trustee.

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(b) Individual or Surviving Spouse as the Trustee. If the holder of this permit is a living trust with an
individual or a surviving spouse as the trustee and the individual or surviving spouse dies, this permit
shall terminate. Pending disposition of the trust, an annual renewable permit, using form FS-2700-4, shall
be issued to the executor or personal representative of the trustee’s estate. Upon disposition of the trust,
the authorized officer shall issue a new permit, updated as necessary to reflect Forest Service policy
changes, to a qualified beneficiary of the trust for the remainder of the term of this permit. To qualify, a
beneficiary must be one individual 21 years of age or older or a married couple and must have title to the
recreation residence authorized by this permit as shown by a court order, bill of sale, recorded will, or
other legally sufficient documentation.
IX. CONTINUATION OF THE AUTHORIZED USE AND OCCUPANCY UPON EXPIRATION OF THE
PERMIT
A. CONSISTENCY DETERMINATION. A decision to issue a new permit or convert the permit area to
an alternative public use upon expiration of this permit requires a determination of consistency with the
applicable land management plan (the plan).

D

1. Where continued use is consistent with the plan, the authorized officer shall issue a new permit, in
accordance with applicable requirements for environmental analysis.

2. If, as a result of an amendment or revision of the plan, the permit area is allocated to an alternative
public use, the authorized officer shall conduct site-specific environmental analysis to determine the
range and intensity of the alternative public use.
(a) If the environmental analysis results in a decision that the authorized use may continue, the holder
shall be notified in writing, this permit shall be modified as necessary, and a new permit shall be issued
upon expiration of this permit.
(b) If the environmental analysis results in a decision that the authorized use shall be converted to an
alternative public use, the holder shall be notified in writing and given at least 10 years continued
occupancy from the date of that notice. The holder shall be given a copy of the environmental analysis
and decision document.

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(c) If a land use decision relating to the permit area and its supporting environmental documentation are
more than 5 years old, the decision and supporting documentation shall be reviewed at least 2 years prior
to permit expiration. If the review indicates that the conditions resulting in the decision are unchanged,
the decision may be implemented. If the review indicates that conditions have changed, new
environmental analysis shall be conducted to determine the proper course of action.
B. NEW TERMS. In issuing a new permit, the authorized officer shall include terms that reflect new
requirements imposed by current federal and state land use plans, laws, regulations, or other
management decisions.
C. NEW PERMIT TO ACCOMMODATE 10-YEAR CONTINUED OCCUPANCY. If the holder receives
notice that the permit area will be converted to an alternative public use and the 10-year period of
continued occupancy would extend beyond the expiration date of this permit, upon expiration of this
permit, a new term permit shall be issued for the remaining portion of the 10-year period.

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X. RIGHTS AND RESPONSIBILITIES UPON REVOCATION OR TERMINATION WITHOUT
ISSUANCE OF A NEW PERMIT

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A. REMOVAL OF IMPROVEMENTS. Except as provided in clause VIII.B, upon revocation of this
permit or termination of this permit without issuance of a new permit, the authorized officer has the
discretion to require the holder to sell or remove all structures and improvements, except those owned by
the United States, within a reasonable period prescribed by the authorized officer and to restore the site
to the satisfaction of the authorized officer. If the holder fails to sell or remove all structures or
improvements within the prescribed period, they shall become the property of the United States and may
be sold, destroyed, or otherwise disposed of without any liability to the United States. However, the
holder shall remain liable for all costs associated with their removal, including costs of sale and
impoundment, cleanup, and restoration of the permit area.
B. OFFER OF AN IN-LIEU LOT. Upon revocation (other than revocation for noncompliance) or upon
notification that a new permit will not be issued after expiration of this permit, the authorized officer may
offer an in-lieu lot, if available, to the holder for building or relocating a recreation residence. An in-lieu lot
must be in a location that is consistent with the applicable land management plan in the same National
Forest as the authorized improvements or in an adjacent National Forest. An offer of an in-lieu lot must
be accepted within 90 days or within 90 days of final disposition of administrative appeal of the revocation
decision, termination when rebuilding is not allowed, or notification that a new permit will not be issued
upon permit expiration, whichever is later, or the offer will expire. Upon acceptance of an in-lieu lot, this
permit shall terminate.

D

C. CONTINUATION OF OBLIGATIONS AND LIABILITIES BEYOND TERMINATION OR
REVOCATION. Notwithstanding the termination or revocation of this permit, its terms and conditions
shall remain in effect and shall be binding on the holder and the holder’s personal representative,
successors, and assignees until all the holder’s obligations and liabilities accruing before or as a result of
termination or revocation of this permit have been satisfied.

D. TERMINATION FOR THE DEVELOPMENT OF HYDROELECTRIC POWER OR RECLAMATION
PURPOSES. Any lands covered by this permit which have been withdrawn for hydroelectric power under
the act of March 3, 1879, or the act of June 25, 1910, or are covered by an application or license
governed by the Federal Power Act of June 10, 1920, are subject at any time to use for the development
of hydroelectric power. Any lands covered by this permit which have been withdrawn under the
Reclamation Act of June 17, 1902, are subject at any time to use for reclamation purposes. This permit is
issued with the specific understanding that (1) the use and occupancy authorized by this permit shall not
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interfere with such development of hydroelectric power or reclamation and that (2) this permit shall
terminate after 90 days written notice when, in the judgment of the Federal Energy Regulatory
Commission, the lands in question are needed for the development of hydroelectric power or, in the
judgment of the Bureau of Reclamation, the lands in question are needed for reclamation purposes. The
holder shall have 90 days to remove the authorized improvements. Termination under this clause does
not constitute revocation for specific and compelling reasons in the public interest under clause VIII.B and
shall not give rise to any claim for damages, including lost profits and damage to improvements, by the
holder against the Federal Energy Regulatory Commission, the Bureau of Reclamation, the Forest
Service, or hydroelectric power licensees.
XI. MISCELLANEOUS PROVISIONS
A. MEMBERS OF CONGRESS. No member of or delegate to Congress or resident commissioner shall
benefit from this permit either directly or indirectly, except to the extent the authorized use provides a
general benefit to a corporation.

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B. SUPERSEDED PERMIT. This permit replaces a special use permit issued to:
#PREV_REISSUE_HOLDER#, #PREV_AUTH_ID#, on #PREV_REIS_ISSUE_DATE#.

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C. DISCLAIMER REGARDING TITLE. Issuance of this permit shall not be construed as an admission
by the United States as to the title to any of the authorized improvements. The United States disclaims
any liability for issuance of a permit in the event of disputed title.
D. RULE OF CONSTRUCTION. If this permit is issued to a living trust and there is a conflict between
any of the terms of this permit and the terms of the trust documents or state law applicable to the trust,
the terms of this permit shall control.

THIS PERMIT IS ACCEPTED SUBJECT TO ALL ITS TERMS.

D

ACCEPTED:

#HOLDER_NAME#

DATE

#HOLDER_NAME#

DATE

APPROVED:

#AUTHORIZED OFFICER NAME#
#TITLE#
______________________ National Forest
USDA Forest Service

DATE

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PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to
respond to, an information collection request unless it displays a valid Office of Management and Budget (OMB) control number.
The valid OMB control number for this information collection request is 0596-0082. Response to this information collection request
is required to obtain or retain benefits, specifically, a special use authorization. The authority for this information collection request is
the Act of March 4, 1915, 16 U.S.C. 497. The time required to complete this information collection request is estimated to average 1
hour per response, including the time for reviewing instructions, searching existing data sources, collecting and maintaining the data
needed, and completing and reviewing the information collection request. Send comments regarding this burden estimate or any
other aspect of this information collection request, including suggestions for reducing the burden, to Forest Service Information
Collections Officer, SM.FS.InfoCollect@usda.gov, with OMB control number 0596-0082 in the subject line.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the
information on this form.

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Purpose: The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the
Director of Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request
information.
Authority: Collection of this information solicited on this form is authorized by the Act of March 4, 1915, 16 U.S.C. 497.
.

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Routine Uses: The information collected will be used by Forest Service officials to ensure that your use of National Forest System
lands is administered in accordance with applicable statutes, regulations, and directives. The information collected from you is
retained in the Special Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special
Uses Program, generate bills for collection of land use fees for your authorization, monitor compliance with your special use
authorization, and other matters pertaining to administration of your special use authorization. SUDS is a component of the Forest
Service’s Natural Resources Manager database (NRM). A complete list of the routine uses of NRM can be found in the system of
records notice associated with this form, FS-24.
Disclosure: The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.
NONDISCRIMINATION STATEMENT

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the
USDA, its agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income
derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or
activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by
program or incident.

D

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,
audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA
through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available
in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the
letter all the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit the completed
form or letter to USDA by (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400
Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

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