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 information required by this application.
AUTHORITY: 43 U.S.C. 1068
PRINCIPAL PURPOSE: The information is to be used to process your application and to document the administrative action
relating to the application.
ROUTINE USES: In accordance with the System of Records titled, “Land and Minerals Authorization Tracking System—
Interior, LLM-32,” disclosure outside the Department of the Interior may be made: (1) To appropriate Federal agencies when
concurrence or supporting information is required prior to granting or acquiring a right or interest in lands or resources, (2) To
Federal, State, or local agencies or a member of the general public in response to a specic request for pertinent information,
(3) To the U.S. Department of Justice or in a proceeding before a court or adjudicative body when (a) the United States, the
Department of the Interior, a component of the Department, or when represented by the government, an employee of the
Department is a party to litigation or anticipated litigation or has an interest in such litigation, and (b) the Department of
the Interior determines that the disclosure is relevant or necessary to the litigation and is compatible with the purpose for
which the records were compiled, (4) To an appropriate Federal, State, local, or foreign agency responsible for investigating,
prosecuting, enforcing, or implementing a statute, regulation, rule, or order, where the disclosing agency becomes aware of
an indication of a violation or potential violation of civil or criminal law or regulation, (5) To a member of Congress or a
Congressional staff member from the record of an individual in response to an inquiry made at the request of that individual,
(6) To the Department of the Treasury to effect payment to Federal, State, and local government agencies, nongovernmental
organizations, and individuals, and (7) To individuals involved in responding to a breach of Federal data. The BLM will only
disclose this information in accordance with the Freedom of Information Act, the Privacy Act, and the provision in 43 CFR
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to process your request for Federal lands under the provisions of the Color-of-Title Regulations,
found in 43 CFR Section 2540.
Information will be used to illustrate whether the applicant meets requirements of regulations found in 43 CFR Subpart 2540,
Response to this request is required to obtain a benet, see 43 CFR Subpart 2541.2.
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 a currently valid OMB control number.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is voluntary. If all the information is not
provided, the application may result in delay or preclude the BLM’s acceptance of your form.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated at 1 hour per response, including the
time for reviewing instructions, gathering, and maintaining data and completing and reviewing the form. Direct comments
regarding the burden estimate or any other aspect of this form to the U.S. Department of the Interior, Bureau of Land
Management (1004-0012), Bureau Information Collection Clearance Ofcer (WO-630), 1849 C Street, N.W., Mail Stop 401
LS, Washington, D.C. 20240.
(Form 2540-1, page 3)