Attached is a map showing the existing access routes proposed to be used for casual use exploration purposes, primary areas of interest,
and types of activities to be conducted.
The above described activities will be managed by:
Mailing Address _________________________________________________________
Phone Number (include area code) ___________________________________________
Dated this _______________________ day of ___________________ , 20 _______ .
18 U.S.C. 1001 and 43 U.S.C. 1212 make it a crime for any person knowingly and willfully to make to any department or agency of the United States
any false, ctitious or fraudulent statements or representations as to any matter within its jurisdiction.
The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with the information requested by
AUTHORITY: 43 U.S.C. 299(b) and 43 CFR subpart 3814 and part 3838 permit collection of the information requested by this form.
PRINCIPAL PURPOSE: The BLM will use the information you provide to verify that you have complied with the pre-location requirements at
43 U.S.C. 299(b) and 43 CFR subpart 3814 and part 3838, and are therefore qualied to locate and record mining claims on land patented under the
Stock Raising Homestead Act.
ROUTINE USES: The BLM will only disclose this information in accordance with the provisions at 43 CFR 2.56(b) and (c).
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the requested information is required by 43 U.S.C. 299(b) and 43 CFR subpart 3814
and part 3838 for mining claimants who desire to locate a mining claim or tunnel site on land previously patented under the Stock Raising Homestead
Act. Failure to comply and submit all the requested information or to complete this form will delay the BLM’s processing of the form or may preclude the
BLM’s acceptance of your notice of intent to locate (NOITL) a mining claim or site on lands patented under the Stock Raising Homestead Act. Failure to
comply with the requirements of 43 U.S.C. 299(b) and 43 CFR subpart 3814 and part 3838 will void your NOITL. Mining claims or sites located under a
void NOITL are null and void from the beginning and will be cancelled by the BLM.
RELEVANT SYSTEM OF RECORDS NOTICE (SORN) CITATION: The Recordation of Mining Claims SORN may be found at 47 FR 55326
(December 8, 1982).
The Paperwork Reduction Act requires us to tell you that:
The BLM collects this information to determine whether or not you are qualied to locate a lode or placer mining claim and/or tunnel site on lands
patented under the Stock Raising Homestead Act.
Submission of the requested information is necessary to obtain or retain a benet.
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.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 25 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any other
aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-0114), Bureau Information Collection Clearance Ocer (WO-
630), 1849 C St., N.W., Mail Stop 401 LS, Washington, D.C. 20240.
(Form 3830-3, page 2)
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