Form 4130-1
(January 2018)
OMB NO. 1004–0041
Expires: 12/31/2020
Authorization No. _____________________________________
Schedule No.
Billing Code
Special Bill Code
Name (last, rst, middle initial)
Address (include street, city, State, and zip code)
I hereby apply for the following grazing use on the public lands and/or other lands administered by the Bureau of Land Management (BLM).
(1) (2) (3) (4) (5) (6) (7) (8)
Show your recorded brands, earmarks, and wattles
Show reason for nonuse, if requested: conservation and protection of the public lands; annual fluctuation of livestock operations; financial
or other reasons beyond control of the operator; or livestock disease or quarantine.
Printed Name
Reason for nonuse: Approved Disapproved (Decision Required)
Signature of BLM
Title U.S.C. Section 1001, makes 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 statement or presentations as to any matter within its jurisdiction.
%PL Use: Percent forage from public land use.
Type Use: Categories with specic rules that govern AUM and grazing fee calculation and input on grazing authorizations and bills (A=Active Use,
D=Custodial Use, N=Nonuse, L=Ephemeral Use, T=Trailing Use).
(See terms and conditions on page 2) (Form 4130-1)
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(See 43 CFR 4100)
1. Grazing permit or lease terms and conditions and the fees charged for grazing use are established in accordance with all the provisions of the
grazing regulations now or hereafter approved by the Secretary of the Interior.
2. They are subject to cancellation, in whole or in part, at any time because of:
a. Noncompliance by the permittee/lessee with rules and regulations.
b. Loss of control by the permittee/lessee of all or a part of the property upon which it is based.
c. A transfer of grazing preference by the permittee/lessee to another party.
d. A decrease in the lands administered by the Bureau of Land Management within the allotment(s) described.
e. Repeated willful unauthorized grazing use.
3. They are subject to the terms and conditions of allotment management plans if such plans have been prepared. Allotment management plans must
be incorporated in permits or leases when completed.
4. Those holding permits or leases must own or control and be responsible for the management of livestock authorized to graze.
5. The BLM may require counting and/or additional or special marking or tagging of the livestock authorized to graze.
6. The permittee’s/lessee’s grazing case le is available for public inspection as required by the Freedom of Information Act.
7. Grazing permits or leases are subject to the nondiscrimination clauses set forth in Executive Order 11246 of September 24, 1964, as amended. A
copy of this order may be obtained from the BLM.
8. Livestock grazing use that is different from that authorized by a permit or lease must be applied for prior to the grazing period and must be led
with and approved by the BLM before grazing use can be made.
9. Billing notices are issued which specify fees due. Billing notices, when paid, become a part of the grazing permit or lease. Grazing use cannot be
authorized during any period of delinquency in the payment of amounts due, including settlement for unauthorized use.
10. The holder of this authorization must notify the authorized ofcer immediately upon the discovery of human remains, funerary objects, sacred
objects, or objects of cultural patrimony (cultural items), stop the activity in the area of the discovery and make a reasonable effort to protect the
remains and/or cultural items.
11. Grazing fee payments are due on the date specied on the billing notice and must be paid in full within 15 days of the due date, except as otherwise
provided in the grazing permit or lease. If payment is not made within that time frame, a late fee (the greater of $25 or 10 percent of the amount
owed but not more than $250) will be assessed.
12. Members of Congress may not enter into a grazing permit or lease. 41 U.S.C. 6306 (2014). Further, no ofcer, agent, or employee of the
Department of the Interior, other than members of Advisory committees appointed in accordance with the Federal Advisory Committee Act (5
U.S.C. App. 1) and Sections 309 of the Federal Land Policy and Management Act of 1976 (42 U.S.C. 1701 et. seq.) shall be admitted to any share
or part in a permit or lease for grazing or derive any benet to arise from a permit or lease for grazing.
The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with information requested by this
AUTHORITY: 43 U.S.C. 315b, 315m, 1181d, 1732, 1752, and 1903, and 43 CFR part 4100.
PRINCIPAL PURPOSE: The BLM will use the information you provide to process your application to graze livestock or request a change in grazing
use on the public lands.
ROUTINE USES: In accordance with the Bureau of Land Management’s (BLM) System of Records Notice published in the Federal Register on
December 29, 2010 [Bureau of Land Management’s Range Management System—Interior, LLM–2; Notice To Amend an Existing System of Records;
Privacy Act of 1974; as Amended], names and addresses provided by the applicant on this form will be publically available in reports on the BLM
public website.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is required to obtain or retain a benet. Failure to submit all of the
requested information or to complete this form may result in delay or the rejection and/or denial of your application.
The Paperwork Reduction Act requires that you be furnished with the following information in connection with the information requested by this
form: BLM collects this information to authorize livestock grazing on public lands. Response to this request is required in order to obtain or retain
a benet. 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 15 minutes 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: U.S. Department of the Interior, Bureau of Land Management (1004-0041), Bureau Information Collection Clearance
Ofcer (WO-630), 1849 C Street, N.W., Room 2134LM, Washington, D.C. 20240.
(Form 4130-1, page 2)