Fillable Sf 299 2006 (National Telecommunications and Information Administration)

Fill Online, Printable, Fillable, Blank Sf 299 2006 (National Telecommunications and Information Administration) Form

Use Fill to complete blank online NATIONAL TELECOMMUNICATIONS AND INFORMATION ADMINISTRATION (DC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Sf 299 2006 (National Telecommunications and Information Administration)

On average this form takes 19 minutes to complete

The Sf 299 2006 (National Telecommunications and Information Administration) form is 4 pages long and contains:

  • 1 signature
  • 0 check-boxes
  • 73 other fields

Country of origin: US
File type: PDF

U.S.A. forms for National Telecommunications and Information Administration

BROWSE NATIONAL TELECOMMUNICATIONS AND INFORMATION ADMINISTRATION (DC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
STANDARD FORM 299 (1/2006)
Prescribed by DOI/USDA/DOT
P.L. 96487 and Federal
Register Notice 5-22-95
APPLICATION FOR TRANSPORTATION AND
UTILITY SYSTEMS AND FACILITIES
ON FEDERAL LANDS
6.
If an individual,
or
partnership are you
a citizen(s)
of the United States?
7.
Project description
[describe in detail):
(a)
Type
of
system or facility, (e.g.,
canal, pipeline, road); (b)
related structures and facilities; (c) physical specifications
(length, width, grading, etc.); (d)
(d) term of years needed; (e) time of year
of
use or operation; (f) Volume or amount of product to be transported; (g) duration and
Yes No
timing of construction; and (h) temporary work areas needed for construction
(Attach additional sheets, if additional space is needed,)
NOTE:
Before completing and filing the application, the applicant should completely review this package and schedule a
preapplication meeting with representatives
of
the agency responsible for processing the application. Each agency
may have specific and unique requirements to be met in preparing and processing the application. Many times, with
the help of the agency representative, the application can
be
completed at the preapplication meeting.
Name and address of applicant
(include zip code)
4.
As applicant are you?
(check one)
a.
Individual
b.
Corporation*
c.
d. State Government/State Agency
e. Local Government
f. Federal Agency
*
If
checked, complete supplemental page
2.
Name, title, and address of authorized agent
if
different
from Item
1
(include zip code)
FORM APPROVED
OMB NO.
1004
-
0189
Expires: November 30, 2008
FOR AGENCY USE ONLY
Application Number
Date filed
3.
TELEPHONE
(area code)
Applicant
Authorized Agent
5.
Specify what application is for:
(check one)
a. New authorization
b. Renewing existing authorization No.
c. Amend existing authorization
No.
d. Assign existing authorization No.
e. Existing use for which
no
authorization has been received*
f.
Other*
*
provide details under Item
7
8.
Attach
a
map covering area and show location of project proposal
9.
State or local government approval: Attached Applied for Not required
Nonreturnable application fee. Attached Not required
Does project cross international boundary or affect international waterways? Yes
Give statement of your technical and financial capability to construct, operate, maintain, and terminate system for which authorization is being requested.
No (If "yes," indicate on map)
(Continued on page 2)
This form is authorized for local reproduction.
1.
Partnership/Association*
If checked
10.
12.
11.
Describe other reasonable alternative routes and modes considered.
Signature of Applicant
b. Why were these alternatives not selected?
Date
c. Give explanation
as
to why it is necessary to cross Federal Lands
14. List authorizations and pending applications filed for similar projects which may provide information to the authorizing agency. (Specify
number,
date,
code,
or name)
15.
Provide statement of need for project, including the economic feasibility and items such
as:
(a)
cost
of
proposal
(construction, operation, and maintenance);
(b)
estimated cost of next best alternative; and (c) expected public benefits.
Describe probable effects on the population in the area, including the social and economic aspects, and the rural lifestyles.
17.
Describe likely environmental effects that the proposed project will have
on:
(a) air quality; (b) visual impact; (c) surface and ground water quality and quantity; (d)
the control
or
structural change on any stream
or
other body of water;
(e)
existing noise levels; and (f) the surface of the land, including vegetation, permafrost, soil,
and soil stability.
18.
Describe the probable effects that the proposed project will have on
(a)
populations of fish, plantlife, wildlife, and marine life, including threatened and endangered
species; and (b) marine mammals, including hunting, capturing, collecting,
or
killing these animals.
19. State whether any hazardous material,
as
defined in this paragraph, will
be
used, produced, transported
or
stored
on
or
within the right
-
of
-
way
or
any
of
the right
-
of
-
way
facilities,
or
used in the construction, operation, maintenance
or
termination of the right
-
of
-
way
or
any of its facilities.
"
Hazardous material
"
means any substance,
pollutant or contaminant that
is
listed
as
hazardous under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended, 42 U.S.C.
9601 et seq., and its regulations. The definition
of
hazardous substances under CERCLA includes any
"
hazardous waste
"
as defined in the Resource Conservation and
Recovery Act of 1976 (RCRA),
as
amended, 42 U.S.C. 9601 et seq., and its regulations. The term hazardous materials also includes any nuclear or byproduct material
as defined by the Atomic Energy Act of 1954,
as
amended, 42 U.S.C. 2011 et seq. The term does
not
include petroleum, including crude oil
or
any fraction thereof that
is not otherwise specifically listed
or
designated
as
a
hazardous substance under CERCLA Section 101(14), 42 U.S.C. 9601(14),
nor
does the term include natural gas.
20. Name all the Department(s)/Agency(ies)
where this application is being filed.
Title 18, U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any department
or
agency of the United
States any false, fictitious,
or
fraudulent statements
or
representations
as
to any matter within its jurisdiction.
(Continued on page 3)
(SF
-
299,
page
2)
13a.
16.
I HEREBY CERTIFY, That I am of legal age and authorized to do business in the State and that I have personally examined the information contained in the application and
believe that the information submitted is correct to the best of my knowledge.
click to sign
signature
click to edit
APPLICATION FOR TRANSPORTATION AND UTILITY SYSTEMS
AND FACILITIES ON FEDERAL LANDS
GENERAL INFORMATION
ALASKA NATIONAL INTEREST LANDS
This application will be used when applying for a right
-
of
-
way, permit,
license, lease,
or
certificate for the use of Federal lands which lie within
conservation system units and National Recreation
or
Conservation Areas
as defined in the Alaska National Interest Lands Conservation Act.
Conservation system units include the
National
Park
System,
National
Wildlife Refuge System, National Wild and Scenic Rivers System,
National Forest Monuments.
Transportation and utility systems and facility uses for which the
application may
be
used are:
1.
Canals, ditches, flumes, laterals, pipes, pipelines, tunnels, and
other
systems for the transportation of water.
2. Pipelines and other systems for the transportation of liquids other than
water, including oil, natural gas, synthetic liquid and gaseous fuels,
and any refined product produced therefrom.
3.
Pipelines,
slurry
and emulsion systems, and conveyor belts for
transportation of solid materials.
4. Systems
for
the transmission and distribution of electric energy.
5. Systems for transmission
or
reception of radio, television, telephone,
telegraph, and other electronic signals, and other means of
communications.
6. Improved rights
-
of
-
way
for
snow machines, air cushion vehicles, and
all
-
terrain vehicles.
7. Roads, highways, railroads, tunnels, tramways,
airports,
landing
strips, docks, and other systems of general transportation.
National Trails System, National Wilderness Preservation System, and
This application
must
be filed simultaneously with each Federal
department or agency requiring authorization to establish and operate
your proposal.
In Alaska, the following agencies will help the applicant file an
application and identify the other agencies the applicant should contact
and possibly file with:
Department of Agriculture
Regional Forester, Forest Service (USFS)
Federal Office Building, P.O. Box 21628
Juneau, Alaska 99802-1628
Telephone: (907) 586
-
7847
(or
a local
Forest
Service Office)
Department of the Interior
Bureau
of
Indian Affairs (BIA)
Juneau Area Office
9109 Mendenhall Mall Road, Suite 5, Federal Building Annex
Juneau, Alaska 99802
Telephone: (907) 586
-
7177
Bureau
of
Land
Management (BLM)
222 West 7th Ave., Box
13
Anchorage, Alaska 99513
-
7599
Telephone: (907) 271
-
5477
(or
a local
BLM
Office)
National
Park
Service (NPS)
Alaska Regional Office, 2525 Gambell St., Rm.
107
Anchorage, Alaska 99503
-
2892
Telephone: (907) 257
-
2585
U.S.
Fish &Wildlife Service (FWS)
Office of the Regional Director
101 1 East Tudor Road
Anchorage, Alaska 99503
Telephone: (907) 786
-
3440
Note
-
Filings with any Interior agency may be filed with any office noted
above
or
with the: Office of the Secretary of the Interior, Regional
Environmental Officer, Box 120, 1675 C Street, Anchorage, Alaska
99513.
(For supplemental, see page 4)
Department of Transportation
Federal Aviation Administration
Alaska Region
AAL
-
4,222
West 7th Ave., Box 14
Anchorage, Alaska 99513
-
7587
Telephone: (907) 271
-
5285
-
The Department of Transportation has established the above
central filing point for agencies
within
that Department. Affected
agencies are: Federal Aviation Administration (FAA), Coast Guard
(USCG), Federal Highway Administration (FHWA), Federal Railroad
Administration (FRA).
OTHER THAN ALASKA NATIONAL INTEREST LANDS
Use
of
this form is not limited to National Interest Conservation Lands
of
Alaska.
Individual departments/agencies may authorize the use of this form by
applicants for transportation and utility systems and facilities on other
Federal lands outside those areas described above.
For proposals located outside of Alaska, applications will be filed at the
local agency office
or
at a location specified by the responsible Federal
agency.
SPECIFIC INSTRUCTIONS
not
listed
are
self
-
explanatory)
Item
7 Attach preliminary site and facility construction plans. The
responsible agency will provide instructions whenever specific
plans are required.
Generally, the map
must
show the section(s), township(s), and
within
which the project
is
to be located. Show the
proposed location
of
the project
on
the map as accurately
as
possible. Some agencies require detailed survey maps. The
responsible agency will provide additional instructions.
9,
10,
and 12
-
The responsible agency will provide additional
instructions.
13
Providing information on alternate routes and modes in as much
detail as possible, discussing why certain routes
or
modes were
rejected and why it is necessary to cross Federal lands will assist
the agency(ies) in processing your application and reaching a
final decision. Include only reasonable alternate routes and
modes as related to current technology and economics.
14 The responsible agency will provide instructions.
15 Generally, a simple statement of the purpose of the proposal will
be sufficient. However, major proposals located in critical
or
sensitive areas may require a full analysis with additional specific
information.
The
responsible
agency
will provide additional
instructions.
16 through 19
-
Providing this information in as much detail as
possible will assist the Federal agency(ies) in processing the
application and reaching a decision. When completing these
items,
you should use
a
sound judgment in
furnishing
relevant
information. For example, if the project is not near
a
stream or
other body of water,
do not
address this subject. The responsible
agency will provide additional instructions.
Application
must
be
signed by the applicant
or
applicant's
authorized representative.
8
If
additional space
is
needed
to
complete any item, please put
the
information
on
a separate sheet of paper and identify it as
"Continuation of Item ".
(SF
-
299,
page
3)
NOTE
(Items
ranges
SUPPLEMENTAL
CHECK APPROPRIATE
NOTE:
The responsible agency(ies) will provide additional instructions
a.
Articles of Incorporation
b. Corporation Bylaws
-
PRIVATE CORPORATIONS
ATTACHED
FILED*
c. A certification from the State showing the corporation is in good standing and is entitled to operate within the State.
d. Copy of resolution authorizing filing
e. The name and address of each shareholder owning
3
percent
or
more of the shares, together with the number and percentage
of
any
class of voting shares of the entity which such shareholder is authorized to vote and the name and address of each affiliate of the entity
together with, in the case of
an
affiliate controlled by the entity, the number of shares and the percentage of any class of voting stock
of
that affiliate owned, directly
or
indirectly, by that entity, and in the case
of
an affiliate which controls that entity, the number of shares
and the percentage of any class of voting stock of that entity owned, directly
or
indirectly, by the affiliate.
f. If application is for an oil or gas pipeline, describe any related right-of-way or temporary use permit applications, and identify
previous applications
b. Proof of organization
d. If
application is for an oil
or
gas pipeline, provide information required by Item "I-f" and "I-g" above.
c. Copy of Bylaws
d. Copy
of
resolution authorizing filing
e.
If application is for an oil
or
gas pipeline, provide information required by Item "I-f" and "I-g" above.
a.
Articles of association,
if
any
b.
If
one partner is authorized to sign, resolution authorizing action is
c.
Name and address of each participant, partner, association,
or
other
(Continued on page 5)
(SF-299, page 4)
g. If application is for an oil and gas pipeline, identify all Federal lands by agency impacted by proposal.
1
II - PUBLIC CORPORATIONS
a. Copy of law forming corporation
III - PARTNERSHIP OR OTHER UNINCORPORATED ENTITY
* If the required information is already filed with the agency processing this application and is current, check block entitled "Filed." Provide the file identification
information (e.g., number, date, code, name). If not on file or current, attach the requested information.
I
BLOCK
NOTICES
NOTE: This applies to the Department of the Interior/Bureau of Land Management (BLM).
The Privacy Act of 1974 provides that you be furnished with the following information in connection with the
information provided by this application for an authorization.
AUTHORITY: 16 U.S.C. 310 and 5 U.S.C. 301.
PRINCIPAL PURPOSE: The primary uses of the records are to facilitate the (1) processing of claims or
applications; (2) recordation of adjudicative actions; and (3) indexing of documentation in case files supporting
administrative actions.
ROUTINE USES: BLM and the Department of the Interior (DOI) may disclose your information on this form: (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 members or the public who have a need for the information that is
maintained by BLM for public record; (3) to the U.S. Department of Justice, court, or other adjudicative body when
DOI determines the information is necessary and relevant to litigation; (4) to appropriate Federal, State, local, or
foreign agencies responsible for investigating, prosecuting violation, enforcing, or implementing this statute,
regulation, or order; and (5) to a congressional office when you request the assistance of the Member of Congress in
writing.
EFFECT OF NOT PROVIDING THE INFORMATION: Disclosing this information is necessary to receive or
maintain a benefit. Not disclosing it may result in rejecting the application.
The Paperwork Reduction Act of 1995 requires us to inform you that:
The Federal agencies collect this information from applicants requesting right-of-way, permit, license, lease, or
certifications for the use of Federal Lands.
Federal agencies use this information to evaluate your proposal.
No Federal agency may request or sponsor and you are not required to respond to a request for information which
does not contain a currently valid OMB Control Number.
BURDEN HOURS STATEMENT: The public burden for this form is estimated at 25 hours 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 (1004-0189), Bureau Information Collection Clearance Officer (WO-630) 1849 C Street,
N.W., Mail Stop 401 LS, Washington, D.C. 20240.
A reproducible copy of this form may be obtained from the Bureau of Land Management, Land and Realty Group,
1620 L Street, N.W., Rm. 1000 LS, Washington, D.C. 20036.
__________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
(SF – 299, page 5)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Sf 299 2006 (National Telecommunications and Information Administration)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document