Form 5-5524, Application for Allocation of Grazing Privileges, Page 2 of 2
Permittee Initial ______
List here any land owned or controlled by you that is available for grazing your livestock. Indicate
how many animals this land will support and for how long (Attach additional sheet if needed).
Table 4. Non-allocated lands controlled by applicant.
Do you now allow or intend to allow anyone else to graze or pasture their livestock on any of the
lands listed in Table 4 rather than graze your own livestock on these lands?
Yes ____ No ____ If yes, state how many livestock: ______________.
I (We) agree to abide by the regulations at 25 CFR Part 166, and all Tribal grazing regulations
and, if a grazing permit is issued, to comply fully with its terms.
Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act. It is used to establish the respective
rights and responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or
retain a benefit. In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the
Office of Management and Budget and assigned a number and an expiration date. The number and expiration date are at the top
right corner of the form. An agency may not sponsor or conduct, and a person is not required to respond to, a request for
information collection unless it displays a currently valid OMB Control Number. The public reporting burden is estimated to average
20 minutes per respondent. This includes the time needed to understand the requirements, gather the information, complete the
form, and submit it to the Department. Comments regarding the burden or other aspects of the form may be directed to the Indian
Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141,
Washington, DC 20240.