Fillable Tribe hereby apply for an allocation of grazing (Bureau of Indian Affairs)

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Tribe hereby apply for an allocation of grazing (Bureau of Indian Affairs)

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Form 5-5524, Application for Allocation of Grazing Privileges, Page 1 of 2
Permittee Initial ______
Form 5-5524
OMB No. 1076-0157
UNITED STATES
Expires 3/31/2023
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
APPLICATION FOR ALLOCATION OF GRAZING PRIVILEGES
AGENCY _________________________________
TRIBE ____________________________________
I (We) the undersigned enrolled member(s) of the ________________________________ Indian
Tribe hereby apply for an allocation of grazing privileges without competitive bidding, as authorized at 25
CFR 166.218, as described in Table 1 below:
Table 1. Requested grazing area and grazing privileges.
Kind of Stock
Number
of Head
Grazing Season (day/month)*
AUMs**
From
To
Months
/
/
/
/
/
/
/
/
/
/
Total Privileges Requested
---
---
---
* For year-long grazing omit dates and indicate 12 under Months.
** AUMS = number of head times number of months. For sheep, divide result by five (5). For horses, multiply result by 1.25.
I (We) certify that the number of livestock over 6 months of age owned by me (us) and to be
grazed under my (our) exclusive control and supervision are as follows:
Table 2. Livestock currently owned by applicant.
Kind of Livestock
Number
of Head
Brand and
Location
Recorded Owner of Brand
Name of Mortgage Holder
Total Number Owned
---
---
---
If this application requests allocated grazing privileges for more livestock than the applicant owns,
state briefly the plans made to acquire the additional livestock, including financial arrangements for
purchase. ___________________________________________________________________________
____________________________________________________________________________________
If the applicant intends to graze any livestock owned by another person, list the kind, number, and
ownership of such livestock:
Table 3. Livestock not owned by applicant to be grazed under allocation.
Kind of Livestock
Number
of Head
Brand and
Location
Name and Address of Owner
Tribal Member
Yes ___ No ___
Yes ___ No ___
Yes ___ No ___
Total Number of Head
---
---
---
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.
Land Description
Acres
How
Controlled
(Owned,
Leased, …)
Grazing Capacity
Number
of Head
Months
AUMs
TOTALS
---
---
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.
__________________________________
(Applicant)
_____________________________________________
(Address)
_________________
(Date)
__________________________________
(Applicant)
_____________________________________________
(Address)
_________________
(Date)
__________________________________
(Applicant)
_____________________________________________
(Address)
_________________
(Date)
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.
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Tribe hereby apply for an allocation of grazing (Bureau of Indian Affairs)

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Completed 26 September 2021

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