Form 1120-19 - Bureau Of Land Management Resource Advisory Council Application (Page 5 of 5) in pdf

NOTE: Although applications are submitted to the BLM office within the RAC's area of

jurisdiction, appointments are ultimately conferred by the Secretary of the Interior. Applications will

be reviewed and nomination packages will be completed at the local level. Governors of affected

States will be consulted during this process. Recommendations will be endorsed by the appropriate

BLM State Director and forwarded to the BLM Washington Office. Following the BLM Director's

endorsement, recommendations will be forwarded to the Department of the Interior for background

checks, ethics, and other reviews before presentation to the Secretary. The time between submission

of application and receipt of member appointment letter may take 4-5 months.

The Privacy Act and the regulation at 43 CFR 2.48 (d) require that you be furnished the following

information in connection with information required by this form.

AUTHORITY: The authority to request this information is contained in 5 U.S.C. App. 2, the

Federal Advisory Committee Act; 5 U.S.C. 1739, the Federal Land Policy and Management Act;

and 43 CFR Subpart 1784, Bureau of Land Management advisory committee regulations.

PURPOSE: The information will be used by the appointment officer to determine the qualifications

such as education, training, and experience of candidates related to qualifications to serve on a

Resource Advisory Council of the Bureau of Land Management.

ROUTINE USES: This information will be maintained in the Interior Volunteer Service File

System (Interior/DOI-05) and is subject to routine uses of that system of records. These routine

uses can be found at 66 FR 28536.

DISCLOSURES: Failure to submit this information will inhibit full consideration of a prospective

advisory council member's qualifications, and could result in non-selection. If you are appointed as

an advisor, the information will be retained by the appointing official as long as you serve.

Otherwise, it will be destroyed 2 years after termination of your membership or returned (if

requested) following announcement of the Council appointments.

THE PAPERWORK REDUCTION ACT requires us to inform you that:

This collection is in accordance with the clearance requirements of 5 U.S.C. 3507. Completion of

this form is required to obtain or retain a benefit. You do not have to respond to this or any other

Federal agency-sponsored information collection and no Federal agency may conduct or sponsor

such a collection, unless it displays a valid OMB control number. The information is used to

determine qualifications, suitability, and availability for service on resource advisory councils.

Failure to submit this information will inhibit full consideration of a prospective advisory council

member's qualifications, and could result in non-selection.

BURDEN HOURS STATEMENT: The estimated public reporting burden for this form is 4 hours

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-XXXX), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W.,

Room 2134LM, Washington, D.C. 20240.

Form 1120-19 - Bureau Of Land Management Resource Advisory Council Application Page 5