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• USDA Forest Service OMB 0596-0217 <br />FS -1500-19 <br />12. G&A "VIEW <br />12. A. The authority and fbi-inat of this modification (14 -LE -1 1061720-01 I -M4) have been reviewed and <br />12. B. DATE <br />approved for signature by: <br />SIGNED <br />A <br />Zz/ <br />2-11 <br />AMY D'.f VERELLEN <br />tJ-S- Forest Service Grants Man2aement, Specialist <br />Burden Statement <br />According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB <br />control number, The val' OMB control number for this information collection is 0596-0217. The time required to complete this information collection is estimated to average 30 minutes per <br />c id I <br />response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. <br />The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital <br />status, familial status, parental status, religion, sexual odentation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public <br />assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, <br />etc.) should contact USDA's TARGET Center at 202-720-2600 (voice and TDD). <br />To file a complaint of discriminatiom write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (86160) 632-9992 (voice), TDD <br />users can contact USDA through local relay or the Federal relay at (800) 877-M9 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer. <br />