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m USDA Forest Service <br />12. G&A REVIEW <br />12.A. The authority and format of this modification (U-LE-I 1061720-011 M2) have been reviewed and <br />appro d fOT signature by: <br />Burden Statement <br />OMB 0596-0217 <br />FS-1500-19 <br />I2.B. DATE <br />SIGNED <br />According to the PapelWOrk Reduction Ad of 1995, an agency may not condud or sponsor, and a person is not required to respond to a collection of in formation unless it displays a valid OMB <br />cxmtrol number. The valid OMS control number for this information collection is 05S6~217 . The time rllGuired to complete this information collection is estirnated to average 30 minutes per <br />response, including the time for reviewing instructions, searthing existing data sources, gathering and maintaining the data needed, and compteting 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 , !amnial status, parental status , religion , sexual orientation. genetic information, political beliefs, reprisal, or because all or part of an individuars 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 contad USDA's TARGET Center at 202-720-2600 (voice and TOO). <br />To file a complaint of discrimination, write USDA, Oiredor, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250·9410 or call toll free (866) 632-9992 (voice). TOO <br />users can conlad USDA through local relay or the Federal relay at (800) sn ~339 (TOO) or (S66) 377 ~642 (relay voice). USDA is an llGual opportunity provider and employer.