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USDA. forest S.:rvicc <br />GENE DA.l"lA , Sheriff <br />Ki tt itas County Sheriffs Office <br />MJCHAEL R. WILLIAMS, Forest Supervisor <br />U.S. Forest Service, Okanogan-Wenatchee National <br />Forest <br />J BYAS, Special Agent in Charge <br />Region 6 Pacific Northwest <br />Date <br />Date <br />Date <br />The authority and format of this agreement ( 19-LE-l l 061700-009) have been <br />reviewed and approved for signature. <br />Ai\1Y ri. VERELLEN Date <br />U.S. Forest Service Grants Management Specialist <br />Burden Sta leC11€11t <br />01'IB 0596-0J I 7 <br />FS-1 ·oo . <br />A=rc!ing to the Paperwoik Reduellon Act of 1995, an agency may not conduct or sponsor. and a person is not required ta respond :a a a:lledicn of infollllation <br />unless it displays a va lid OMS CXlnlrol mimber. The val.~ 0MB control number for this inrormaoon collection is 0596-0217. The time required Ill ccmp!ete this <br />information collection is estimated to average J hcurs per response , indud ing the time fer review ing instructions, searching existing data soo=. gathering and <br />maintaining ihe data neeced . aml completing ar.d reviewir,g the co ltedion of information. <br />In a=roance with Federal civi rights law and U.S. Department of Agriculture (USDA) C'lil rights regula tions and po licies. the USDA, its Agencies, offices. and <br />emp loyees. and institutions pal1bpaling in or admilisle!ir.g USDA programs are proh ibited from discriminating based on race, colar, national origin. re&;;ion, sex, <br />gender identity (induding gender expression). sexual orientation, disability, age, marital status, family/parental status , incooie derived from a public assistance <br />program, po litical beliefs. or reprisal or retaliation for prier civil rights activity , in any program or activity conducted or funded by USDA (not all bases apply to an <br />programs). Remedies and corr.plaint filing deadlines vary by program or incidenl <br />?erscns with disabilities who require alternative rreans of communication for program information (e.g., Bra illa, large print au<f10tape , American S:gn Language, <br />etc.) should contact the responsille Agency or USOA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through Ille Federal Relay Service <br />at (800) 877-3339. Additionally, program ilfollTli!tioo may be made available in languages other than English . <br />Ta fi le a program discrimination complaint ccmplere 11'.e USDA Program Discrimina tion Compla int Form . AD.J027, !oornl oofir.e at Ho-• lD File a ?rcgram <br />Discrimination Complaint and at any USDA office or write a letter ac'dressed ta USDA and provide in the letter an of the infonnation reques4.ed in 1he fonn. To <br />request a copy of the complaint :Crm. call (866) 632-9992. Submit your completed form or letter to USDA by : (1) mail : U.S. Department of Agricuul!. Office o/ the <br />Assistant Secretary for Civil RiJhls. 1400 Independence Avenue. SW, Washington , D.C. 20250-9410; (2) f2x: (202) 690-7442: or (3) email: <br />program .in take@usda.gov . USDA is an equal opportunity provider, employer, and lender. <br />Page9of9 (Rev. 9-15)