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Olvts 0s96-02 17 <br />FS- 1 500.8AUSDA, Forest Service <br />The authority and format of this agreement (19-LE-l1061700-009M2) have been <br />reviewed and approved for signature. <br />SEE SIGNATURE ON MODIFICATION <br />KELLY M. LTNDERWOOD <br />U.S. Forest Service Grants Management Specialist <br />Date <br />Burden Stahment <br />According lo he Papenrvork Reduction Ac-t of 1995, an agency may nol conduct or sponsor, and a person is not rEuirsd to rospond lo a collectjon of information <br />unless it displays a valid OMB onbol number. The valid OMB mntol number for this inlomation mllection is 0596{217. The time required to complete fris <br />information colleclion is estimaled lo average 3 hours per response, including the time lor reviewing insfuctions, searching existing dala sources, gatriring and <br />maintaining he data needed, and complaling and reviewing fre collection of information. <br />The U.S. Deparbnent ofAgriculture (USDA) prohibib discrimination in all it6 programs and ac'tivities on lhe basis olrace, color, national origin, ag€, disability, and <br />where_applicable, sex, marital stafus, hmilial stafus, parental sbhrs, religion, sexual odenhtion, genetic inbrmation, political belieb, reprisal, or because all orpailolan individual's incdne is dsrived from any public assistanc€. (Notall prohibited bases ipply to all programs.) Pensons wifr'disabilities who require <br />altemative means for communicalion of program informa$on (Braille, large prinl audiobpe, etc.) should ontact USDA's TARGET Center at 202-720-2600 (voice <br />and TDD), <br />To file a complaint of discriminatim, write USOA, Director, Office of Civil Righb, 1400 lndependence Avenue, SW, Washington, <br />{866) 632-9992 (voice). TDO usens can @ntact USDA through local relay or he Federal relay at (800) 877-8339 (TDD) or (866) <br />b an equal opportunity provider and employer. <br />DC 20250-9410 or call toll ftee <br />377 4642 (relay voice). USDA <br />Page 8 of8 (Rev. l2-13)