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oMB 059642r7 <br />FS- I 500-8USDA, Forest Service <br />Buden $tahment <br />Accodirg to ho Paperwork Reduction Ad ol 1995, an agoncy may not conducl or sponsor, and a penon is nol required b nspond to a colledkn of inbrmaUon <br />unles it displays e valiJ 0{r,lB onfol number. The valid OMB onfol number br his inhmador oolleclion b 05ffi217. Iho time rquimd lo crxrplolo his <br />inbmatioo ollection b eslimated to averags 3 houm p€r respome, in*ding tn lime lor reviewirg insbuclions, searching existirg data sourcer, gahefing and <br />mainlaining he dab needed, and compbUng and reviewing he collection ol information. <br />ln acordancs wilh Federalcivil righb law and U.S. Depaftnent olAgriculbn (USDA) civil righh rogulalions 8nd policies,lhe US0A, its Agencies, officas, and <br />employees, and irclifuli0ns parlicipating in or adminbleriq USDA pngnams are pDhibilod fom disuiminaling based on nace, color, national orfuin, religion, sex, <br />gender idenlity (including gendor expression). sexual odenblion, dkubility, age, maftal slatus, hmily/parsnlal stafus, hcome derived fiom a public assisbnce <br />pmgnam, political belieb, or mpdsal or reblialion br prior civil righF aciivity, h any program or ac'livi$ conducl€d or funded by USDA (nol all basos spply h str <br />prcgrams). Remedies ard complainl filing deadlines vary by progran or incidenl <br />Penoos wilh disabililies t,lp require altemalive means of omrwunic€f,on for pognam infunmtiofi (0.9., Bnaille, laqe print, audiohpe, American Sign Longuage, <br />etc.) shoub cmtac{ he responsible Agency or USDAs TARGET Center al (202) 72&2600 (roice and TfU or conhcl USOA hruLqh he Fedanl Relay Serulce <br />at (600) 077{339. Addifionally, prognam inbrrntion may be made avaihble in languages oh€r han English. <br />To file a prognam discdminalion complainl, comploh lho U$DA Program Oiwiminaton Conplaint Fom, AD'fl127, found online al Hofl lo Fib a Prcgram <br />Discdminalion Comphint and al sny USOA offce or wdle a lefter addrossed to USDA and pnvide in he lothr all of ho infomation requoshd in he lbrm. To <br />r€gust a copy othe omplaint hrm, cal (866)632-9992.Submityourcompl€ied form orhtterto USDAby:{1) mail: U,S. Depafirenlof Agrhultuie, ffice of tlu <br />Assishnl Seuehry br Civil Righb. 1400 lndependance Avenue, SW, Washington, D.C. 2025&9410; (2) far (2021 6W7442; or (3) email: <br />pr0gmm.intske@urda,gov. USDA is an equalopportunity poviJsq employer, and lender. <br />Page 10 of 19 <br />(Rev.9-15)