Form 4710-10 - Application For Adoption Of Wild Horse(S) Or Burro(S) - 2014 Page 4
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4NOTICES
The Privacy Act and the regulation at 43 CFR 2.48 (d) require that you be
(5) Provide necessary program management information to other agencies
involved in management of wild horses and burros on public lands, i.e.,
furnished the following information in connection with information required
the U.S. Forest Service (FS) and the Animal and Plant Health Inspection
by this application.
Service (APHIS);
AUTHORITY: 16 U.S.C. 1333 and 31 U.S.C. 7701.
(6) Identify and assign level of system access required by BLM, FS and
APHIS wild horse and burros program personnel; and
PRINCIPAL PURPOSE: The BLM will use this information to process
(7) Authorize the disclosure of records to individuals involved in responding
your agreement for private maintenance and care of wild horses or burros.
to a breach of Federal data.
BLM will use your driver’s license and social security numbers for debt
collection purposes under the authority of the Debt Collection Improvement
EFFECT OF NOT PROVIDING INFORMATION: Submission of the
Act, 31 U.S.C. 7701.
requested information is necessary to obtain or retain a benefit. Failure to
submit all of the requested information or to complete this form may result
ROUTINE USES: The primary uses of the information are to:
in the rejection and/or denial of your application.
The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) requires us
(1) Identify individuals who have applied to obtain custody of a wild horse
to inform you that:
or burro through adoption or sale;
(2) Document the rejection, suspension or granting of the request for
The BLM collects this information in accordance with the statutes and
adoption or sale;
regulations listed above, and for the purposes listed above.
(3) Monitor compliance with laws / regulations concerning maintenance of
Submission of the requested information is necessary to obtain or retain a
adopted animals;
benefit. You do not have to respond to this or any other Federal agency-
(4) Identify contractors / employees / volunteers/ service providers required
sponsored information collection unless it displays a currently valid OMB
to perform program functions;
control number.
BURDEN HOURS STATEMENT
Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and
maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U.S.
Department of the Interior, Bureau of Land Management (1004-0042), Bureau Information Collection Clearance Officer, (WO-630), 1849 C
Street, N.W., Washington, D.C. 20240.
(Form 4710-10, page 4)
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