Application For The America The Beautiful - The National Parks And Federal Recreational Lands Access Pass Page 3
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3NPS Form 10-596 (Rev. 08/2017)
OMB Control No. 1024-0252
Expiration Date 9/2020
National Park Service
NOTICES
PRIVACY ACT STATEMENT
General: The Federal Lands Recreation Enhancement Act of 2004 (REA), 16 U.S.C. 6804 et seq.
Authority: The information collected is required to establish eligibility; process financial transactions to complete Pass purchase
requests; fulfill Passes to individuals (‘‘fulfill’’ and ‘‘fulfillment’’ refer to shipping and handling of Passes), federal recreation sites, and
third parties; and provide associated customer services such as sending renewal notices and providing information about the Pass
program and federal lands. Informational or promotional messages will be sent to individuals and organizations only if they have
affirmatively requested such messages through an ‘‘opt-in’’ mechanism.
Purposes and Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or
information contained in this system may be disclosed outside the National Park Service as a routine use pursuant to 5 U.S.C.
552a(b)(3) to other Federal, state, tribal, territorial, foreign or local government, educational, and other organizations, entities or
individuals for the purpose of verifying eligibility to receive a Pass, prevent duplication, fraud and abuse, or as otherwise required by law
when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records
notice “America the Beautiful—The National Parks and Federal Recreational Lands Pass System, DOI–06”
Effects of Nondisclosure: Voluntary, however, failure to provide the requested information may impede individual from obtaining a
Pass from the National Park Service.
PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to collected to determine adequate proof of
disability and residency. The obligation to respond is required to obtain the Interagency Access Pass. You are not required to respond
to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number. OMB has
approved this collection of information and assigned Control No. 1024-0252.
ESTIMATED BURDEN STATEMENT
The public burden for the collection of information is estimated to be 10 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing the form. Direct comments regarding this burden estimate, or any aspects
of this form, to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Mail Stop 242, Reston,
VA 20192. Please do not send your form to this address.
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