Form 5460-17 - Substitution Determination Page 3

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NOTICES
The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with the information
requested by this form.
AUTHORITY: 43 CFR part 5420 permits collection of the information requested by this form.
PRINCIPAL PURPOSE: The BLM will use the information to determine whether Federal timber has been substituted for exported
unprocessed private timber.
ROUTINE USES: The BLM will only disclose this information in accordance with the Freedom of Information Act, the Privacy Act,
and the provisions at 43 CFR 2.56(b) and (c).
EFFECT OF NOT PROVIDING INFORMATION: Submission of the 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 in delay or preclude the BLM’s acceptance of your
application.
The Paperwork Reduction Act requires us to inform you that:
The BLM collects this information to determine whether Federal timber has been substituted for exported unprocessed private timber.
Submission of the requested information is necessary to obtain or retain a benefit. You do not have to respond to this or any other Federal
agency-sponsored information collection unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: The public reporting burden for this form is estimated to average 1 hour per response, including
the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments
regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-
0058), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.
(Form 5460-17, page 3)

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