Form DI Form 1926 DI Form 1926 Application for Permit for Acheological Investigations

Form DI-1926 (Rev. 06/2017) OMB Control No. 1024-0037

Department of the Interior Expiration Date ##/##/####

APPLICATION FOR PERMIT FOR ARCHEOLOGICAL INVESTIGATIONS

Under the Authority of

The Archaeological Resources Protection Act of 1979

(16 U.S.C. 470aa-mm; 43 CFR 7);

FOR OFFICIAL USE ONLY

Date Received: _____________

Sent for Review: ____________

Control No. _________________

and/or The Antiquities Act of 1906

(P.L. 59-209; 34 Stat. 225; 54 U.S.C. 320301-320303; 43 CFR 3)

and/or the appropriate Bureau-specific statute Such as

The Reclamation Act; The National Park Service Organic Act;

The National Wildlife Refuge System Administration Act;

The Federal Land Policy and Management Act

Instructions: Complete and return two copies of this application form and required attachments to the appropriate State or Regional Office of the land managing bureau involved. All information requested must be completed before the application will be considered. Use separate pages if more space is needed to complete a section.
1. Name of applicant (institution, corporation, partnership, individual, or other entity)
     
2. Mailing address
     
3. Telephone Number		3A. Alternate Telephone Number
     	Home Work Cell	     	Home Work Cell
4. Email address(es)
     
5. Nature of archeological work proposed
Survey and Recordation Limited Testing and/or Collection (project-specific) Excavation and/or Removal (project-specific)
6. Location of proposed work (attach additional sheets)
a. Description of Federal lands involved. Indicate State, county, and Federal administrative unit. Specify the best available location data, e.g., GPS coordinates, UTM coordinates, township, range and section (cadastral) subdivisions, or metes and bounds. Include a readable copy of a map or plan at an appropriate scale showing specific areas for which permit is desired.
b. Identification of archeological resource(s) or other cultural resource(s) involved (if applicable).
7. Time of Proposed Work
Overall Duration of Project:		Estimated Duration of Fieldwork:
From      	To      	From      	To      
8. Principal Investigator Name of individual(s) responsible for planning and generally overseeing field projects, including overall supervision of staff and overall responsibility for the professional quality of resource evaluations and recommendations.		Telephone Number
		     		Work Cell
		Email address(es)
		     
9. Field Director Name of individual(s) responsible for carrying out field projects, for technical quality of fieldwork through direct on-the-ground supervision of all aspects of fieldwork and data gathering, for proposing resource evaluations and recommendations for further treatment, and for preparing field records and descriptive reports.		Telephone Number
		     		Work Cell
		Email address(es)
		     
10. Permit Administrator Name of individual responsible for fulfilling the terms and conditions of the permit (must be legally empowered to obligate applicant organization).		Telephone Number
		     		Work Cell
		Email address(es)
		     

11. Applicant must include the following attached to the application form. Description of the purpose, nature, and extent of the work proposed, including how and why it is proposed to be conducted: (include research design, methods, curation); Summary of organizational capabilities, including information on location(s) and description of facilities and equipment, on organizational structure and staffing, and on facilities, equipment and staff to be involved in the proposed work; Summary of organizational history in completing work of the kind proposed, including similar past projects, government contracts, and Federal permits (previously held, currently in force with effective dates, and currently pending or planned, by agency and region/state), reports and/or publications resulting from similar work, and any other pertinent organizational experience; For each individual named in 8 and 9 above, a curriculum vitae or similar resume or summary of education, training, and experience in the kind of work proposed and in the role proposed; Written certification, signed by a properly authorized official of the proposed curatorial facility, attesting to the facility’s capability and willingness to accept any collections, as applicable, and records, data, photographs, and other documents generated during the proposed term of the permit, and to assume permanent curatorial responsibility for such materials on behalf of the United States Government pursuant to 36 CFR 79. In the case of an application on Indian lands where the Indian Tribe or Indian owner(s) do not wish to take custody, written consent to undertake curation is required from the Indian Tribe or the Indian owner(s) pursuant to 25 CFR 262.8. Custody of any Native American human remains or cultural items subject to the Native American Graves Protection and Repatriation Act (NAGPRA), 25 USC 3001-3013, removed from public lands or Indian lands shall be determined in accordance with NAGPRA and its implementing regulations, 43 CFR 10.
12. Proposed outlet(s) for public written dissemination of the results
13. Signature of individual named in 10	14. Date signed

NOTICES

PRIVACY ACT STATEMENT

Authority: 16 U.S.C. 470aa-mm; 43 CFR 7, The Archaeological Resources Protection Act of 1979; P.L. 59-209; 34 Stat. 225; 54 U.S.C. 320301-320303; 43 CFR 3, The Antiquities Act of 1906; 16 U.S.C. 1, National Park Service Organic Act

Purpose: The primary use of the records maintained in the system is to 1.) administer scientific archeological research within areas administered by Federal land managers and assess individuals’ capabilities and organizational capacities to carry out the research and 2.) maintain a record of the research performed through the interim and final reports, and arrangements made to care for collections through the curation agreement.

Routine 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 DOI or other Federal agencies as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other federal, state, local, tribal or foreign governments and organizations, and members of the general public based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.

Disclosure: Voluntary, however, failure to provide the requested information may impede the institution, corporation, partnership, individual, or other entity from obtaining a permit for archeological investigations.

PAPERWORK REDUCTION ACT STATEMENT

This information is being collected pursuant to 16 U.S.C. 470cc and 470mm, to provide the necessary facts to enable the Federal land manager (1) to evaluate the applicant’s professional qualifications and organizational capability to conduct the proposed archeological work; (2) to determine whether the proposed work would be in the public interest; (3) to verify the adequacy of arrangements for permanent curatorial preservation, as United States property, of specimens and records resulting from the proposed work; (4) to ensure that the proposed activities would not be inconsistent with any management plan applicable to the public lands involved; to reports to Congress on Federal Archeology Programs; and (6) to allow Federal agencies to evaluate Federal archeological protection programs and assess compliance with the Archaeological Resources Protection Act of 1979 (16 U.S.C. 470). Submission of the information is required before the applicant may enjoy the benefit of using publicly owned archeological resources. To conduct such activities without a permit is punishable by felony-level criminal penalties, civil penalties, and forfeiture of property. A federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. OMB has approved this collection of information and assigned Control No. 1024-0037

ESTIMATED BURDEN STATEMENT

Public reporting for this collection of information is estimated to average 2.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Dr. (MS-242), Reston, VA 20192. Do not send your completed form to this address.