Form 5-5522 Modification of Grazing Permit

Form 5-5522	UNITED STATES	OMB No. 1076-0157
	DEPARTMENT OF THE INTERIOR	Expires: _________
	BUREAU OF INDIAN AFFAIRS	Modification No. __

MODIFICATION OF GRAZING PERMIT (5‑5515)

Range Unit No.___________________________ _____________________________________Agency

Contract No. _____________________________ _____________________________________Reservation

Permittee________________________________ Date of permit ___________________________________

BY AUTHORITY OF LAW and under the regulations (25 CFR 166), the above cited grazing permit, as previously modified by Modification Number(s)_______________________, is hereby modified to include or exclude the lands on which rental is paid, or those under the on‑and-off provision in 25 CFR 166.308, described in detail on the attached schedule which is made a part hereof, or to increase or decrease the number of livestock allowed, or to change the season of use, or to adjust the grazing rental (25 CFR 166.408).

Purpose of Modification:_______________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________

Area of tribal land From ____________ to _________________ acres

Area of allotted land (fees paid) From ____________ to _________________ acres

Area of allottee use From ____________ to _________________ acres

Area of Government‑owned land From ____________ to _________________ acres

TOTAL From ____________ to _________________ acres

Area of owned land From ____________ to _________________ acres

Area of leased land From ____________ to _________________ acres

TOTAL ON-AND-OFF From ____________ to _________________ acres

SEASON OF USE: From ____________ to _________________

Kind of Livestock (Cattle, Horses, Sheep, etc.) From ____________ to _________________ Number of Stock under permit (Exclusive of allottee use and On-and-Off) From ____________ to _________________ head

Number of stock under allottee use From ____________ to _________________ head

Number of stock under On‑and-Off From ____________ to _________________ head

TOTAL NUMBER OF STOCK From ____________ to _________________ head

Annual grazing rental From $___________ to $ _______________.

Cash bond From $___________ to $ _______________.

Administrative fee From $___________ to $ _______________.

THIS MODIFICATION becomes effective ________________________, and does not change any of the terms, conditions, or stipulations of the permit, except as specifically set forth herein.

__________________________________________ _______________

(Permittee) (date)

APPROVED: __________________________________________ _______________

(Superintendent) (date)

Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act.  It is used to establish the respective rights and responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or retain a benefit.  In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management and Budget and assigned a number and an expiration date.  The number and expiration date are at the top right corner of the form.  An agency may not sponsor or conduct, and a person is not required to respond to, a request for information collection unless it displays a currently valid OMB Control Number.  The public reporting burden is estimated to average 20 minutes per respondent.  This includes the time needed to understand the requirements, gather the information, complete the form, and submit it to the Department.  Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240.