Availability of Revised Bureau Forms 3809-1, 3809-2, 3809-4, 3809-4a, 3809-5
In Reply Refer To:
3809 (NV-923c) P
United States Department of the Interior
BUREAU OF LAND MANAGEMENT
Nevada State Office
P.O. Box 12000 (1340 Financial Blvd)
Reno, Nevada 89520-0006
http://www.nv.blm.gov
September 20, 2007
EMS TRANSMISSION 09/20/07
Instruction Memorandum No. NV-2007-056
Expires: 09/30/2008
To: Field Managers, Deputy State Directors, Nevada
From: Ron Wenker State Director, Nevada
Subject: Availability of Revised Bureau Forms 3809-1, 3809-2, 3809-4, 3809-4a, 3809-5
Program Area: Mining Law Administration, Surface Management.
Purpose: This instruction memorandum identifies the availability of five revised Bond and Change of Operator Notification forms for use in accordance with regulations 43 CFR 3809.
Policy/Action: The Bureau of Land Management (BLM) forms listed below, that relate to surface management activities under regulations 43 CFR 3802 and 43 CFR 3809, have received approval from the Office of Management and Budget (OMB). The latest revision date for all the forms listed below is June 2007. Please destroy all other editions of these forms immediately.
Form No. Title OMB No. Expiration Date
3809-1, Surface Management Surety Bond, 1004-0194, April 30, 2010
3809-2, Surface Management Personal Bond, 1004-0194, April 30, 2010
3809-4, Form for Bond Rider Extending Coverage Of Bond to Assume Liabilities for Operations Conducted by Parties Other Than the Principal (Consent of Surety) RIDER, 1004-0194, April 30, 2010
3809-4a, Surface Management Personal Bond Rider, 1004-0194, April 30, 2010
3809-5, Notification of Change of Operator and Assumption of Past Liability, 1004-0194, April 30, 2010
Effective Date: The forms are available from Forms Central-Internal at: http://web.blm.gov/blmforms/ and Forms Central-External at: http://www.blm.gov/blmforms/
as fillable Adobe Acrobat PDFs. The forms are not savable with Adobe Reader 8.0 at this time.
The BLM Nevada will accept the previous version of the forms, issued January 2004 and expired January 31, 2007 only until December 28, 2007. Any bonds submitted on any previous forms after that date will be returned as unacceptable.
Please note that there are spaces for the bond principal to enter a Federal Taxpayer Identification Number (either a Social Security Number [SSN], for an individual principal, or an Employer Identification Number [EIN], for a business principal. The Federal Taxpayer Identification Number is not required by the BLM Nevada to be shown on the bond forms filed for operations conducted in Nevada. While not required on the bond forms, the Federal Taxpayer Identification Number is required operator information as part of an existing or a new notice or plan of operations filed in the BLM Nevada field offices in accordance with 43 CFR 3809.301(a) (1) and 43 CFR 3809.401(a)(1).
Background: In accordance with the Paperwork Reduction Act, the OMB has approved the above listed forms as a new information collection under revisions to the BLM regulations at 43 CFR 43 CFR 3809, which govern locatable mineral exploration and development on the public lands and Federal interests in lands. The above forms are used by the BLM to collect information in managing surface-disturbing activities carried out during exploration or mining under regulations 43 CFR 3809.
Manual/Handbook Sections Affected: None
Coordination: NV-920
Contact: Cynthia Dragon, Land Law Examiner, Branch of Minerals Adjudication (NV-923) at 775-861-8458 or cdragon@nv.blm.gov.
Signed by:
Amy L. Lueders
Acting State Director, Nevada
Authenticated by:
Pam Collins
Staff Assistant
Attachments:
1 - Form 3809-1 Surface Management Surety Bond (2 pp)
2 - Form 3809-2 Surface Management Personal Bond (2 pp)
3 - Form 3809-4 Bond Rider Extending Coverage of Bond to Assume Liabilities for Operations Conducted by Parties Other Than the Principal (1 p)
4 – Form 3809-4a Surface Management Personal Bond Rider (2 pp)
5 – Form 3809-5 Notification of Change of Operator and Assumption of Past Liability (2 pp)