Pesticide-Use-Proposal-Form.pdf

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This Solicitation is Restricted to the Current LMIR Invasive Plant Control BPA Holders.
Solicitation number
12363N25Q4120
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The accompanying metadata indicates this is related to a Department of Agriculture Forest Service solicitation (Number 12363N25Q4120) restricted to current LMIR Invasive Plant Control BPA Holders, but the actual content of the Pesticide-Use-Proposal-Form.pdf is not visible in this upload.

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File Code: 2100 Page of For technical questions and Section 508 accommodation, please contact fseforms@fs.fed.us

FS-2100-0002 (REV.06/2022)

OMB 0596-0241 Exp.05/31/2025 (Reference FSM 2150) Pesticide-Use Proposal Forest Service Logo Forest Service Logo .\form design elements\FS_shield.png File Code: 2100 Page of For technical questions and Section 508 accommodation, please contact fseforms@fs.fed.us

FS-2100-0002 (REV.02/2019)

OMB 0596-0241 Exp. 05/31/2025 Pesticide-Use Proposal Kimberley Denson 11.0.0.20130303.1.892433 12-1-16

ORMS

06/07/2022 To complete this form, see instructions for Form FS-2100-0002, Pesticide-Use Proposal You cannot leave this field blank How would you like to be informed of the decision on your proposal?* For Official Use Only Burden Statement According to the Paperwork Reduction Act of 1995, an 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. The Valid OMB control number for this information collection is 0596-0241. The time required to complete this information collection is estimated to average 2 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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (not all prohibited bases apply to all programs) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc) should contact USDA's TARGET Center at (202) 720-2600 (Voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

8. REVIEWER SIGNATURE(S)

CurrentPage:
PageCount:
agency:
contactInfo:
region:
forestDistrict:
dateSubmitted:
:
objective:
pesticideProducts:
typeOfApplication:
fieldApplicationInformation:
treatmentAreaDescription:
sensitiveAreas:
projectImplementation:
PUC_Signature:
Other_Signature:
Approver_Signature:
For use only when using Wet Signature:
For use only when using Wet Signature:
Approver_date_sig:
Please use this button to attach a file to your form:
EmailSubmitButton1:
SignatureField1:
SignatureField2:

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