CO-CPA-300

FOTG, Section I Technical Guide Notices

NRCS, CO May 2017

FREEDOM OF INFORMATION ACT AND PRIVACY ACT OF 1974 Voluntary Authorization for Release of Information

The Privacy Act of 1974 and Section 1619 of the USDA Farm Bill provides for the protection of the integrity, security, and confidentiality of conservation plans and client files. NRCS must have your written permission to share your protected information.

Authorization for Release of Information to Consult with Federal, State, Tribal or local Agencies. I authorize the NRCS to provide the required agencies with the appropriate information from my case file, when consultation with other Federal agencies is necessary or required.

Purpose. When a USDA participant receives Federal funding or final designs/specifications, it is NRCS's legal responsibility to ensure that the project meets the obligations of environmental and historic preservation laws (i.e., Endangered Species Act, National Historic Preservation Act). In some cases this may require that NRCS consult with other agencies to ensure the planned actions comply with the law. Consultation requires that NRCS be able to release your information related to the action which may affect a protected natural resource (i.e., location of the project and description of the project). If you choose not to give your consent, you may work directly with these agencies to ensure compliance and then provide this documentation to NRCS.

Authorization for Release of Information to Conservation Districts I authorize the NRCS to provide the CD with the appropriate information from my case file or as specified here: _____________________________________________________________________. This information may or may not be presented at a public meeting.

To Provide a Referral. I authorize the NRCS to provide my contact information to other landowners or operators; in order for us to share information on similar resources or conservation practices.

Media Release. I authorize the NRCS to use pictures, video or narrative of my conservation project in presentations, public meetings, newsletters, newspaper articles, publication or on a website.

Restrictions can be detailed here: ________________________________________________________.

Authorization. I have control of said project and/or property, and hereby authorize the Natural Resources Conservation Service (NRCS) to release certain information, as specified above. This consent is provided for the duration of the USDA contract, until_______________________________________, or until I give written notice to cancel my consent.

__________________________ ___________ Participant Signature Date

Privacy Act of 1974 Compliance Information: Solicitation of information contained herein is authorized by Executive Order 10450, and/or Section 231 of the Crime Control Act of 1990 (42 U.S.C. 13041), and may be used as a basis for suitability determinations. Disclosure of the information by you is voluntary. Information may be transferred as a routine use to appropriate federal, state or local agencies when relevant to the issuance of a license, grant, or approval for participation in a conservation program. Failure to provide information requested on this form may result in the government’s inability to determine your suitability for the program you are applying for.

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