Section 1 - General
APD ID
Tie to previous NOS? (select)
-None-
Submission Date
BLM Office *
-- Please Select --
User
Title
Federal/Indian APD *
Surface access agreement in place? *
Yes
No
Allotted? *
Yes
No
Reservation *
-- Select --
Agreement in place? *
Federal or Indian agreement *
Agreement number *
Valid?
Agreement name *
Keep application confidential?
Designated Agent?
Yes
No
APD Operator *
Operator letter of designation *
Designated Agent Info
Agent Address
Agent PO Box
Agent City
State
Zip
Agent Phone
Agent Internet Address
Operator Info
Operator Organization Name
Operator Address
Operator PO Box
Operator City
State
Zip
Operator Phone
Operator Internet Address
AppID
UserID
Agreement ID
ORG ID
AgreeNumber
Validation result
Validation Msg