Section 1 - General
APD ID
Tie to previous NOS? (select)
-None-
Submission Date
BLM Office
-- Please Select --
User
Title
Federal/Indian APD
Federal
Indian
Surface access agreement in place?
Yes
No
Allotted?
Yes
No
Reservation
*
-- Select --
Tribe
-- Select --
Agreement in place?
Yes
No
Federal or Indian agreement
Federal
Indian
Agreement number
Agreement name
Keep application confidential?
Yes
No
Designated Agent?
Yes
No
APD Operator
-- Please Select --
Operator 1
Operator 2
Operator 3
Operator letter of designation
view file
Designated Agent Info
Agent Organization Name
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