Annual Report Form
Form 10-660 (Rev. 11/2016)
Expiration Date: 11/15/2019
National Park Service
John Day Fossil Beds National Monument
32651 Hwy 19
Kimberly, Oregon 97848
Phone Number: 541-987-2333 x 1212
ANNUAL REPORT INSTRUCTIONS
A report is required for each Commercial Use Authorization (CUA) issued. These instructions correspond to the numbered questions in Form 10-660.
Example: If you take clients on ten (10) mile rafting trips and eight (8) of the ten (10) miles are inside the park, then 80% of the activity takes place in the park OR If you spend four (4) hours on a hike and the last hour is hiking outside the park then you spend 75% of the activity in the park.
Example: If the park is the exclusive destination for clients participating in the services provided, then 100% of the holder’s gross receipts are a result of visiting the park. If the services provided within the park are primary or incidental, or the visit to the park is part of a multi-destination tour, then estimate what percentage of gross receipts are directly attributable to visiting the park.
Attachment A: CUA Annual Report - Sample Tables for Reporting
ANNUAL REPORT FORM
1. CONTACT INFORMATION
Primary Contact Information
Alternate Contact Information
2. SERVICES PROVIDED: (As it appears on your authorization.)
VISITOR USE INFORMATION
3. VISITORS AND/OR TRIPS:
Enter the number of clients serviced within the park over the past year:
Enter the number of trips (if applicable) your company made to the park over the past year:
4. LENGTH OF STAY: (If applicable)
Enter the average length of time your clients were in the park as a result of the service you provided (if applicable). For day trips, show the average number of hours that you spend in the park per trip. For overnight trips show the average number of nights that you spend in the park per trip from the first travel day to the last day exiting the park.
Average hours per trip (Trips that use lodging outside of the park are considered day trips.):
Average number of nights per trip:
(If provided, use table below to report total visitor use numbers.)
5. The park is (select one):
the EXCLUSIVE destination for your clients. (This means it is the only designation being offered on the trip, not including brief stops along the way. 100% of your trip is a result of your visiting the park.)
a KEY DESTINATION or a SIGNIFICANT LOCATION. (This means it is one of several sites where your services are provided. Some percentage of your trip is a result of being in the park.)
6. What percentage of the service you provide is a result of visiting the park?:
7. Enter the total gross receipts for your operation:
8. Enter the portion of the total gross receipts earned that resulting from visiting the park: (See Instructions)
9. Did any reportable injuries occur during your trips this year?
If “Yes”, please use a separate sheet of paper to report the date of the incident and a brief statement of the incident. Include a description of the activity taking place at the time of the injury, the type of injury, and the action taken to provide patient care. Please include the sex and age of the patient (omit the patient’s name). A reportable injury involves any medical incident or injury requiring medical aid beyond Basic First Aid and/or when a request for medical aid/rescue assistance is made. You do not need to send in a report if you have already done so.
10. Does your company plan to return next year?
11. SIGNATURE: False, fictitious or fraudulent statements or representations made in this report may be grounds for denial or revocation of the Commercial Use Authorization and may be punishable by fine or imprisonment (U.S. Code, Title 18, Section 1001). Authorized Agents must attach proof of authorization to sign below.
By my signature, I hereby attest that all my statements and answers on this form and any attachments are true, complete, and accurate to the best of my knowledge.
Privacy Act Statement
Authority: The authority to collect information on the attached form is derived from 16 U.S.C. 5966, Commercial Use Authorizations.
Purpose: The purposes of the system are (1) to assist NPS employees in managing the National Park Service Commercial Services program allowing commercial uses within a unit of the National Park System to ensure that business activities are conducted in a manner that complies with Federal laws and regulations; (2) to monitor resources that are or may be affected by the authorized commercial uses within a unit of the National Park System; (3) to track applicants and holders of commercial use authorizations who are planning to conduct or are conducting business within units of the National Park System; and (4) to provide to the public the description and contact information for businesses that provide services in national parks.
Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or information contained in this system may be disclosed outside the National Park Service as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other Federal, State, territorial, local, tribal, or foreign agencies and other authorized organizations and individuals based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.
Disclosure: Providing your information is voluntary, however, failure to provide the requested information may impede the processing of your commercial use authorization application.
Paperwork Reduction Act Statement
Estimated Burden Statement
CUA ANNUAL REPORT
Sample Tables for Reporting
RETAIL SALES: (Farmers Markets, Special Performances, Special Events)
GUIDED BACKCOUNTRY TIPS:
1 The number of times the guides led trips. If there are 2 guides on each trip and 5 trips, the total number of guides is 10.
Last updated: December 12, 2017