NARCAM Data Submission and Observation Form

NARCAM: Data Submission Form

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OMB Control Number: 1028-0056
Expiration Date: XX/XX/XXXX

NARCAM: Data Submission Form
Please note: fields denoted with a red asterisk * are mandatory.

I. Information About the Reporter
*Reporter's Name:
*Email address:
Phone number with area code:
Your Street Address:
State: ALABAMA

City:
Zip Code:

*Are you a student
List your position/title and institution, if applicable :

*May we follow up with you if we have additional questions about your report? yes
Is this report being submitted in conjunction with No Program

II. Location of Amphibian Sighting
Zip:
Latitude:

Find coordinates of sighting location
Longitude:

*Location Name:
e.g. my backyard; Old Mill Pond; Rock Creek Park; culvert along I25 east

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Approximate distance and direction to nearest crossroads:
e.g. 123 Main St; 2 mi west of visitor entrance on Nature Loop Trail; State highway rest area at I25
milepost 123
*Nearest Town/City:
County:

*State:

Description of Habitat
*Describe nearest wetland area:
Wet Meadow
Swamp
Pond/Lake
Stream/Creek/Brook
Spring/Seep
River/Floodplain area
Vernal Pool
Roadside puddle/rut
Other
Please describe:
Not Known

*Describe land area:
Wilderness
Fragmented natural area
Suburban residential area
Rural residential area

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Farmland/Rangeland
To your knowledge, are any pesticides herbicides or fertilizers used? yes
If you answered yes, please describe them
Other
Please describe:

III. Date of Sighting
Day (dd):
Month (mm):
Year (yyyy):

REPORT SPECIES OBSERVED

This NBII site is developed and maintained by the
University of Georgia's Savannah River Ecology Laboratory and
Center for Biological Informatics of the U.S. Geological Survey

Text-only
NBII Disclaimer and Privacy Statement | Accessibility | FOIA

North American Reporting Center for Amphibian Malformations

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IV. Species Observed at This Location
We are interested in knowing which species you observed on this sighting date, as well as their
condition and number, even if you observed no malformed individuals.
If you observed more than one species at this location, we ask that you complete a single report for
each species. For instance, if you observed both spring peepers and northern cricket frogs on the
same day at your location, you would need to fill out a complete report on the spring peepers you
observed, submit it, and then create a new report to describe the northern cricket frogs you saw at
that same location.
If you need assistance identifying a species, you can view an Amphibian Identification Guide
window.
1. Tell us about the species you observed.
Species Scientific Name:
OR
Species Common Name:
OR
Description of Species Color, Size, Markings

2. How many total individuals of this species did you observe?
3. How many of these were malformed individuals?

submit

North American Reporting Center for Amphibian Malformations

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This NBII site is developed and maintained by the
University of Georgia's Savannah River Ecology Laboratory and
Center for Biological Informatics of the U.S. Geological Survey

Text-only
NBII Disclaimer and Privacy Statement | Accessibility | FOIA

PAPERWORK REDUCTION ACT STATEMENT: The U.S. Geological Survey (USGS) is authorized under the Fish and Wildlife Act of 1956
(16 U.S.C. 742 et seq) to request this information for the protection of fisheries and wildlife through research. This form is used to collect
information concerning malformed amphibians in North America. The Paperwork Reduction Act requires that we inform you that a person is not
required to respond to a federally sponsored collection of information unless it displays a currently valid OMB control number. Public burden for
this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions and completing the
form. Public response to this request is voluntary. Please direct any comments regarding this collection to the USGS information Collection Officer,
U.S. Geological Survey, 2150-C Centre Avenue, Fort Collins, CO 80525.
PRIVACY ACT STATEMENT: You are not required to provide your personal contact information in order to submit this form. However, if you
do not provide contact information, we will not be able to contact you for additional information to verify your responses. If you do provide contact
information, this information will only be used to initiate follow-up communications with you and will be deleted from our files immediately
afterwards. The records for this collection will be maintained in the appropriate Privacy Act System of Records identified as Computer Registration
System. (INTERIOR/USGS-20) published at 74 FR 23430 (May 19, 2009).