WS Form 14 Project Report

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0335. The time required to complete this information collection is estimated to average .044 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved 0579-0335 EXP XX/XXXX

United States Department of Agriculture Animal and plant health inspection service Wildlife services Project report

State

County

Date

name of resource owner or contact

address

telephone

Location of damage or incident

Project type

Urban Damage Prevention

Urban Damage

Airport Safety

Rural Damage Prevention

Rural Damage

Disease Suppression (Specify on comments)

confirmed damage/incident

unconfirmed damage/incident

Number

Type

Approximate Value

Number

Type

Approximate Value

Species responsible

Land status Private State Federal (specify) Other (specify)

Comments (Recommendations, Dates of Loses, Results of Work, Types of diseases, etc.)

received and reported by ws representative

Personal

Phone

Written

Other

WS FORM 14

JAN 2011

Instructions For Completing WS Form 14 – Project Report

Items

1	Enter the state where the project takes place
2	Enter the County where the project takes place
3	Enter the current date
4	Enter the name of the resource owner or contact person for the resource owner
5	Location - Enter the location where the damage or incident took place
6	Project Type - Mark the box which describes the type of project. More than one box may be marked
7	Confirmed Damaged 7a – Enter the total number of incidents of damage that were confirmed by WS. 7b – List the type of damage that occurred (Example: predation, harassment, human health and safety, general property). 7c – Record an estimated value (in dollars and cents) for losses which occurred.
8	Unconfirmed Damage 8a – Total number of damage incidents that were reported but not confirmed by WS. 8b – List the type of damage that occurred (Example: predation, harassment, human health and safety, general property). 8c – Record an estimated value (in dollars and cents) for losses which occurred.
9	Species Responsible - Name of species that is responsible for the damage.
10	Land Status - Mark the box that defines the land class where the damage occurred.
11	Comments - Print additional information about the project in this section.

Distribution: Primary signature copy to State WS Office

One copy to District Office

One copy to WS Employee

Provide contributor of information a copy of the Privacy Act Notice

Privacy Act Notice

Title 5, United States Code, Section 552a(e)(3) requires that each agency that maintains a system of records provide each individual from whom the agency solicits information with the following information.

Authority for Requesting Information

Title 7, United States Code, Section 426-426c, and Title 16 United States Code, Section 667, authorizes officers, agents, and employees of the USDA, APHIS, Wildlife Services to conduct a program of Wildlife Services and to enter into agreements with States, local jurisdictions, individuals, and public and private agencies, organizations, and institutions for the purpose of conducting such services.

Nature of Your Disclosure of Information

Disclosure of information solicited by USDA, APHIS, Wildlife Services is voluntary.

Principle Purpose for Which the Information is Solicited

Information is solicited from you for the purpose of executing and implementing agreements for control of wildlife damage.

Routine Uses Which May be Made of the Information

The routine uses which may be made of the information are:

1) Agency procedure requires that Wildlife Services obtain permission to enter on property of cooperators. Information collected about cooperators will be used to document authority and license to enter premises to conduct wildlife damage management activities, pursuant to requests from cooperators for services to be conducted on their behalf.

2) Wildlife Services managers need to evaluate the effectiveness of program activities being conducted by Federal, State, and contractual personnel as program activities occur on cooperator property or on behalf of the cooperator. Information collected about the cooperator will help managers conduct such evaluations.

3) Preparing mailing labels and pre-addressed forms to enhance field activities, when such activities require sending correspondence to cooperators or when surveying cooperators to determine their satisfaction with program activities or results.

4) Wildlife Services may conduct surveys by selecting cooperators to provide them information about various facets of program activities related to services provided. Information provided by the cooperator during the course of business enables Wildlife Services to contact them and request voluntary participation in a survey.

5) Protecting the health and safety of the personnel and cooperator is an important goal of Wildlife Services. By using the information volunteered by the cooperator determinations can be made about how and when work will be performed, what methods will be used, and what information to provide the cooperator about the methodology, process, frequency, results, and time lines to be used in program activities, and to assist in developing safety measures and protocols.

6) Information may be used to make a referral to the appropriate agency, whether Federal, State, Local, or Foreign, charged with the responsibility of investigating or prosecuting a violation of law or of enforcing or implementing a statute, rule, regulation, or order issued pursuant thereto, of any record within this system when information available indicates a violation or potential violation of law, whether civil, criminal, or regulatory in nature, and either arising by general statute or particular program statute, or by rule, regulation, or court order issued pursuant thereto;

7) Information about cooperators may be provided to the Department of Justice in certain litigation procedures, when the agency, or any component thereof, or any employee of the agency in his or her official capacity, or any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee, or the United States, where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation or has an interest in such litigation, and the use of such records by the Department of Justice is deemed by the agency to be relevant and necessary to the litigation; provided, however, that in each case, the agency determines that disclosure of the records to the Department of Justice is a use of the information contained in the records that is compatible with the purpose for which the records were collected;

8) To appropriate agencies, entities, and persons when the Agency suspects or has confirmed that the security or confidentiality of information in the system of records has been compromised; the Agency has determined that as a result of the suspected or confirmed compromise there is a risk of harm to economic or property interests, a risk of identity theft or fraud, or a risk of harm to the security or integrity of this system or other systems or programs (whether maintained by the Agency or another agency or entity) that rely upon the compromised information; and the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with the Agency’s efforts to respond to the suspected or confirmed compromise and prevent, minimize, or remedy such harm.

9) Wildlife Services personnel are sometimes requested to appear in court or in the presence of some other panel or body of legal officials to provide information about program activities. Information collected about the cooperator may be used in such a proceeding , when the agency, or any agency subdivision, or employee of the agency acting in his or her official or individual capacity, where the agency has agreed to represent the employee or the United States, where the agency determines that litigation is likely to affect the agency or any of its components, or if the agency is a party to litigation or has an interest in such litigation, and the agency determines that use of such records is relevant and necessary to the litigation. Such information about the cooperator will only be provided, in each case, when the agency determines that disclosure of the records to the court is a use of the information contained in the records that is compatible with the purpose for which the records were collected;

10) Specific information about a cooperator may be provided in response to a request from a congressional office in regard to the record of an individual when the person whom the information is about has made the request to that congressional office;

11.) Information about cooperators may be provided to Comptroller General or any of his authorized representatives to assist them in their evaluation of Wildlife Services activities conducted with the public.

12) In accordance with Section 3711(e), Title 31, United States Code, agencies are directed to provide information to a consumer reporting agency that a person is responsible for a claim that is overdue and for which the person has not attempted payment or filed for a review about the claim. Information about a cooperator that is relevant to this procedure may be provided to the consumer reporting agency.

Effects of Failure to Furnish Information

Failure to provide the solicited information will not subject you to penalties or adverse consequences