WS Form 37 Migratory Bird Damage 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 permit review
						RENEWAL Permit No: ___________ Without Change
1. Name, Address, and Telephone Number Telephone Home Work Fax/Email:				2. Location of Damage
				3. County			4. State
5. RESOURCE/DAMAGE ESTIMATE
A. Resources Damaged				B. Description of Damage
6. MIGRATORY BIRD SPECIES		7. PERMIT RECOMMENDATION
Depredating Species	Number Involved	Take Recommendation		Number Recommended	Methods
1.		Yes No
2.		Yes No
3.		Yes No
4.		Yes No
8a. PREVIOUS ACTIONS TO ADDRESS PROBLEM AND RESULTS OF THOSE ACTIONS:
8b. COMMENTS:
9. RECOMMENDED ACTIONS
Action: Harassment Habitat Alteration Husbandry Exclusion Lethal trapping Chemical repellent Capture and relocation Egg/nest destruction Shooting Other: _____________________________________
10A. WS Investigator Name and Address: (Print) Telephone Number: Email:			10B. WS Investigator Signature Date:

WS Form 37

FEB 2011

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 (USC), Section 426-426c, and Title 16 USC, 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. Further, 5 USC 552a authorizes USDA, APHIS, Wildlife Services to collect information about private individuals for its system of records pursuant to the conduct of program activities with those private individuals.

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:

Routine use 1 provides for disclosure to the cooperative State government officials, employees, or contractors, as necessary to carry out the program.

Routine use 2 provides for the referral to the appropriate agency, whether Federal, State, local, or foreign, charged with responsibility of investigating or prosecuting a violation of law or of enforcing, implementing, or complying with 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;

Routine use 3 permits disclosure to the Department of Justice 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, in litigation, 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;

Routine use 4 permits disclosure for use in a proceeding before a court or adjudicative body before which the Agency is authorized to appear, 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 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, 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; provided, however, that in each case, 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;

Routine use 5 permits disclosure to a congressional office in response to a request from that office for the record of an individual made at the request of that individual;

Routine use 6 permits disclosure to the Comptroller General or any of his authorized representatives in the course of their duties at the Government Accountability Office; and

Routine use 7 permits disclosure to a consumer reporting agency in accordance with section 31 U.S.C. 3711(e).

Routine use 8 permits disclosure 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.

Effects of Failure to Furnish Information

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