WS 37 Migratory Bird Damage Project Report

Clear Form
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 8 minutes 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
WILDLIFE SERVICES

NEW

USFWS MIGRATORY BIRD
PERMIT APPLICATION
OR REVIEW

1. REQUESTER INFORMATION

OMB Approved
0579-0335
EXP: XX/XXXX

RENEWAL
PERMIT NO.
AMENDED
WITHOUT CHANGE

2. LOCATION OF DAMAGE

A. NAME AND ADDRESS

A. LOCATION

B. TELEPHONE

B. COUNTY

HOME

C. STATE

WORK
C. FAX OR EMAIL
3. RESOURCE/DAMAGE ESTIMATE
A. RESOURCES DAMAGED
(select all that apply)

AGRICULTURE

HEALTH & SAFETY

NATURAL RESOURCES

PROPERTY

C. DESCRIPTION OF DAMAGE

B. LIST SPECIFIC RESOURCES

4. MIGRATORY BIRD SPECIES
A. DEPREDATING SPECIES

5. PERMIT RECOMMENDATION
B. NUMBER
INVOLVED

A. TAKE
RECOMMENDATION

(1)

YES

NO

(2)

YES

NO

(3)

YES

NO

(4)

YES

NO

(5)

YES

NO

(6)

YES

NO

(7)

YES

NO

(8)

YES

NO

B. NUMBER
RECOMMENDED

C. METHODS

Continued on reverse
6. ACTIONS
A. PREVIOUS ACTIONS TO ADDRESS PROBLEM AND RESULTS OF THOSE ACTIONS

B. COMMENTS

7. RECOMMENDED ACTIONS
HARASSMENT

HABITAT ALTERATION

CAPTURE AND RELOCATION

HUSBANDRY

EGG/NEST DESTRUCTION

EXCLUSION

LETHAL TRAPPING

SHOOTING

OTHER:

CHEMICAL REPELLENT

8. WS INVESTIGATOR INFORMATION
A. WS INVESTIGATOR NAME AND CONTACT INFORMATION

B. WS INVESTIGATOR SIGNATURE

9. DATE OF INVESTIGATION (use this date as MIS entry date)
TELEPHONE NUMBER
EMAIL ADDRESS

WS FORM 37
APR 2018

CONTINUATION
4. MIGRATORY BIRD SPECIES
A. DEPREDATING SPECIES

5. PERMIT RECOMMENDATION
B. NUMBER
INVOLVED

A. TAKE
RECOMMENDATION

( 9)

YES

NO

(10)

YES

NO

(11)

YES

NO

(12)

YES

NO

(13)

YES

NO

(14)

YES

NO

(15)

YES

NO

(16)

YES

NO

(17)

YES

NO

(18)

YES

NO

(19)

YES

NO

(20)

YES

NO

(21)

YES

NO

(22)

YES

NO

(23)

YES

NO

(24)

YES

NO

(25)

YES

NO

(26)

YES

NO

(27)

YES

NO

(28)

YES

NO

(29)

YES

NO

(30)

YES

NO

(31)

YES

NO

(32)

YES

NO

(33)

YES

NO

(34)

YES

NO

(35)

YES

NO

(36)

YES

NO

(37)

YES

NO

(38)

YES

NO

(39)

YES

NO

(40)

YES

NO

WS Form 37 (Reverse)

B. NUMBER
RECOMMENDED

C. METHODS

PRIVACY ACT NOTICE
5 U.S.C. 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
7 U.S.C. 8351 to 8353, and 16 U.S.C. 667, authorizes officers, agents, and employees of the United States Department of Agriculture (USDA), Animal
and Plant Health Inspection Service (APHIS), Wildlife Services (WS) 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
(1) To cooperative Federal, State, Tribal, and local government officials, employees, or contractors and other parties as necessary to carry out the
program; and other parties engaged to assist in administering the program. Such contractors and other parties will be bound by the nondisclosure
provisions of the Privacy Act. This routine use assists the agency in carrying out the program, and thus is compatible with the purpose for which the
records are created and maintained;
(2) To the appropriate agency, whether Federal, State, local, Tribal, 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;
(3) 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;
(4) 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;
(5) 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 of 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;
(6) To USDA contractors, partner agency employee or contractors, or private industry employed to identify patterns, trends, or anomalies indicative of

fraud, waste, or abuse;
(7) To land management agencies, such as the Bureau of Land Management and the U.S. Fish and Wildlife Service, relating to wildlife damage on
grazing allotments;
(8) To consumer reporting agencies in accordance with 31 U.S.C. 3711(e);
(9) To Federal, State, Tribal, and local regulatory agencies and their employees and contractors who collaborate with Wildlife Services in

implementation of, or agencies that regulate, wildlife management projects or programs, or who have an interest in, or regulate, animal or public health,
or national security;
(10) To Federal or State Government-level representatives of the U.S. Environmental Protection Agency, in compliance with the Federal Insecticide,

Fungicide, and Rodenticide Act (FIFRA) mandate in 7 U.S.C. 136(f, and i thru l), of the location on a cooperator’s property where certain regulated
pesticide devices are deployed or regulated pesticides are applied; and
(11) To the National Archives and Records Administration (NARA) or to the General Services Administration for records management inspections

conducted under 44 U.S.C. 2904 and 2906.
EFFECTS OF FAILURE TO FURNISH INFORMATION
Failure to provide the solicited information will not subject you to penalties or adverse consequences.

Instructions
WS Form 37, USFWS Migratory Bird Permit Application/Review
for requester management of migratory bird damage to resources
REVIEW TYPE (upper right‐corner): Select “NEW”, “RENEWAL”, or “WITHOUT CHANGE”. Select RENEWAL only if this
is a renewal action for an existing U.S. Fish and Wildlife Service (USFWS) migratory bird damage management permit.
Also include the permit number.
SECTION 1, REQUESTER’S INFORMATION: Enter the Requester’s name, address, home and/or work telephone
number(s), and fax number or email address.
SECTION 2, LOCATION OF DAMAGE: In Part A, describe the location of the damage using a physical address, or a
descriptive address such as “requester’s corn field located on Highway 422, 3 miles east of Rodunka, WA” or “back yard
of requester’s residence”. In Parts B and C, enter the county and state.
SECTION 3, RESOURCE/DAMAGE ESTIMATE: In Part A, select all boxes which identify the resources being damaged
by category (Agricultural, Health and Safety, Natural Resources, or Property). In Part B, list the specific resources (e.g.,
field corn, soybeans). In Part C, describe what kind of damage is occurring (e.g., “Canada Geese are feeding on field
corn and soybeans and trampling plants. About on‐half acre of corn and about one acre of soybeans has been destroyed
or damaged”).
SECTION 4, MIGRATORY BIRD SPECIES: On separate rows, list the depredating species (common name or scientific
name) doing the damage and the number of birds involved.
SECTION 5, PERMIT RECOMMENDATION: On separate rows, continue Section 4 by marking YES or NO for
recommended “permit to take”, the number of birds that are recommended for the Requester to be allowed to take, and
the method(s) that are recommended for the requester to use. This should be distinguished from the list in Section 7 by
listing the actual tools to be used (e.g. firearms, cage traps, corral traps, repellents, pyrotechnics, gas cannons, vehicles,
vegetable oil, etc.).
SECTION 6, ACTIONS: In Part A, if the requester has taken action in the past to address the damage, enter information
about it as well as the results. Include only actions that have not been covered under another permit (e.g., the requester
may have changed the location of his resource or put up scarecrows to try to mitigate the damage before seeking more
effective measures.) Permitted actions for previous years should also be listed if this is a permit review application. If no
actions have been taken previous to completing this form, enter “NONE”. In Part B, enter any comments that may be
relevant to USFWS’s review of this request.
SECTION 7, RECOMMENDED ACTIONS: Check all boxes for the actions/methods that are to be recommended for this
project.
SECTION 8, WS INVESTIGATOR INFORMATION: In Part A, enter the WS Investigator’s name, address, telephone
number, and email address. In Part B, enter the WS Investigator’s signature.
SECTION 8, PART B - DIGITAL SIGNATURE: If the form is being digitally signed in Part B, only a LincPass or other
USDA-authorized certificated identity may be used. To digitally sign the form:
a. Click on the digital signature icon (red arrow) in Section 8, Part B
b. A “Sign Document” window will open allowing selection of an identity from a “Sign As” dropdown list.
c. Select the applicable Entrust identity (e.g. John Doe (Entrust) yyyy.mm.dd).
d. A confirmation message will appear providing information specific to this digital signing operation including the fact that
it is being signed by you. This information will appear stamped in Section 8, Part B, when the signing is finalized.
e. Mark the “Lock Document After Signing” box to lock the document from any further editing once signed.
f. Select the “Review” button to confirm there are no errors with the form that might interfere with the digital signature.
g. Select the “Sign” button and save the newly signed document to a predetermined location. Be sure to save the
document with a modified file name so the base electronic WS Form 37 is not accidentally overwritten (e.g., change WS
FORM 37 to WS FORM 37 SMITH).
h. With VPN connections, an ActivClient Login PIN may be needed. Enter the PIN and select OK.
SECTION 9, DATE OF INVESTIGATION: Enter the date of the investigation. This is usually the date the form is signed
by the WS Investigator. It is also the date for the MIS entry.
A copy of the Privacy Act Notice must accompany the Requester’s copy of the completed WS Form 37.