WS 30 Wildlife Services Assistance Request

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 2 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

OMB Approved
0579-0335
EXP: XX/XXXX

WILDLIFE SERVICES
ASSISTANCE REQUEST

REQUEST DISPOSITION
1. DISPOSITION
2A. SEND OR PROVIDE

2B. DATE SENT OR PROVIDED

3A. REQUESTER NAME

3D. DIRECTIONS TO PROPERTY (if needed)

3B. REQUESTER ADDRESS

3C. REQUESTER TELEPHONE NUMBER
4A. PROPERTY LOCATION (county or city)
5A. DATE RECORDED

4B. PAR

5B. TIME SPENT ON PROJECT

4C. URB

4D. RUR

4E. ADDITIONAL FORM

5C. PROJECT TYPE

6A. DEPREDATING SPECIES

6B. NO. OF LEAFLETS

6C. NO. OF PARTICIPANTS

DAMAGE DATA
7A. RESOURCE TYPE 1

8A. RESOURCE TYPE 2

7B. NO. OF INCIDENTS OR 7C. DAMAGE TYPE
QTY OF RESOURCE

7D. DOLLAR VALUE 7E.

8B. NO. OF INCIDENTS OR 8C. DAMAGE TYPE
QTY OF RESOURCE

8D. DOLLAR VALUE 8E.

7F.
REPORTED

7G.
VERIFIED

8F.
REPORTED

N/A
8G.

VERIFIED

N/A

DEPREDATION PERMITS
9. FEDERAL
10. STATE

9A. NEW
10A. RECOMMENDED

9B. RENEWAL

9C. RECOMMENDED

10B. ISSUED

10C. REFERRAL AGENCY

9D. NOT RECOMMENDED

CHEMICAL CONTROL DATA
11A. RESOURCE 1

11B. METHOD

11C. QUANTITY

11D.

11E.
DEMONSTRATED

12A. RESOURCE 1

12B. METHOD

12C. QUANTITY

12D.

11F.
DISTRIBUTED

12E.

SOLD
12F.

DEMONSTRATED

DISTRIBUTED

14A(4).
LOANED
14B(4).
LOANED
14C(4).
LOANED

14A(5).
SOLD
14B(5).
SOLD
14C(5).
SOLD

15C.

15D.

SOLD

13. DEPREDATING SPECIES QUANTITY
EQUIPMENT DATA
14A(1). METHOD 1

14A(2). QUANTITY

14B(1). METHOD 2

14B(2). QUANTITY

14C(1). METHOD 3

14C(2). QUANTITY

15A. RESOURCE 1

15B. METHOD

14A(3).
DISTRIBUTED
14B(3).
DISTRIBUTED
14C(3).
DISTRIBUTED
RECOMMENDATIONS

RECOMMENDED
16A. RESOURCE 1

16B. METHOD

16C.

17A. RESOURCE 1

17B. METHOD

17C.

18A. RESOURCE 2

18B. METHOD

18C.

19A. RESOURCE 2

19B. METHOD

19C.

20A. RESOURCE 2

20B. METHOD

20C.

CEM
16D.

RECOMMENDED

CEM
17D.

RECOMMENDED

CEM
18D.

RECOMMENDED

CEM
19D.

RECOMMENDED

CEM
20D.

RECOMMENDED

CEM

COMMENTS
21. COMMENTS

22. WS EMPLOYEE

WS FORM 30
APR 2017

23. ENTERED IN DATABASE

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 for Completing WS Form 30, Wildlife Services Assistance Request
This form is used to collect information about a person who has requested assistance from WS about wildlife damage. This information will usually be
collected by telephone from requesters who call a WS office seeking assistance. The information captured includes the location of the problem, name of
caller, phone number and data about the nature of the damage and the species involved. It also collects information about what recommendations might
be provided for resolving the damage. If the number of items to be reported exceeds the capacity of this form, a new form should be filled out for those
additional items. Example: The form is designed to capture information about one species (Item 6a). If the requester reports damage from two separate
species, a form should be filled out for each.
The WS employee filling out this form is instructed to refer to the MIS Help Files for further information about entries.
1. Keep short notes on this line about what stage of the process you are in with the customer. Example: an entry such as “called, left message on voice
mail” could mean you called the customer back but he/she was not available and you left a message on the voice mail. Messages to yourself about
commitments to loan equipment or distribute supplies could be entered here also.
2a-b. After discussing the problem with the customer, you may have agreed to send a wildlife damage management leaflet, or some material to the
person, or you may have agreed to provide a damage control device, tool, or supply. This line is to be used to instruct the WS employee (or to remind
yourself) to send or provide such items to the requester and to post the date that it was sent or provided.
3a-c. Enter the name, address, phone number of the requester.
3d. If a trip to the requesters property to look at the problem is planned, you may need additional directions beyond the address. They are entered here.
Example: if the requester lives at one site and the wildlife damage is occurring at another, you may need directions or an address for that property.
4a. Enter the county or city where the requester lives or where the property receiving damage is located.
4b. (= Participant): Mark this box if you are helping a fellow employee with this project or if you want to record that the project is not yet completed. When
this project is completed DO NOT mark this bubble on the last form you turn in for it.
4c-d. If this project is in an urban environment mark “URB.” If in a rural environment, mark “RUR.” Refer to your MIS Field Handbook for definitions of
these two environments.
4e. Mark this block if this is an additional form to capture more information about a requester than you could enter on the original form. Refer to your MIS
Field Handbook for guidance on what information is to be entered into an “Additional Form.”
5a. Enter the date you recorded this information.
5b. Enter the time spent on the project (optional).
5c. Enter the project type.
6a. Enter the depredating species involved in the damage.
6b. Enter the number of leaflets sent to the requester.
6c. Enter the number of requester participants involved in this project.
7a. Enter the resource type affected by the reported wildlife damage.
7b. Enter the number of incidents of damage or the quantity of the resource affected by the damage.
7c. Enter the damage type for this project.
7d. Record the dollar value of loss to the requester from the reported damage.
7e-g. Mark the appropriate block to indicate whether the dollar value of loss was “reported” by the requester, “verified” by the WS employee, or “not
available” from any source.
8a. This line is to be used to record a second resource type affected (if applicable).
8b-g. Refer to instructions for # 7b-g.
9a-b. If a federal permit is discussed as a means to address the damage problem, record whether the permit is to be a “NEW” permit or “RENEWAL” of
an existing one.
9c-d. Notate whether the permit was recommended or not recommended by marking the appropriate box.
10a-b. If a state permit is recommended by WS, mark item a; if a state permit is issued by the appropriate state agency representative mark the
“ISSUED” box.
10c. If this is a personal consultation or a Written/telephone consultation, record the agency who referred the call to you OR the agency you referred the
call to (optional; check with your state director).
11-12a-f. Record chemical control information in these lines. Item 11 is for entries about chemical control associated with Resource #1 (Item 7a) and
item 12 is for entries about chemical control associated with Resource #2 (Item 8a). Record each resource in a, any chemical method provided to the
requester in b, the quantity in c, whether you demonstrated the method (d), loaned (e) or sold (f) it to the requester.
13. (Optional) Record the numbers of individuals of the depredating species which you listed in 6a.
14a-c. Use these lines to record information about any equipment related to this project. In “a” record the equipment by method name (example cage
trap, leghold, conibear, neck snare, gas exploder, pyrotechnics), in “b” record the quantity provided, in “c”, “d”, or “e” mark the appropriate box to indicate
whether you distributed, loaned or sold the equipment to the requester. You have space to record information about 3 pieces of equipment in this item.
15-20. Enter recommendations made in these lines. Record which resource the recommendation was made for in item “a.” Record the method or
component recommended by WS or already used by the requester in item “b.” Record by marking the appropriate block whether the method you
recorded in “b” was recommended (item c:) or employed by the requester (item d).
21. Record any comments about this project you may have.
22. Print your name in this line.
23. When you have entered this information into the MIS database, mark this block.