Form 3-200-37g Annual Report - ESA Cull/Take

OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-37g (Rev. 02/2023)
U.S. Department of the Interior

ESA Cull/Take Annual Report

Due: March 31st of the following year
Email to: managementauthority@fws.gov referencing “ESA Take Annual Report YYYY for Take Permit # MA#####” in subject line.
Permittee Name:

Reporting Year:

ESA Take Permit #:

CBW Permit #:

Year-end Inventory:
Scientific Name
(Genus, species, and if
applicable, subspecies)
EXAMPLE:
Oryx leucoryx

Common
Name

Quantity

Sex Ratio
(male.female.unknown sex,
10.5.2)

# Births over
the reporting
year

# Deaths over
the reporting
year

Arabian
oryx

17

10.5.2

2

1

Approx Death Date(s)
and Cause of Death(s)
(attach necropsy report,
as needed)
Aug 2019,
predation

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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-37g (Rev. 02/2023)
U.S. Department of the Interior

Take Activities Conducted:
Scientific Name
(Genus, species, and if
applicable, subspecies)

EXAMPLE:
Oryx leucoryx

Common Name

Arabian oryx

Quantity

2

Sex Ratio
(male.female.unknown
sex, 2.0.0)

Trophy Fee
charged per
individual hunt ($)

Amount of $
donated per
hunt ($)

2.0.0.

$1,500

$500

Documentation
Showing
Receipt of
Donation (see
below)
Yes ☒
No ☐
Yes ☐
No ☐
Yes ☐
No ☐
Yes ☐
No ☐
Yes ☐
No ☐

For each culled specimen listed above, provide:
●
●
●
●
●
●
●

A signed acknowledgement of donation from the conservation organization that clearly indicates how the donation will be used to enhance the
conservation of the species in the wild, including:
Name of project
Location of project
Duration of project
Target species (scientific and common name)
Project overview
Any published results from funded activities (if applicable)

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FWS Form 3-200-37g (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the following: the Bald and Golden Eagle Protection Act (16
U.S.C. 668), 50 CFR 22; the Endangered Species Act (16 U.S.C. 1531-1544), 50 CFR 17; the Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21; the
Marine Mammal Protection Act (16 U.S.C. 1361, et seq.), 50 CFR 18; the Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15; the Lacey Act: Injurious
Wildlife (18 U.S.C. 42), 50 CFR 16; Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), 50 CFR 23; General
Provisions, 50 CFR 10; General Permit Procedures, 50 CFR 13; and Wildlife Provisions
(Import/export/transport), 50 CFR 14.
Purpose: The collection of contact information is to verify the individual has an eligible permit to conduct activities which affect protected species. This helps FWS
monitor and report on protected species and assess the impact of permitted activities on the conservation and management of species and their habitats.
Routine Uses: The collected information may be used to verify an applicant’s eligibility for a permit to conduct activities with protected wildlife; to provide the
public and the permittees with permit related information; to monitor activities under a permit; to analyze data and produce reports to monitor the use of protected
wildlife; to assess the impact of permitted activities on the conservation and management of protected species and their habitats; and to evaluate the
effectiveness of the permit programs. More information about routine uses can be found in the System of Records Notice, Permits System, FWS-21.
Disclosure: The information requested in this form is voluntary. However, submission of requested information is required to process applications for permits
authorized under the listed authorities. Failure to provide the requested information may be sufficient cause for the
U.S. Fish & Wildlife Service to deny the request.
PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) in order provide the U.S. Fish and Wildlife Service the information
necessary, under the applicable laws governing the requested activity, for which a permit is requested. Information requested in this form is purely voluntary.
However, submission of requested information is required in order to process applications for permits authorized under the applicable laws. Failure to provide all
requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. 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 currently valid OMB control number.
OMB has approved this collection of information and assigned Control No. 1018-0093.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 20 minutes (electronically) to 30 minutes (paper-based), including time for reviewing
instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the
form to the Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls
Church, VA 22041-3803, or via email at Info_Coll@fws.gov. Please do not send your completed form to this address.
Questions regarding permits from Management Authority should be sent to managementauthority@fws.gov.

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