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

FWS Form 3-200-37g (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

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

Common Name

Quantity

(Genus, species,
and if applicable,
subspecies)

EXAMPLE:
Oryx leucoryx

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

# Births over the
reporting year

# Deaths over
the reporting
year

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

Arabian oryx

17

10.5.2.

2

1

Aug 2019,
predation

Page 1 of 3

FWS Form 3-200-37g (Rev. 02/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

Take Activities Conducted:
Scientific Name

Common Name

Quantity

(Genus, species,
and if applicable,
subspecies)

EXAMPLE:
Oryx leucoryx

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

Arabian oryx

2

2.0.0.

Trophy Fee
charged per
individual hunt

Amount of $
donated per
hunt

($)

($)

$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)

Page 2 of 3

FWS Form 3-200-37g (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

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 averages 20 minutes (electronically) to 30 minutes (paperbased), 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/PERMA (JAO), Falls
Church, VA 22041-3803, or via email at Info_Coll@fws.gov. Please do not send your completed form to this address.

Page 3 of 3