Sample Completed Tribal Permit Request and Rules

OMB Control No. 1018-0178
Expires ##/##/20##

OMB Control No. 1018-0178
Expires ##/##/20##

OMB Control No. 1018-0178
Expires ##/##/20##

OMB Control No. 1018-0178
Expiration Date: ##/##/20##

NOTICES
PRIVACY ACT STATEMENT
Authority: The Migratory Bird Treaty Act (MBTA) of 1918 (16 U.S.C. 703-712) and the Fish and
Wildlife Act of 1956 (16 U.S.C. 742d).
Purpose: The information collected will be used for the continuation of customary and traditional
subsistence uses of migratory birds in Alaska and to prescribe regional information on when and where
the harvesting of birds may occur.
Routine Uses: The information collected may be shared in accordance with the Privacy Act of 1974
and the routine uses listed in the System of Records Notices INTERIOR/FWS-21 Permits System (June
4, 2008) 73 FR 31877 and INTERIOR/FWS/-26, Migratory Bird Population and Harvest Systems - 64
FR 29055 (May 28, 1999) available at https://www.doi.gov/privacy/doi-notices.
Disclosure: Furnishing this information is voluntary; however, failure to provide the requested
information may prevent the FWS from being able to determine the take’s legality or may limit FWS’
ability to monitor migratory bird harvests.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501 et seq), the U.S. Fish and Wildlife
Service collects information necessary as a required condition of permits requested and authorized under
the applicable laws governing the requested activity, and to respond to requests made under the Freedom
of Information Act and the Privacy Act of 1974. 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 above 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. 1018-0178.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 30 minutes, 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.