Bird Banding Laboratory


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OMB Control #1028-0082
Approval expires: 1/31/2016

Permit Renewal Form

Please select the type of permit you are renewing:

Personal Permit
Station Permit

Applicant, or for a station permit, Responsible Individual:

Station Name (if applicable):

Address to be used for correspondence:


Telephone (home):
(please enter digits only, it will be formatted automatically)
Telephone (work):
(please enter digits only, it will be formatted automatically)
Cell Phone:
(please enter digits only, it will be formatted automatically)
Fax: (please enter digits only, it will be formatted automatically)

 

NOTICE

In accordance with the Paperwork Reduction Act (PUB.L. 96-511), Privacy Act of 1974 (PUB.L. 93-579), please be advised that:
1. The gathering of information on migratory birds and their uses is authorized by the Migratory Bird Treaty Act (16 U.S.C. 703-711) and the Fish and Wildlife Act of 1956 (16 U.S.C. 742d). The requested information is required as a condition of your migratory bird permit.

2. Information from this application will be used to further the understanding, management, and utilization of the North American migratory bird resource, by Federal, State, and private conservation organizations, and the Canadian Wildlife Service.

3. Failure to answer any questions fully may be sufficient cause for the U.S. Geological Survey to deny your permit. Your participation in the survey is voluntary.

4. In the event there is an indicated violation of a statute, regulation, rule, order, or license, whether civil, criminal, or regulatory in nature, the requested information may be transferred to the appropriate Federal, State, local, or foreign agency charged with investigating or prosecuting such violations.

5. In the event of litigation involving the records of the subject matter of the records, the requested information may be transferred to the U.S. Department
of Justice.

PAPERWORK REDUCTION ACT STATEMENT: In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), please note the following. This information collection is authorized by The Migratory Bird Treaty Act, 16 U.S.C. 703-712. Your response is required to obtain or retain a benefit in the form of a permit. We estimate that it will take approximately 2 minutes to prepare and submit the form. 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 Office of Management and Budget control number. OMB has reviewed and approved this information collection and assigned OMB Control Number 1028-0082. You may submit comments on any aspect of this information collection, including the accuracy of the estimated burden hours and suggestions to reduce this burden. Send your comments to: Information Collection Clearance Officer, U.S. Geological Survey, 12201 Sunrise Valley Drive, MS 807, Reston, VA 20192.

Privacy Act Statement

AUTHORITY: The Migratory Bird Treaty Act (16 U.S.C. §§ 703-712) and the Bald and Golden Eagle Protection Act (16 U.S.C. §§ 668-668d).

PRINCIPAL PURPOSE: The principal purpose for collecting the information is to manage banding permits and sub permits issued by the Bird Banding Laboratory (BBL), and to provide contact information for Certificates of Appreciation and other rewards to people who report bird bands to the BBL.

ROUTINE USE:  To manage banding permits and sub permits issued by the BBL that authorizes bird banding activities in the United States and its Territories, and for other necessary actions required to manage and maintain the United States bird banding program within the intent of the authorizing legislation.  Contact information will be shared with Canadian, Federal and state agencies upon request.  Contact information will be shared with the approved bird bander for the purpose of providing the bander the opportunity to obtain additional information if needed.

DISCLOSURE IS VOLUNTARY: All information is voluntary.  Individuals have the option to not provide the contact information. Individuals applying for banding permits will not be allowed to participate in the program if contact information is declined.  Those reporting a bird band to the BBL do not have to provide contact information to report encounters.

I hereby certify that I have read and am familiar with the regulations contained in Title 50, Parts 13 & 21, of the Code of Federal Regulations and the other applicable parts in Subchapter B of Chapter 1 of Title 50 (http://www.gpoaccess.gov/efr/), and I further certify that the information submitted in this application for a permit is complete and accurate to the best of my knowledge and belief. I have not been convicted of, entered a plea of guilty or nolo contender for a felony violation of the Lacey Act, Migratory Bird Treaty Act, or the Bald and Golden Eagle Protection Act. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001. I realize that I must comply with the rules and requirements in the Bird Banding Manual and that marking and/or salvaging birds requires a significant amount of my time if a permit is issued. I agree to maintain and submit data promptly and in the prescribed format, to cooperate fully with the U.S. Geological Survey in the Bird Marking Program, and to abide by the terms and limitations of that permit.

NOTE: Please complete the Signed By and Date fields. By clicking on the SUBMIT button you will verify that you have read and agree to the information contained within this document.


Today's date is 05/28/2016