Form 3-2309 Peregrine Falcon Feather Contaminants Data Sheet

OMB Control No. 1018-0101
Expires XX/XX/XX

Peregrine Falcon Feather Contaminants Data Sheet
Monitoring Region: ___________________________________________________________
Collector name and affiliation: ___________________________________________________
Date Collected: _________________
Nest Number or location:________________________________________________________
USFWS band number: __________________________________________________________
Additional band description and numbers: ________________________________
Estimated age of nestling: _______________________________________________
Estimated sex of nestling: _______________________________________________
Was feather sample collected from (circle) left or right side of nestling?
Additional comments:

Paperwork Reduction Act: The total annual paperwork burden per respondent is estimated to
be 2 1/2 hours. This includes time for reviewing instructions, gathering and maintaining data, and
preparing and transmitting reports. Send comments regarding the burden estimate or any other
aspect of the reporting requirement(s) to the Service Information Collection Clearance Officer,
Fish and Wildlife Service, 4401 N. Fairfax Drive, MS 222, Arlington, VA 22203.
An agency may not conduct 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 OMB Control No. 1018-0101.
FWS Form 3-2309
REV 04/08