Form 3-2323 Regional Advisory Council Reference and Key Contact Inte

OMB Control No. 1018-0075
Expires: XX/XX/XXXX

REGIONAL ADVISORY COUNCIL REFERENCE & KEY CONTACT INTERVIEW
Applicant:___________________________________________
Panelist: ____________________________________________
Date: _______________________________________________
Before beginning the interview with the key contact or reference, let them know that there are five
questions and that the interview may take 15 minutes or less. If the contact or reference does not
know the applicant or does not want to participate, thank them for their time and close the interview.

____Reference

____ Key Contact

(Please check whichever applies.)

Name: ___________________________________________________
Organization: _____________________________________________
Title: ____________________________________________________
Number of years in region: ______________

1. Please describe the applicant’s knowledge of your region’s fish and wildlife resources.

2. Please describe the applicant’s knowledge of your region’s customary and traditional
subsistence practices.
Does the applicant participate in subsistence practices?
If the answer is no, describe their knowledge of practices.

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FWS Form 3-2323
REV 10/09

OMB Control No. 1018-0075
Expires: XX/XX/XXXX

3. Please describe the applicant’s knowledge of your region’s commercial, sport, and other
activities.
Does the applicant participate in commercial, sport, and other activities?
If the answer is no, describe their knowledge of these activities.

4. Please describe how well the applicant communicates with:
a. individuals, small and large groups

b. State, Federal, and tribal agency staff

c. people in their community

d. people in the region

5. Please describe the applicant’s leadership ability and his/her ability and experience with
local, regional, and statewide organizations.

In accordance with the Privacy Act (5 U.S.C. 552a) and the Paperwork Reduction Act (44 U.S.C. 3501), please note the following
information. This information collection is authorized by the Alaska National Interest Lands Conservation Act and associated
regulations. The Federal Subsistence Board will use information that you provide to make recommendations to the Secretaries of
the Interior and Agriculture for appointment of members to the Federal Subsistence Regional Advisory Councils. It is our policy not
to use your name for any other purpose. We will maintain this information in accordance with the Privacy Act, but may release it
under a Freedom of Information Act request (5 U.S.C. 552). Your response is voluntaryt. We may not conduct or sponsor and you
are not required to respond to an information collection unless it displays a currently valid OMB control number. OMB has approved
this information collection and assigned OMB Control No. 1018-0075. The relevant burden for completing this form is 15 minutes.
This burden estimate includes time for reviewing instructions and the interview. You may direct comments regarding the burden
estimate or any other aspect of the form to the Service Information Collection Clearance Officer, Fish and Wildlife Service, Mail Stop
222, Arlington Square, U.S. Department of the Interior, 1849 C Street, NW., Washington D.C. 20240.

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FWS Form 3-2323
REV 10/09