Information Collection

SHA/CCAA (Application Form 3-200-54) - Individuals

IC 38235 under ICR 201612-1018-005 · OMB 1018-0094.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1018-0094 can be found here:

Documents and Forms

Document Name Document Type
Form 3-200-54 SHA/CCAA (Application Form 3-200-54) - Individuals Form and Instruction
3-200-54 Enhancement of Survival Permits Associated with Safe Har 3-200-54 Rev 12-2016.docx www.fws.gov/forms Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SHA/CCAA (Application Form 3-200-54) - Individuals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 50 CFR 13 and 17

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3-200-54	Enhancement of Survival Permits Associated with Safe Harbor Agreements and Candidate Conservation Agreements with Assurances	3-200-54 Rev 12-2016.docx	http://www.fws.gov/forms	Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title: Permits Sytem--Interior, FWS-21	FR Citation: 68 FR 52610

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	3	2
Annual IC Time Burden (Hours)	15	9	6
Annual IC Cost Burden (Dollars)	250	150	100

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.