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

OMB Control No. 1018-0075
Expires 06/30/2019

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. 03/2017

OMB Control No. 1018-0075
Expires 06/30/2019

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.

Paperwork Reduction Act Statement: We are collecting this information subject to the Privacy Act (5 U.S.C.
552a) and Paperwork Reduction Act (44 U.S.C. 3501. 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 voluntary, but is required to obtain or
retain a benefit. We may not conduct or sponsor and you are not required to respond to this or any other Federal
agency-sponsored information collection unless it displays a currently valid OMB control number. OMB has
approved this information collection and assigned OMB Control No. 1018-0075.
Estimated Burden Statement: Public reporting burden for this form is estimated to average 15 minutes per
response including the time it takes to read, gather and maintain data, review instructions and complete the form.
You may direct comments regarding this burden estimate, or any aspects of this form, to the Service Information
Collection Clearance Officer, Division of Policy, Performance, and Management Programs, U.S. Fish and Wildlife
Service, 5275 Leesburg Pike, Falls Church, VA 22041-3803. Please do not send your completed form to this
address.
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FWS Form 3-2323
Rev. 03/2017