Depredation Order Report Form

FWS Form 3-2436 (Rev. 12/2018) OMB Control. No. 1090-0011

U.S. Fish and Wildlife Service Expiration Date: 10/31/2021

Annual Report – Depredation and Control Orders

Migratory Bird Permit Office

Click here for Return Addresses

See the instructions on the following page for Order numbers and specific reporting requirements by Order. Continue on additional sheet(s) as needed.

Depredation/Control Order Number: 21. ___ ___

Reporting Person or Organization: ­­­­­­­­­­­­­­­­­­­________________________________________________________________

Mailing Address: __________________________________________________________City__________________ State _____ Zip _______

Telephone Number:_______________ Email Address: _________________________________ Report for Calendar Year___________

Species (include non-target species)	Number Taken	Take Method	Month	State	County (HI: Use Island)	Purpose of the Take	Disposition (e.g. left in place, buried, trash, rehabilitation, donation)

I certify that the information in this report is true and correct to the best of my knowledge. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001.

Signature: _______________________________________________________________ Date: ______________________________________

INSTRUCTIONS.

Depredation Orders and Control Orders authorize the take of migratory birds without a permit in certain circumstances. The regulation outlines the purpose of take, who can take, and the species, method, location, and other restrictions on take. Annual reports are required for most Orders. Below is a summary of the reporting requirements for each Order. The regulations governing Depredation and Control Orders are located in 50 CFR 21.43-21.55 and can be found online at Title 50, Volume 9, Part 21 of the ECFR.

Submit annual reports to your Regional Migratory Bird Permit Office by January 31 for activities conducted the previous calendar year (January 1 and December 31). Use of this form is not mandatory, but you must submit the information required in the regulation and the certification statement on the form.

Regulation	Order Name	Due Date	Required Report Information	Methods of Take Authorized
21.43	Depredation order for blackbirds, cowbirds, crows, grackles, and magpies	1/31	Species, Number, Method, Month, State, County, Purpose, Disposition (50 CFR 21.43(i))	Shoot, trap/kill, trap/release
21.44	Depredation order for horned larks, house finches, and white-crowned sparrows in California.	1/31	Species, Number, Method, Month, State, County, Purpose, Disposition (50 CFR 21.44(e))	Shoot, trap/kill, trap/release
21.46	Depredation order for depredating scrub jays and Steller’s jays in Washington and Oregon	1/31	Species, Number, Method, Month, State, County, Purpose, Disposition (50 CFR 21.46(f))	Shoot, trap/kill, trap/release
21.49	Control order for resident Canada geese at airports and military airfields	12/31	Species, Number, Method, Month, State, County (50 CFR 21.49(d)(8))	Shoot, trap/kill, trap/release, Egg destroy
21.50	Depredation order for resident Canada geese nests and eggs	n/a	REGISTRATION REQUIRED. Use the Resident Canada Goose Registration system at: https://epermits.fws.gov/ercgr/
21.51	Depredation order for resident Canada geese at agricultural facilities	n/a	NO REPORT REQUIRED.
21.52	Public health control order for resident Canada geese	12/31	Species, Number, State, County (50 CFR 21.52(e)(9))	Shoot, trap/kill, trap/release, Egg destroy
21.53	Control order for purple swamphen	n/a	NO REPORT REQUIRED.
21.54	Control order for Muscovy ducks in the United States	n/a	NO REPORT REQUIRED.
21.55	Control order for invasive migratory birds in Hawaii	1/31	Species, Number, Method, Month, State, and Island (50 CFR 21.55(i))	Shoot, trap/kill, trap/release, Egg destroy

Note: Missing regulation numbers are intentional. There is currently no regulation 21.42, 21.45, 21.47 or 21.48.

NOTICES

PRIVACY ACT STATEMENT

Authority: The information requested is authorized by the following: the Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22; the Endangered Species Act (16 U.S.C. 1531-1544), 50 CFR 17; the Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21; the Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15; the Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16; Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), 50 CFR 23; General Provisions, 50 CFR 10; General Permit Procedures, 50 CFR 13; and Wildlife Provisions (Import/export/transport), 50 CFR 14.

Purpose: The collection of contact information is to verify the individual has an eligible permit to conduct activities which affect protected species. The information the individual provides helps the FWS monitor and report on protected species and assess the impact of permitted activities on the conservation and management of species and their habitats.

Routine Uses: The collected information may be used to verify an applicant’s eligibility for a permit to conduct activities with protected wildlife; to provide the public and the permittees with permit related information; to monitor activities under a permit; to analyze data and produce reports to monitor the use of protected wildlife; to assess the impact of permitted activities on the conservation and management of protected species and their habitats; and to evaluate the effectiveness of the permit programs. More information about routine uses can be found in the System of Records Notice, Permits System, FWS-21.

Disclosure: The information requested in this form is voluntary. However, submission of requested information is required to process applications for permits authorized under the listed authorities. Failure to provide the requested information may be sufficient cause for the U.S. Fish & Wildlife Service to deny the request.

PAPERWORK REDUCTION ACT STATEMENT

In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to monitor take and disposition of migratory birds, under the applicable laws governing the requested activity, for which a permit is requested, and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. Information requested in this form is purely voluntary. However, submission of requested information is required in order to process applications for permits authorized under the above laws. Failure to provide all requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. According to the Paperwork Reduction Act of 1995, 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 OMB control number. OMB has approved this collection of information and assigned Control No. 1090-0011.

ESTIMATED BURDEN STATEMENT

The relevant burden for a Depredation and Control Order report is 4 hours (2 hours for reporting and 2 hours for recordkeeping). This burden estimate includes time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: BPHC, Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.

FREEDOM OF INFORMATION ACT

For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request that you identify any information that should be considered privileged and confidential business information to allow the Service to meet its responsibilities under FOIA. Confidential business information must be clearly marked "Business Confidential" at the top of the letter or page and each succeeding page and must be accompanied by a non-confidential summary of the confidential information. The non-confidential summary and remaining documents may be made available to the public under FOIA [43 CFR 2.26 – 2.33].