Form 3-2471 Permission to Inspect and Appraise

OMB Control No. 1018-####
Expiration Date ##/##/####

FWS Form 3-2471 (Rev. 09/2018)
U.S. Fish and Wildlife Service

PERMISSION TO INSPECT AND APPRAISE
U.S. Fish and Wildlife Service
Division of Realty

Property Address or Location:

Property Owner’s (or Representative’s) Name and Contact Information
Contact:

☐ Property owner

☐ Property owner’s representative

Name:

Phone #:

Mailing Address:
(if different from above)

Permission to Inspect Property for Acquisition Purposes

I hereby grant the U.S. Fish and Wildlife Service, its contractors, agents, and all others deemed
necessary by the Service, permission to enter and inspect this property for real estate acquisition
purposes. I understand this inspection may include a physical examination of any structures on the
property, a boundary survey, and/or a hazardous materials examination. I also understand that I am
under no obligation for the cost of the appraisal, survey, contaminant survey, nor to sell my property once
the appraisal is completed.
I would like to be contacted so I may accompany the appraiser on their inspection.
Property owner’s signature

Date

☐ Yes

☐ No

FWS Form 3-2471 (Rev. 09/2018)
U.S. Fish and Wildlife Service

OMB Control No. 1018-####
Expiration Date ##/##/####

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the following: the National Wildlife Refuge System Administration Act of 1966,
16 U.S.C. § 668dd; the Migratory Bird Hunting and Conservation Stamp Act,16 U.S.C. § 718d; the Migratory Bird Conservation Act, 16
U.S.C. 715-715r, as amended; the Fish and Wildlife Act of 1956, 16 U.S.C. §§ 742a-742j; the Uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970, 49 CFR 24; and the Endangered Species Act of 1973, as amended, 16 U.S.C. § 1534.
Purpose: The contact and property information requested is to coordinate reality acquisition activities with the property owner or its
representative.
Routine Uses: The primary uses of the information is to monitor and update the status of land transaction activities with private
property owners who are selling land or land interests to FWS. More information about the routine uses may be found in the System
of Records Notice, FWS-11 Real Property Records.
Disclosure: The information requested is voluntary. While a landowner can decline to provide contact and property information, the
FWS cannot conduct land transaction activities.
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 about the
property owner and location, and grants permission to enter and inspect the property for real estate acquisition purposes, and to
respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. Information requested in this form is
required to obtain or retain a benefit. 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. 1018-####.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 30 minutes for individuals/private sector respondents and 2
hours for government respondents, including 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.