Fs-2800-22D Paleontological Specimen Data Form

FS-2800-22D (REV-02/17)

OMB 0596-0082

Office Use Only

Authorization Number:

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United States Department of Agriculture

Forest Service

Paleontological Specimen Data Form

For each specimen collected (or observed, if specimen was not collected) provide the following information (form template may be duplicated as necessary):

1. Repository Name and Address: Click here to enter text.	2. Repository Institutional Acronym: Click here to enter text.
3. Repository official name, title, and contact information: Click here to enter text.
4. Field number: Click here to enter text.	5. Specimen identification: Click here to enter text.
6. Locality name/number: Click here to enter text.	7. GPS information: Click here to enter text.
8. Attach 1:24,000 scale topographic map depicting location of specimen/locality; include map name, source, size, edition, projection, datum, and/or other mapping information.
9. Repository accession number: Click here to enter text.	10. Repository catalog number: Click here to enter text.
11. Notes regarding specimen condition and curatorial needs related to condition: Click here to enter text.

BURDEN & NON-DISCRIMINATION STATEMENT

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 valid OMB control number. The valid OMB control number for this information collection is 0596-0082. The time required to complete this information collection is estimated to average 6.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern the confidentiality to be provided for information received by the Forest Service.

INSTRUCTIONS:

Completing the Paleontological Specimen Data Form

For each specimen collected (or observed, if specimen was not collected) provide the following information (form template may be duplicated as necessary): This data table was designed to facilitate recording of data for individual specimens. However, data may also be entered for single localities from which aggregates of taxa and/or individuals were collected in bulk. Data for specimens and/or localities may be entered in the provided data form, or may be submitted in an alternative digital format, such as an ArcMap shapefile or GPS field unit data dictionary, provided that such digital format contains all the requested information and is compatible with data management systems in use by the Forest Service paleontological resources management program.

1. Repository Name and Address: Enter the name and correspondence address of the repository institution. Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

2. Repository Institutional acronym: Enter the standard acronym of the repository institution. ex: Yale Peabody Museum of Natural History = YPM

3. Repository official name, title, and contact information: Enter the name, title, and correspondence address of the authorized repository officer who signed the repository agreement. Alternatively, enter “see permit” if a copy of the signed Authorization to Conduct Paleontological Resources Research or Collection containing this information is appended to this report.

4. Field number: Enter the specimen-specific and/or location-specific field number assigned by the collector(s).

5. Specimen identification: identify the taxon and anatomical part(s) to the most detailed extent practicable. If collected in bulk, describe the nature of the assemblage.

6. Locality name/number: Enter the name of the locality or locality number as used in the field and/or field notes to differentiate this collecting area from other areas of collection.

7. GPS information: Provide UTM coordinates for the specimen collection site or the approximate center of the collection locality. Alternatively, one or more digital GIS shape files containing the requested coordinates may be submitted. Digitally-submitted GIS data must be compatible with existing Forest Service software and must be approved in advance by the FS project reviewer. If submitted digitally, the file name(s) should be referenced in this block.

8. Attach 1:24,000 scale topographic map depicting location of specimen/locality; include map name, source, size, edition, projection, datum, and/or other mapping information: Attach hard copy map sheets depicting the specimen collection sites and/or localities, together with the specified map information. One or more digital GIS shape files containing the requested information may be submitted in lieu of hard copy maps. If submitted digitally, the file name(s) should be referenced in this block.

9. Repository accession number: Enter the number assigned by the repository to accession the collection.

10. Repository catalog number: Enter the catalog number assigned by the repository to the specimen or bulk sample.

11. Notes regarding specimen condition and curatorial needs related to condition: Enter any observation(s) related to need for immediate curatorial care which may be required to ensure preservation of the specimen or bulk sample.

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