Form DS-4131 Advance Notification Form

U.S. Department of State

ADVANCE NOTIFICATION FORM

OMB APPROVAL NO. 1405-0181
EXPIRES: XX/XX/20XX
ESTIMATED BURDEN: 9.0 HOURS

TOURIST AND OTHER NON-GOVERNMENTAL ACTIVITIES IN THE ANTARCTIC TREATY AREA
This information is requested in furtherance of U.S. obligations under Article VII(5)(a) of the Antarctic Treaty of 1959,
and consistent with Antarctic Treaty Consultative Meeting Recommendation XVIII-1. Information below should be
submitted no later than three months prior to intended travel to the Antarctic Treaty Area. Responses will facilitate a
determination of U.S. jurisdiction over the activity and permit timely dissemination of expedition information to Treaty
Parties and the Antarctic Treaty Secretariat's public Electronic Information Exchange System.
All U.S. nationals organizing expeditions to Antarctica, and all persons organizing expeditions proceeding to Antarctica
from the United States, should submit this form to the U.S. Department of State as indicated below. Providing this
information is voluntary. However, failure to provide the information requested on this form may prevent the U.S. from
being able to comply with a Treaty obligation that mandates notice to other parties of Antarctic travel plans. The
Department of State may share information on this form with other federal agencies and with Treaty Parties to the
Antarctic Treaty (AT), to ensure we have fulfilled our obligations under the AT to notify other Treaty Parties of the
specifics of each intended expedition to the Antarctic zone. The information provided will be shared with the U.S.
Environmental Protection Agency to ensure compliance with 40 CFR (Code of Federal Regulations) Part 8,
Environmental Impact Assessment (EIA) of Nongovernmental Activities in Antarctica, the U.S. National Science
Foundation to ensure compliance with the Antarctic Conservation Act (ACA), as amended, 16 U.S.C. § 2401, et seq.,
and with other relevant U.S. and foreign government agencies, including the Antarctic Treaty Secretariat, for law
enforcement, search and rescue, administrative purposes, and/or public awareness. More information on the Routine
Uses for the system can be found in the System of Records Notice, State-77, Country Clearance Records.
Include attachments for responses that require more space than the form provides. If an organizer is planning more
than one expedition, details specific to each individual expedition should be provided as attachments to this form. Each
organizer should prepare only one Advance Notification form. The signed completed form should be submitted to the
Senior Advisor for Antarctica, Office of Ocean and Polar Affairs, Room 2665, Bureau of Oceans, Environment and
Science, U.S. Department of State, 2201 C Street NW, Washington DC 20520 or emailed to [email protected].
NOTE: For the purposes of this form, "expeditions to Antarctica" include activities south of Sixty degrees South Latitude,
excluding commercial fishing voyages. Crew includes an expedition's captain and officers, helicopter pilots, and deck,
engine, and hotel/catering staff. Expedition staff include guides, lecturers, and small boat drivers who are not otherwise
counted as crew. Passengers include other persons accompanying the expedition, but exclude national representatives
or observers.
Expedition Organizer
1. Name of Expedition Organizer (Company, entity, or person(s) as appropriate)

2. Expedition Organizer's Contact Person

3. Mailing Address (Please also provide physical address if using a post office box)

4. Nationality of Expedition Organizer

5. Principal Place of Business (Home office)

6. Total Number of Expedition Staff per Excursion

7. International Phone

8. International Fax

9. Explain activities undertaken by the organizer, including, for example, acquiring the use of vessel or aircraft, hiring expedition staff, or planning
itineraries.

10. Explain if the organizer maintains substantial ties to a country or countries other than the United States; for example, a U.S. national who habitually
resides in another country, or a company which is the subsidiary of an entity incorporated in or with other substantial ties to another country.

DS-4131
03-2021

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11. Explain whether any organizing activities will be or are being performed by a party or parties other than the named expedition organizer; e.g., a
sub-charter. Identify the nationality of individuals or commercial entities to whom the expedition organizer has delegated specified organizational
responsibilities.

12. Describe where the organizing activities conducted prior to the expedition will be or are being performed.

13. Arrangements for self-sufficiency and contingency plans including for medical evacuations and search and rescue in the event of an emergency.

Expedition Vessel(s)
14. Ship/Aircraft Registered Name

15. Ship/Aircraft Type

16. Country of Registration

17. Ship Ice Rating and Classification Society (If applicable)

18. Ship/Aircraft Call Sign

19. (Check one)
Ship

Yacht

Aircraft

20. Maximum Number of Passengers

21. Maximum Number of Crew

22. Radio Frequency(ies) Monitored

23. INMARSAT/Other Number(s)

24. Captain's/Commander's Name(s)

25. Ship/Aircraft E-mail Address(es)

Other

Expedition Details
26. Planned Port of Embarkation

27. Planned Date of Embarkation (mm-dd-yyyy)

28. Planned Port of Disembarkation

29. Planned Date of Disembarkation (mm-dd-yyyy)

30. Planned Cruise/Flight Number or Voyage Name

31. Estimated Number of Passengers to be Carried per Excursion

32. Proposed itinerary with dates and places to be visited. Include a proposed itinerary for all expeditions that will proceed south of 60 degrees South
Latitude, even if there is no intention for individuals to disembark onto land. Include information about activities to be undertaken and the purpose of
those activities.

Signature of Tour/Expedition Organizer

DS-4131

Date (mm-dd-yyyy)

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