Information Collection

(ePermits) Form 3-2541: 6(a)(2) Adverse Incident Report

IC 247430 under ICR 202105-1018-003 · OMB 1018-0182.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1018-0182 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3-2541 (ePermits) Form 3-2541: 6(a)(2) Adverse Incident Report	Form
3-2541 6(a)(2) Adverse Incident Report 3-2541 6(a)(2) Adverse Incident Report Form 05172021.docx fwsepermits.servicenowservices.com/fws/	Form
3-2541 6(a)(2) Adverse Incident Report 3-2541 6(a)(2) Adverse Incident Report Form 05172021.docx fwsepermits.servicenowservices.com/fws/	Form

IC Title:

(ePermits) Form 3-2541: 6(a)(2) Adverse Incident Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3-2541	6(a)(2) Adverse Incident Report	3-2541 6(a)(2) Adverse Incident Report Form 05172021.docx	https://fwsepermits.servicenowservices.com/fws/	Yes	Yes	Fillable Fileable Signable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records

Title: INTERIOR/FWS-21, Permits System

FR Citation: 68 FR 52610

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.