Form 3-1552 Native American Tribal Eagle Retention

FWS Form 3-1552 (Rev. 02/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION

OMB Control No. 1018-0167
Expires 07/31/2023

Native American Tribal Eagle Retention
(Bald and Golden Eagle Protection Act; 50 CFR 22;
50 CFR 22.60; 25 USC 479a-1; 42 USC 1996)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

SELECT YOUR TYPE OF REQUEST

BEFORE FILLING OUT THIS FORM, please access
the Return Addresses (to obtain the email/postal
addresses where this form can be returned).

New Application
Update Contact Information

If updating contact information, provide permit number:
Name of Federally Recognized Tribe:
A.

1.a. Last name

.
Complete
for the Tribal Leader (e.g. Governor or Chief) of your Federally Recognized Tribe

2. Title (Governor or Chief, etc.)

B.

1.c. Middle name or initial

1.b
1. First name

3.a. E-mail address

1.d. Suffix

3.d. Alternate Telephone Number

3.b. Telephone number

Complete for the Primary Contact Person
(The US Fish and Wildlife Service, Office of Law Enforcement will communicate with this tribal member for
questions related to the official transfer of possession of eagle remains.)

4.a. Primary Contact Last name.

4.b. Primary Contact First Name

5. Primary Contact's Business Telephone Number

C.

6. Contact's Alternate Telephone Number

7. Business e-mail address

Tribal Office Information

8. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
9. City

10. State

11. Zip code/Postal code:

12. County/Province

13. Country

14. Mailing Address (include if different than physical address; include name of contact person if applicable)
15. City

D.

16. State

17. Zip code/Postal code:

18. County/Province

19. Country

Tribal Leader Identified in Box A. Must Read and Sign

1. Processing fee: This application has no processing fee.
2. Certification: I hereby certify that I have read and am familiar with the regulations contained in Title 50, Part 13 of the Code of Federal Regulations and
the other applicable parts in subchapter B of Chapter I of Title 50, and I certify that the information submitted in this application for a permit is complete and
accurate to the best of my knowledge and belief. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001.

Signature of the Principal Officer (No stamped signatures. Electronic signatures accepted.)

Date of signature (mm/dd/yyyy)

Page 1 of 3

FWS Form 3-1552 (Rev. 02/2020)
U.S. Department of the Interior

OMB Control No. 1018-0167
Expires 07/31/2023

Section E.
Note: A Federal Eagle Remains Tribal Use permit authorizes a federally recognized tribe to acquire,
possess, and distribute to tribal members whole eagle remains found by a tribal member or employee on
the tribe's tribal land for Indian religious use. The applicant must be a federally recognized tribal entity
under the Federally Recognized Tribal List Act of 1994, 25 U.S.C. 479a-1, 108 Stat. 4791 (1994). The
Tribal Leader's signature on the application affirms that the tribe is requesting eagle(s) for tribal religious
purposes.
Please provide the information requested below.
1. Has a tribal member or employee already discovered an eagle the tribe wishes to retain?
Yes
No
2. You must retain records legibly written or reproducible in English relating to the activities conducted
under your permit for at least 5 years after the date of expiration of your permit. Is the physical
address you provided in Section C on page 1 of this application the address where your records will
be kept?
Yes
No
If "no", provide physical address:

Please read the notices on the next page. Do not send the next page back to USFWS.

Page 2 of 3

OMB Control No. 1018-0167
Expires 07/31/2023

FWS Form 3-1552 (Rev. 02/2020)
U.S. Department of the Interior

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 that 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
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. 1018-0167.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 3.5 hours for the application and 30 minutes for recordkeeping,
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: PRB (JAO/3W), 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].

Page 3 of 3