Form 10-1301A IACUC Amendment Form

NPS Form 10-1301A (03/2016)
National Park Service

OMB Control No. 1024-0265
Expiration Date: 06/30/2023

AMENDMENT FORM
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE
Natural Resources Stewardship and Science Directorate
Biological Resources Division
1201 Oakridge Drive, Suite 200
Fort Collins, CO 80525
Telephone: (970) 267-7237 or Email: [email protected]

Date of Submission:
NPS IACUC Project Name:

Ex: IMR_ROMO_Smith_Birds_2019.A3

Principal Investigator (PI) Name:

PI Email:
PI Phone Number:

Original Approval Date:

No

Is this an ongoing project?

Any questions as to whether or not your proposed protocol change requires an amendment, please consult the NPS IACUC. ANIMAL
ACTIVITIES SHOULD NOT BE CONDUCTED UNTIL APPROVAL OF THIS AMENDMENT IS RECEIVED.

No

Are the objectives or intent of the study changing?

Yes

Will the principal investigator remain the same?

No

Are changes to approved procedures or anesthesia drugs planned? Will new procedures be performed?

Yes, Procedures

Will changes to procedures be made that may increase the potential for more than momentary or slight pain or distress to the
animals? OR Is a non-survival surgical procedure being changed to a survival surgical procedure?

If analgesics, sedation, anesthetics will be used, include the name, route, dosage, frequency, duration, monitoring, and recovery.
If anesthesia or other pain relieving methods are not planned, provide justification for withholding them.
For survival surgery additions, also provide pre, peri, and postoperative monitoring information or attach a complete description.

You will need to complete a new Literature Search on page 3 of this form.

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NPS Form 10-1301A (03/2016)
National Park Service

OMB Control No. 1024-0265
Expiration Date: 06/30/2023

No

Will euthanasia method be changed? American Veterinary Medical Association Guidelines for the Euthanasia of Animals

No

Will new species be added for study or as opportunistic or non-target animals? Will the number of approved species be
increased?

No

Do you have new or additional personnel you need to add to your protocol?

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NPS Form 10-1301A (03/2016)
National Park Service

OMB Control No. 1024-0265
Expiration Date: 06/30/2023

ALTERNATIVE SEARCH FOR NEW OR MODIFIED PROCEDURES THAT MAY CAUSE MORE THAN
MOMENTARY OR SLIGHT PAIN AND DISTRESS
Has the NPS AV or another wildlife veterinarian been consulted in developing these procedures?

No

Please provide the date of this consult:

List procedures that may cause more than momentary or slight pain and distress

Alternatives to Painful Procedures Search
Provide a written description of the methods and sources used to determine that proposed procedures are the most refined possible and that
you have considered alternatives to procedures that may cause more than momentary or slight pain or distress to the animal.
For more information and tips for a successful search visit:

USDA Animal Welfare Information Center's Alternatives Literature Searching
Animal Welfare Information Center - IACUC - Wildlife
Databases Searched (2 at a minimum): Agricola
(Hold CTRL to select multiple choices) Altweb
EBSCO
Google Scholar
JStore
Other
Science Direct
Web of Science (Biosis,...)
If OTHER is selected, enter name here:

Date Search Conducted:
Search Strategy:

Years Covered by Search:

USDA Animal Welfare Information Center's Alternative Literature Searching

Please describe what alternatives were considered and discuss, or explain, why these alternatives cannot be used.

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NPS Form 10-1301A (03/2016)
National Park Service

OMB Control No. 1024-0265
Expiration Date: 06/30/2023

Assurance Statement
The information in this Amendment Form is an accurate description of the animal care and use protocol(s) to be used in the described project. All
people handling animals in this project have been, or will be, properly trained in the methods, protocols, and equipment described in this submission
form. All individuals working under this project will comply with the requirements of the Animal Welfare Act, its Regulations and Standards, and the
Interagency Research Animal Committee U.S. Government Principles.
All work proposed herein is designed to minimize pain and distress to the animals, does not unnecessarily duplicate previous experimentation, and
cannot be reasonably conducted using non-animal alternatives.
Please type your full name as your signature
Date:

NOTICES
Privacy Act Statement
General: This information is provided pursuant to Public Law 93-579, Privacy Act of 1974, for individuals completing this form.
Authority: The authority to collect information on the attached form is derived from the 7 U.S.C. Chapter 54, Transportation, Sale, and Handling of
Certain Animals.
Purposes and Uses: The information is being collected for the purpose of reviewing activities related to the care and use of animals and to approve
all research, teaching, and training activities involving vertebrate animals on NPS managed lands and territories. Information from the application may
be transferred to appropriate Federal, State, and local agencies, when relevant to civil, criminal or regulatory investigations or prosecutions.
Disclosure: Providing your information is voluntary, however, failure to provide the requested information may impede the National Park Service the
review of activities related to the care and use of animals and to approve, all research, teaching, and training activities involving vertebrate animals on
NPS managed lands and territories. . If you provide the information, please be advised that the U.S. Criminal Code, Title 18 U.S.C. 1001, provides
that knowingly falsifying or concealing a material fact is a felony that may result in fines of up to $10,000 or 5 years in prison, or both. Deliberately
and materially making false or fraudulent statements on this form will be grounds for not approving your submission
Paperwork Reduction Act Statement
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to
provide the park managers the information needed to decide whether or not to allow the requested
use. All applicable parts of the form must be completed in order for your request to be
considered. You are not required to respond to this or any other Federal agency-sponsored
information collection unless it displays a currently valid OMB control number.
Estimated Burden Statement
The time to complete this form is estimated to be 30 minutes per response. Direct comments regarding this burden estimate, or any aspects of this
form, to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Mail Stop 242, Reston, VA 20192.

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