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pdfOMB No. 0648-0084; Expires xx/xx/xxxx
Qualifications for Public Display Permits
Instructions: Please submit the following qualifications information with your permit
application. See an example completed form on our website.
Persons authorized as the Principal Investigator (PI; individual overseeing the take or import),
Co-Investigators (CI; team leads for either take or import), and Veterinarians must demonstrate
qualifications commensurate with their duties. If sufficient experience is not provided,
personnel will not be authorized to conduct the proposed activities.
1.
Contact Information
All documentation submitted will be publicly available. DO NOT include personal
information (e.g., social security number, date of birth, or home phone).
Name (first, middle initial, last):
Title:
Affiliation:
Business e-mail address:
Business phone number:
2.
Table 1. Relevant Education
Degree
3.
Major/Field of Study
Institution and Location
Year Received
Relevant Experience
A. Table 2. Relevant Professional History
Job Title
Role
Affiliation
1
Location
(City, State,
Country)
Dates
(MM/YYMM/YY)
OMB No. 0648-0084; Expires xx/xx/xxxx
B. Summary of Experience
Please choose Option 1 (Table) OR Option 2 (Biosketch). Delete the option not used.
Option 1- TABLE. In the table below:
1. List all procedures that you are requesting to perform under any NMFS permit. See
Appendix 1 for a list of commonly used procedures (e.g., transport, restrain, capture).
2.
Do not include procedures for which you have no experience, training or education.
Note you may update your Qualifications Form at any time. Only combine procedures
in the same row for which you have the same experience metrics.
Experience Metrics for each procedure:
a) To the best of your ability, estimate the number of animals, how long you have
been performing the procedure(s) (e.g., hours/months/years), by species and age
class.
b) Most recent year performed.
c) Select the level of experience:
Level 1: I have received education/training in performing this procedure, but have
not successfully performed the procedure.
Level 2: I have performed this procedure while under supervision or training
of an expert (e.g., PI, CI, or veterinarian).
Level 3: I have performed this procedure without supervision by a PI/CI.
Level 4: I am considered an expert in performing this procedure, and I have
supervised or trained others in performing this procedure.
Table 3. Summary of Experience.
Procedures
Experience Metrics: Estimated Number of Animals,
Hours/Months/Years, Species, and Age Class
Most Recent
Year
Performed
Level of
Experience
Option 2- BIOSKETCH
Provide a biosketch describing your experience with all procedures that you are
requesting to perform under any NMFS permit. See Appendix 1 for complete list (e.g.,
transport, restrain, capture). To the best of your ability, include experience metrics to
estimate the number of animals by species and age class and how long you have been
performing the procedure (e.g., months/years, total number of transports).
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OMB No. 0648-0084; Expires xx/xx/xxxx
4.
5.
Avoid vague phrases such as “assisted with,” or “participated in,” which qualify only as
Level 1 experience and will not adequately demonstrate your experience performing the
procedure if you have Level 2 experience or above. You may use the Level 1-4 categories
described in Option 1 to supplement the descriptions of your experience.
Relevant Training, Certificates, or Licenses
Include additional information to support your qualifications including specialized
training (e.g., biopsy sampling, UAS) and certificates or licenses (e.g., diver certification,
Federal Aviation Administration certification) received relevant to the procedures in
Table 3 or your Biosketch. For training, include description of training, year(s) received,
and institution or expert who trained you. For certificates or licenses, include year
received and expiration date. For UAS pilots, include your total flight hours.
Relevant Reports, Publications, or Presentations (Optional; 2 page maximum)
List reports, publications, or presentations to support your qualifications as described
above.
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OMB No. 0648-0084; Expires xx/xx/xxxx
Appendix 1. Take table procedures, by taxa.
Cetaceans
Capture
Captive (maintain or research)
Collect, sloughed skin
Count/survey
Imaging, thermal
Lavage
Measure and weigh
Measure colonic temperature
Observation, behavior or monitoring
Other
Photograph/Video and Photo-Identification
Photogrammetry
Remote vehicle, vessel or amphibious
Remote vehicle, aerial (VTOL or fixed wing)
Restrain
Sample, swab (anal, blowhole, oral, or vaginal)
Sample, blood
Sample, biopsy (skin, blubber, or muscle)
Sample, exhaled air
Sample, biological (milk, urine, fecal, or sperm)
Transport
Ultrasound
Underwater photo/videography
Pinnipeds
Administer drug (IM, IV, IP, subcutaneous, topical)
Anesthesia (injectable sedative or gas [cone, mask,
intubation])
Captive, maintain
Capture
Collect (molt, scat, spew, urine)
Measure and weigh
Observation, (mark resight, monitoring, or behavioral)
Other
Photograph/Video and Photo-Identification
Photogrammetry
Remote vehicle, aerial (VTOL or fixed wing)
Remote vehicle, amphibious or vessel
Restrain (board, cage, hand, or net)
Sample, blood
Sample, biopsy (blubber, skin, or muscle)
Sample (nail, hair, or vibrissae)
Sample, swab (anal, nasal, ocular, oral, fecal, or mucus
membranes)
Sample (milk, fecal [enema or loop], urine, or stomach)
Transport
Ultrasound
Underwater photo/videography
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OMB No. 0648-0084; Expires xx/xx/xxxx
Applicable Laws
This information is required to accompany the Marine Mammal Protection Act
(MMPA) Section 104 public display permit application and is used to determine
whether individuals conducting activities proposed under the requested permit
possess qualifications commensurate with their duties and responsibilities identified
in the application (50 CFR §216.35).
All permit documentation, including the application, qualifications, permit,
amendments, inventory information, reports, and any other associated documents
are considered public information and as such, are subject to the Freedom of
Information Act.
Paperwork Reduction Act Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to,
nor shall a person be subject to a penalty for failure to comply with an information
collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the
information collection has a currently valid OMB Control Number. The approved OMB
Control Number for this information collection is 0648-0084. Without this approval, we
could not conduct this information collection. Public reporting for this information
collection is estimated to be approximately 50 hours per response (i.e., permit application
including qualifications), including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing
the information collection. All responses to this information collection are required to
obtain a permit pursuant to the MMPA and National Environmental Policy Act, and their
implementing regulations. Send comments regarding this burden estimate or any other
aspect of this information collection, including suggestions for reducing this burden to
the Chief, Permits and Conservation Division, Office of Protected Resources, F/PR1,
NOAA/National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD
20910; email [email protected].
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| File Type | application/pdf |
| Author | Amy_Sloan |
| File Modified | 2023-10-13 |
| File Created | 2023-10-13 |