1028-0082 BBL Permit Application form

OMB Control #_1028-0082
Approval expires:1/31/2024

U.S. GEOLOGICAL SURVEY
PWRC – BIRD BANDING LABORATORY
12100 BEECH FOREST ROAD, STE-4037
LAUREL, MD 20708-4037

DO NOT FILL THIS BLOCK
SFR
Applic. No.

RF

Date Sent

SP a b c d e f g h

APPLICATION FOR FEDERAL
BIRD BANDING OR MARKING PERMIT
1. APPLICANT’S NAME – (Last, first, middle initial)

ST

NE

SP
1a.

NEW PERMIT

2. BIRTH DATE
(mm/dd/yyyy)

Renewal Permit # ____________

3. HEIGHT _____ ft. _____ in.

WEIGHT ______ lbs.

4. HOME ADDRESS AND ZIP CODE – (

HAIR COLOR ___________

Use this address for
correspondence)

EYE COLOR

GENDER

5. BUSINESS ADDRESS AND ZIP CODE -- (

) _______-____________

Phone Number: Area Code (

)_______-__________

Fax Number: Area Code

) _______-____________

Fax Number: Area Code

) _______-__________

x

Email address:

Email address:

6. TYPE OF PERMIT APPLIED FOR:

(

F

Use this address for
correspondence)

Phone Number: Area Code (

(

M

6a. NAME AND ADDRESS OF SPONSORING ORGANIZATION

Master-Personal (do not complete item 6a)
Master-Station (Complete item 6a)

7. DO YOU PRESENTLY POSSESS, HAVE YOU EVER POSSESSED, OR DO YOU HAVE APPLICATIONS PENDING FOR OTHER
FEDERAL MIGRATORY BIRD PERMITS?
NO
YES (if “yes” give type of permit, number, date of issue, expiration and/or application)

8. DO YOU WISH TO HAVE BLOOD SAMPLING AUTHORIZED?

NO

YES (if yes, please provide the following information.)

Name and permit number of Master Permittee requiring permission:

Species _________________________________________________

______________________________________________________
Master Permittee
Permit #

Site of blood draw or technique ______________________________
_______________________________________________________
Volume of blood to be taken? _______________________________

Why is blood needed? How will it be used? _____________________________________________________________________________
_____________________________________________________________________________

Applicant’s qualifications for blood sampling (or attach a resume of experience, indicating dates, locations, trapping technique, species, number of
birds handled, etc.).

9. DO YOU WISH TO HAVE FEATHER SAMPLING AUTHORIZED?

NO

YES (if yes, please provide the following information.)

Name and permit number of Master Permittee requiring permission:

Species _________________________________________________

_______________________________________________________
Master Permittee
Permit #

What feathers will be taken and how many? ___________________
_______________________________________________________

Why are feathers needed? How will they be used? _______________________________________________________________________
_______________________________________________________________________
Applicant’s qualifications for feather sampling (or attach a resume of experience, indicating dates, locations, trapping technique, species, number of
birds handled, etc.).

10. SPECIES YOU PLAN TO BAND/MARK – by groups
a. Waterfowl – ducks, geese and swans
b. Doves and pigeons
c. Passerines and near-passerines

e. “Endangered/threatened” species – those designated by the Secretary of the
Interior as endangered/ threatened. Specify which species:
_________________________________________________________________
f. Eagles – bald and/or golden
g. All raptors except eagles or “endangered/threatened”

d. Shorebirds
h. Other. Specify: ________________________________________________

11. INDICATE STATES OR COUNTRIES OTHER THAN YOUR STATE/COUNTRY OF RESIDENCE IN WHICH YOU WISH TO BAND
BIRDS – (Attach a brief statement of your need to band in any non-resident state.)

OMB Control #_1028-0082
Approval expires:3/31/2019

12. DO YOU WISH TO HAVE AUTHORIZATION TO USE:

MIST NETS
ROCKET NETS
CANNON NETS

Yes
Yes

No
No

Yes

No

If “yes” to any of the above, please attach a resume with your experience with such nets. Please list all other capture techniques you intend to use.

13. DO YOU WISH AUTHORIZATION AT THIS TIME TO USE AUXILIARY MARKERS IN ADDITION TO THE STANDARD
NUMBERED METAL LEG BAND?
NO
YES (if yes, please provide the following information)
Name and permit number of Master Permittee requiring permissions:

_______________________________________________
Master Permittee
Permit #

Species ____________________________________________________

Techniques used ____________________________________________

Types of marker used ________________________________________
Why are auxiliary markers needed? How will they be used? _________________________________________________________________
_________________________________________________________________________________________________________________

Applicant’s qualifications for auxiliary markers (or attach a resume of experience, indicating dates, locations, trapping technique, species, number of
birds handled, etc.)

14. ATTACH A ONE-PAGE DESCRIPTION OF WHAT YOU HOPE TO ACCOMPLISH BY BANDING BIRDS.
Permits are only issued for management banding and original research beneficial to the public and U.S. Geological Survey.

15. REFERENCES – (List names, email addresses and complete mailing addresses of at least three licensed bird banders or other ornithologists
whom we may consult concerning your qualifications for a federal bird marking permit. Preferably, they should have worked with you in the field as a
bander.)

NOTICE
In accordance with the Paperwork Reduction Act (PUB.L. 96-511), Privacy Act of 1974 (PUB.L. 93-579), please be advised that:
1.
2.
3.
4.

5.

The gathering of information on migratory birds and their uses is authorized by the Migratory Bird Treaty Act (16 U.S.C. 703-711) and the Fish
and Wildlife Act of 1956 (16 U.S.C. 742d). The requested information is required as a condition of your migratory bird permit.
Information from this application will be used to further the understanding, management, and utilization of the North American migratory bird
resource, by Federal, State, and private conservation organizations, and the Canadian Wildlife Service.
Failure to answer any questions fully may be sufficient cause for the U.S. Geological Survey to deny your permit. Your participation in the survey
is voluntary.
In the event there is an indicated violation of a statute, regulation, rule, order, or license, whether civil, criminal, or regulatory in nature, the
requested information may be transferred to the appropriate Federal, State, local, or foreign agency charged with investigating or prosecuting such
violations.
In the event of litigation involving the records of the subject matter of the records, the requested information may be transferred to the U.S.
Department of Justice.

PAPERWORK REDUCTION ACT STATEMENT: A Federal 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. It is our policy not to use your name for any purpose other than
completing our banding records. All names and identifying information are protected by the Privacy Act of 1974. Your response is required to obtain
a benefit in the form of a permit. We estimate that it will take you about 30 minutes to read the instructions and fill in the requested information.
Comments regarding this collection of information should be directed to: The Bureau Clearance Officer, U.S. Geological Survey, 12201 Sunrise
Valley Drive, MS160, Reston, Virginia 20192. Thank you for your cooperation.

PRIVACY ACT STATEMENT:
AUTHORITY: The Migratory Bird Treaty Act (16 U.S.C. § 703-712) and the Bald and Golden Eagle Protection Act (16 U.S.C. § 668-668d).
PRINCIPAL PURPOSE: The principal purpose for collecting the information is to manage banding permits and sub permits issued by the Bird
Banding Laboratory (BBL), and to provide contact information for Certificates of Appreciation and other rewards to people who report bird bands
to the BBL.
ROUTINE USE: To manage banding permits and sub permits issued by the BBL that authorizes bird banding activities in the United States and its
Territories, and for other necessary actions required to manage and maintain the United States bird banding program within the intent of the
authorizing legislation. Contact information will be shared with Canadian, Federal and state agencies upon request. Contact information will be
shared with the approved bird bander for the purpose of providing the bander the opportunity to obtain additional information if needed.
DISCLOSURE IS VOLUNTARY: All information is voluntary. Individuals have the option to not provide the contact information. Individuals
applying for banding permits will not be allowed to participate in the program if contact information is declined. Those reporting a bird band to the
BBL do not have to provide contact information to report encounters.

I hereby certify that I have read and am familiar with the regulations contained in Title 50, Parts 13 & 21, of the Code of Federal Regulations and the
other applicable parts in Subchapter B of Chapter 1 of Title 50, and I further certify that the information submitted in this application for a permit is
complete and accurate to the best of my knowledge and belief. I have not been convicted of, entered a plea of guilty or nolo contendere for a felony
violation of the Lacey Act, Migratory Bird Treaty Act, or the Bald and Golden Eagle Protection Act. I understand that any false statement herein may
subject me to the criminal penalties of 18 U.S.C. 1001. I realize that I must comply with the rules and requirements in the Bird Banding Manual and
that marking and/or salvaging birds requires a significant amount of my time if a permit is issued. I agree to maintain and submit data promptly and in
the prescribed format, to cooperate fully with the U.S. Geological Survey in the Bird Marking Program, and to abide by the terms and limitations of
that permit.

___________________________________________________________ ___________________________________________________________
Signature
Date