3-202-55g USFWS Sea Turtle Rehabilitation Quarterly Report Rev 01-

FWS Form 3–202–55g

Sea Turtle Rehabilitation Quarterly Report
Turtle Facility:

Turtle Facility ID #

Turtle Facility Address:

City, State:
FWS Permit Number:

State Authorization Number:

Reporter Name:

Veterinarian Name:

Stranding (STSSN)
ID Number

Species:

Date Received
at Facility:

Current Curved
Medically Cleared Medically
Carapace Length (cm): for Release?
Cleared Date:
No

Date
Released:

PIT Tag 
Number:

Stranding (STSSN)
ID Number

Species:

Flipper Tag 
Number ‐ Left:

Date Received
at Facility:

Flipper Tag 
Number ‐ Right:

If not Medically
Cleared, Prognosis:

Current Curved
Medically Cleared Medically
Carapace Length (cm): for Release?
Cleared Date:
No

Date
Released:

PIT Tag 
Number:

Stranding (STSSN)
ID Number

Species:

Flipper Tag 
Number ‐ Left:

Date Received
at Facility:

Flipper Tag 
Number ‐ Right:

If not Medically
Cleared, Prognosis:

Current Curved
Medically Cleared Medically
Carapace Length (cm): for Release?
Cleared Date:
No

Date
Released:

PIT Tag 
Number:

Stranding (STSSN)
ID Number

Species:

Flipper Tag 
Number ‐ Left:

Date Received
at Facility:

Flipper Tag 
Number ‐ Right:

If not Medically
Cleared, Prognosis:

Current Curved
Medically Cleared Medically
Carapace Length (cm): for Release?
Cleared Date:
No

Date
Released:

PIT Tag 
Number:

Flipper Tag 
Number ‐ Left:

Flipper Tag 
Number ‐ Right:

If not Medically
Cleared, Prognosis:

Required “Notices” on FWS Sea Turtle Forms
In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and
the Privacy Act of 1974 (5 U.S.C. 552a), please be advised:
1. The gathering of information on fish and wildlife is authorized by:
(Authorizing statutes can be found at: http://www.gpoaccess.gov/cfr/index.html and
http://www.fws.gov/permits/ltr/ltr.html.)
a. Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50CFR 17;
c. Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;
d. Convention on International Trade in Endangered Species of Wild Fauna and
Flora (TIAS 8249), http://www.cites.org/, 50 CFR 23;
e. General Provisions, 50 CFR 10;
f. General Permit Procedures, 50 CFR 13; and
g. Wildlife Provisions (Import/export/transport), 50 CFR 14.
2. 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. We
may not conduct or sponsor and you are not required to respond to a collection of
information unless it displays a currently valid OMB control number.
3. Certain applications for permits authorized under the Endangered Species Act of
1973 (16 U.S.C. 1539) will be published in the Federal Register as required by the
two laws.
4. Disclosures outside the Department of the Interior may be made without the consent
of an individual under the routine uses listed below, if the disclosure is compatible
with the purposes for which the record was collected. (Ref. 68 FR 52611, September
4, 2003)
a. Routine disclosure to subject matter experts, and Federal, tribal, State, local, and
foreign agencies, for the purpose of obtaining advice relevant to making a
decision on an application for a permit or when necessary to accomplish a FWS
function related to this system of records.
b. Routine disclosure to the public as a result of publishing Federal Register notices
announcing the receipt of permit applications for public comment or notice of the
decision on a permit application.
c. Routine disclosure to Federal, tribal, State, local, or foreign wildlife and plant
agencies for the exchange of information on permits granted or denied to assure
compliance with all applicable permitting requirements.
d. Routine disclosure to the Department of Justice, or a court, adjudicative, or other
administrative body or to a party in litigation before a court or adjudicative or

administrative body, under certain circumstances.
e. Routine disclosure to the appropriate Federal, tribal, State, local, or foreign
governmental agency responsible for investigating, prosecuting, enforcing, or
implementing statutes, rules, or licenses, when we become aware of a violation
or potential violation of such statutes, rules, or licenses, or when we need to
monitor activities associated with a permit or regulated use.
f. Routine disclosure to a congressional office in response to an inquiry to the office
by the individual to whom the record pertains.
g. Routine disclosure to the Government Accountability Office or Congress when
the information is required for the evaluation of the permit programs.
5. For individuals, personal information such as home address and telephone number,
financial data, and personal identifiers (social security number, birth date, etc.) will be
removed prior to any release of the application.
6. The public reporting burden on the applicant for information collection varies
depending on the activity for which a permit is requested. The relevant burden for
completion of this form is 0.5 hours. This burden estimate includes time for reviewing
instructions, gathering and maintaining data and completing and reviewing the form.
You may direct comments regarding the burden estimate or any other aspect of the
form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service,
MS: BPHC, 5275 Leesburg Pike, Falls Church, VA 22041-3803.