3-2323 Regional Advisory Council Reference and Key Contact Inte

FWS Form 3-2323 (Rev. 05/2018)
U.S. Fish and Wildlife Service

OMB Control No. 1018-0075
Expires ##/##/2022

APPLICATION/NOMINATION FORM
Regional Advisory Council Reference and
Key Contact Interview

Applicant: ___________________________________________
Panelist: ___________________________________________
Date: _______________________________________________
Before beginning the interview with the key contact or reference, let them know that there are five questions and
that the interview may take 15 minutes or less. If the contact or reference does not know the applicant or does not
want to participate, thank them for their time and close the interview.

____Reference

Name:

____ Key Contact

(Please check whichever applies.)

___________________________________________________

Organization:

_____________________________________________

Title:

____________________________________________________ Number of years in
region: ______________

1. Please describe the applicant’s knowledge of your region’s fish and wildlife resources.

2. Please describe the applicant’s knowledge of your region’s customary and traditional subsistence
practices.
Does the applicant participate in subsistence practices? If the answer
is no, describe their knowledge of practices.

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FWS Form 3-2323 (Rev. 05/2018)
U.S. Fish and Wildlife Service

OMB Control No. 1018-0075
Expires ##/##/2022

3. Please describe the applicant’s knowledge of your region’s commercial, sport, and other activities.
Does the applicant participate in commercial, sport, and other activities? If the answer is no, describe their
knowledge of these activities.

4. Please describe how well the applicant communicates with:
a. individuals, small and large groups

b. State, Federal, and tribal agency staff

c. people in their community

d. people in the region

5. Please describe the applicant’s leadership ability and his/her ability and experience with local, regional, and
statewide organizations.

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FWS Form 3-2323 (Rev. 05/2018)
U.S. Fish and Wildlife Service

OMB Control No. 1018-0075
Expires ##/##/2022

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the Alaska National Interest Lands Conservation Act; 36 CFR 242 and 50 CFR
100.
Purpose: The applicant’s information will be used to evaluate their qualifications and experience for the potential selection to serve as
a member on one of the Federal Subsistence Regional Advisory Councils.
Routine Uses: The Federal Subsistence Board will use the provided information to make recommendations to the Secretaries of
Interior and Agriculture for the appointment of members to the Federal Subsistence Regional Advisory Councils. More information
about routine uses can be found in the System of Records Notice, Permits System, FWS-21.
Disclosure: Providing the information is voluntary, but required to obtain or retain a benefit.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to
make recommendations to the Secretaries of the Interior and Agriculture for appointment of members to the Federal Subsistence
Regional Advisory Councils. It is our policy not to use your name for any other purpose. Your response is voluntary, but is required to
obtain or retain a benefit. 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. 1018-0075.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Service Information Collection Clearance Officer, Division of Policy, Performance, and
Management Programs, Fish and Wildlife Service, Mail Stop BPHC, 5275 Leesburg Pike, Falls Church, VA 22041-3803, or via email at
[email protected]. Please do not send your completed form to this address.

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