3-1591 Report – Tribal Eagle Retention – Acquisition

FWS Form 3-1591 (Rev. 04/2022)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT REPORT FORM
Tribal Eagle Retention – Acquisition Form

OMB Control No. 1018-0167
Expires ##/##/20##

(Bald and Golden Eagle Protection Act; 50 CFR 22;
50 CFR 22.60; 25 USC 479a-1; 42 USC 1996)

U.S. Fish and Wildlife Service
Division of Migratory Bird Management

(Step 1: to be completed by USFWS OLE and sent to Tribe)
BIRD INFORMATION
Species: _____________________ Band Number or Marking (if applicable): __________________________
Sex: Male

Female

Unknown

Age: Juvenile

Immature

Adult

Location Discovered: ______________________________________________________________________
Latitude: __________________ (Format: DD.ddddd); Longitude: ___________________ (Format: DD.ddddd)
Date Eagle Information was Entered into IMR: ____________________
Date Eagle Discovered: ____________________
Date of Transfer of Eagle to Tribe: ___________________
Name of Tribe: ____________________________________________________________________________
Name of Tribal Contact: ________________________ Contact Phone Number: _________________________

OFFICE OF LAW ENFORCEMENT INFORMATION
Name:

Region:

Address: __________________________________________________________________________________________
City:

State: ___________ Zip: ______________

E-Mail Address: __________________________________
Officer Name (print): __________________________________ Officer Title: _____________________________
Signature of Officer: _________________________________________________ Date of Signature:
(mm/dd/yyyy): _________________
(No stamped signatures. Electronic signatures accepted.)

(Step 2: to be completed by Tribe and sent to Migratory Bird Permit Office)
BEFORE FILLING OUT THIS FORM, please access the Return Addresses (to obtain the
email/postal mail addresses where this form can be returned).
TRIBE INFORMATION
Permit No.:
Date of Acquisition of Eagle: _____________
Principal Officer Name:

Principal Officer Title: _______________________

Address:
City:

State:

Zip:

E-mail Address:

CERTIFICATION. I certify that the information submitted above is true and correct to the best of my knowledge. I understand
that making a false statement may subject me to the criminal penalties of 18 U.S.C. 1001.

Print name:
Signature of Tribal Officer:
(No stamped signatures. Electronic signatures accepted)

Date of Signature:
(mm/dd/yyyy)

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OMB Control No. 1018-0167
Expires ##/##/20##

FWS Form 3-1591 (Rev. 04/2022)
U.S. Department of the Interior

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the Migratory Bird Treaty Act (16 U.S.C. 703 et seq), and Parts 13 and 21 of
Title 50 of the Code of Federal Regulations.
Purpose: To collect the contact information of individuals that hold Federal Raptor Propagation permits, Special Purpose Game Bird
(SPGB) permits, Special Purpose Abatement (SPA) permits and State Falconry programs. The states use a FWS application to
maintain information about the falconers and their birds.
Routine Uses: The information will be used to monitor disposition of captive birds and the take of birds from the wild. More
information about the routine uses may be found in the Systems of Records Notice, FWS-21 Permits System.
Disclosure: Providing the requested information is voluntary. However, submission of the requested information is required to
maintain Federal permit under the MBTA. Failure to disclose the requested information may be sufficient cause for revocation of the
permit. If the information indicates a violation of a statute, regulation, rule, order or license, whether civil, criminal, or regulatory in
nature, the information may be transferred to the appropriate Federal, State, local or foreign agency charged with investigating or
prosecuting such violations.
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 monitor take and disposition of migratory birds, under the applicable laws governing the requested activity, for which a permit is
requested, and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. 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. 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. 1018-0167.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 1 hour for reporting and 15 minutes for recordkeeping,
including time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments
regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, Fish and Wildlife
Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at
[email protected]. Please do not send your completed form to this address.
FREEDOM OF INFORMATION ACT
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request
that you identify any information that should be considered privileged and confidential business information to allow the Service to
meet its responsibilities under FOIA. Confidential business information must be clearly marked "Business Confidential" at the top of
the letter or page and each succeeding page and must be accompanied by a non-confidential summary of the confidential
information. The non- confidential summary and remaining documents may be made available to the public under FOIA [43 CFR
2.26 – 2.33].

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