Form 3-1383-R Research and Monitoring Special Use Application

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

RESEARCH AND MONITORING
SPECIAL USE PERMIT APPLICATION
National Wildlife Refuge System

Section 1: Site Information
Refuge:

For Official Use Only:
Permit #:

Address:
Attn: (Refuge Official)

Station #:

E-Mail:

Permit term:

Phone #:

from

to

Note: We do not require all information for each use. See instructions at the end of the notice and contact the refuge to determine applicability of a
particular item. Attach additional sheets if the text spaces provided are inadequate.

1a) Identify which type of permit you are applying for:

New

Renewal

Modification

Other

1b) Have you applied or do you intend to apply to any other refuges for this same activity?

Yes

No

1c) If yes, which refuges?

Section 2: Applicant Information
2) Principal Investigator:

3) Is curriculum vitae or resumé attached?

Yes

4a) Affiliation/Sponsoring Organization:
4b) Relationship to affiliation/sponsoring organization (professor, staff, student, etc):
5) Physical Address:
City/State/Zip
6) Mailing Address:
City/State/Zip
7) Phone #:

8) Fax #:

9) Email:
10)List known assistants/subcontractors/subpermittees:

(Only required if the assistants/subcontractors/subpermittees will be operating on the refuge without the permittee being present.)
Name

Address

Phone#

No

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

Section 3: Project Information
11) Title of project:
12) Is a full research proposal attached?

Yes

No

Note: Depending on the research and monitoring project for which youare requesting a permit, we may ask you for the following project information
(questions 13–25) if it is not included in your research proposal, or if you have not provided a full research proposal with this application. Please contact
the specific refuge where the activity is being conducted to determine what information is required.
Attach additional sheets to the application if the text spaces provided are inadequate.

13) Describe the project by specifically identifying timing, frequency, and how the project is expected to proceed:

14) Specifically identify location(s) and/or attach a map for the project: (GPS location(s) preferred)

15) Identify species or habitats being studied:

16) Purpose/hypothesis:

17) Expected benefits of research/monitoring:

18) Briefly describe project history and context of research/monitoring project:

19) Briefly describe project’s relationship to other research/monitoring projects either known or conducted by the applicant:

20) Identify the types of specimen collections to be taken (see specimen collection clause in the instruction section #20) or data to be
collected during the proposed project:

21) List other cooperators and institutions involved in the project:

22) Generally identify the anticipated timeline for analysis, write-up, and publication:

22) For research involving animals, attach an Assurance of Animal Care Form or an approval from an Institutional Animal Care and Use
Committee. Is a form or approval attached?
Yes
No
N/A

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

Section 4: License/Insurance Coverage/Certification/Permit
Note: Contact the refuge where the research project is going to be conducted to determine if we will require any type of license(s), insurance(s),
certification(s), or permit(s). We may process this Special Use Permit while the applicant obtains them.
Attach additional sheets to the application if the text spaces provided are inadequate.

24a) List and attach a copy of any licenses you have for equipment operation (i.e., aviation or commercial boats),
pesticideapplication(s), transporters, or others, if required
License Type

Number

Expiration Date

24b) List and attach any insurance coverage(s) you have such as general liability, flight/grounding, contaminants, medical evacuation,
or others, if required:
Insurance Type

Carrier

Expiration Date

24c) List and attach any certifications you have such as rat free, hull inspections, CPR/First Aid, or others, if required:
Certificate Type

Expiration Date

24d) List and attach other Federal, State, or Tribal permits, if required:
Permit Type

Permit Number

Expiration Date

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

Section 5: Logistics and Transportation
Note: We do not require all information for each use. See instructions at the end of the notice and contact the refuge to determine applicability of a
particular item.

25a) Does the project require personnel to stay overnight on the refuge?
25b) If yes, list names of personnel involved:
List Names

List Names

Yes
List Names

No
List Names

26) Specifically describe all major instrumentation/equipment/gear (i.e. use of drones) and materials used, if applicable or required:

27a) Provide details and schedule for the installation of instrumentation:

27b) Provide details and schedule for the removal of instrumentation:

27c) If instrumentation is permanent, describe the need:

27d) If instrumentation requires a maintenance schedule, describe needs and schedule:

27e) Provide a data collection schedule:

28) Provide logistical arrangements for the offsite transportation of samples:

29a) Provide detailed information on the logistics for onsite, intersite, and/or ship-to-shore transportation to or on the refuge, if required:

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

29b) Provide descriptions, license plate and/or identification numbers of vehicles used for onsite transportation, if required:
Vehicle Type

Plate/I.D./Registration #

Vehicle Type

Plate/I.D./Registration #

29c) Provide descriptions, license plate and/or identification numbers of vehicles used for intersite transportation, if required:
Vehicle Type

Plate/I.D./Registration #

Vehicle Type

Plate/I.D./Registration #

29d) Provide descriptions, license plate and/or identification numbers of vehicles used for ship to shore transportation, if required:
Vehicle Type

30a) Is fuel cache needed?

Plate/I.D./Registration #

Yes

Vehicle Type

No

Plate/I.D./Registration #

N/A

30b) Specific location(s) of fuel caches: (GPS Coordinates preferred)

31)Is a Safety Plan attached?

Yes

No

N/A

Section 6: Work and Living Accommodations
29)Specifically describe onsite work and/or living accommodations, including spike camps:

30)Specifically describe on- or off-site hazardous material storage or other on or offsite material storage space (including fuel caches):

Sign, date, and return this form to the refuge for processing. By signing this application, I agree my operations will conform to the information I have
provided in this application, and I understand that any deviations or changes to this information must receive prior written approval.

Signature of Applicant:

Date of Application:

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

NOTICES
No Members of Congress or Resident Commissioner shall participate in any part of this contract or to any benefit that may arise from it, but this provision shall not pertain to
this contract if made with a corporation for its general benefit.
The Permittee agrees to be bound by the equal opportunity “nondiscrimination in employment” clause of Executive Order 11246.

PRIVACY ACT STATEMENT

Authority:

The information requested is authorized by the National Wildlife Refuge System Administration Act (16 U.S.C. 668dd-ee) and the Refuge Recreation Act (16
U.S.C. 460k-460k-4).

Purpose:

To collect the applicant’s information to process permits allowing for commercial activities such as: guiding hunters, anglers or other outdoor users; commercial
filming; agriculture; rental of cabins and trapping while on the National Wildlife Refuge System.

Routine Uses: The information will be used by the refuge’s administrative office for processing Commercial Activity Special Use permits.
routine uses maybe found in the Systems of Records Notice, FWS-5 National Wildlife Refuge Special Use Permits.

More information about the

Disclosure:

Providing the information is voluntary. However, submission of information is required to process and approve commercial activity usage on the National
Wildlife Refuge System.

PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to evaluate the qualifications, determine eligibility, and document permit applicants
and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. The information that you provide is required to obtain or retain a benefit;
however, failure to provide all required information is sufficient cause for the U.S. Fish and Wildlife Service to deny a permit. False, fictitious, or fraudulent statements or
representations made in the application may be grounds for revocation of the Special Use Permit and may be punishable by fine or imprisonment (18 U.S.C. 1001). 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 information collection and assigned control number 1018-0102.

ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 5 hours
Original submission - electronic: 4.75 hours
Amended submission - paper based: 1.5 hours
Amended submission - electronic: 1.25 hours
Renewals - paper based: 2 hours
Renewals - electronic: 1.5 hours
These estimates include 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.

GENERAL CONDITIONS AND REQUIREMENTS
Responsibility of Permittee: The permittee, by operating on the premises, shall be considered to have accepted these premises with all facilities, fixtures, or improvements in
their existing condition as of the date of this permit. At the end of the period specified or upon earlier termination, the permittee shall give up the premises in as good order and
condition as when received except for reasonable wear, tear, or damage occurring without fault or negligence. The permittee will fully repay the Service for any and all
damage directly or indirectly resulting from negligence or failure on his/her part, and/or the part of anyone of his/her associates, to use reasonable care.
Operating Rules and Laws: The permittee shall keep the premises in a neat and orderly condition at all times, and shall comply with all municipal, county, and State laws
applicable to the operations under the permit as well as all Federal laws, rules, and regulations governing national wildlife refuges and the area described in this permit. The
permittee shall comply with all instructions applicable to this permit issued by the refuge official in charge. The permittee shall take all reasonable precautions to prevent the
escape of fires and to suppress fires and shall render all reasonable assistance in the suppression of refuge fires.
Use Limitations: The permittee’s use of the described premises is limited to the purposes herein specified and does not, unless provided for in this permit, allow him/her to
restrict other authorized entry onto his/her area; and allows the U.S. Fish and Wildlife Service to carry on whatever activities are necessary for: (1) protection and maintenance
of the premises and adjacent lands administered by the U.S. Fish and Wildlife Service; and (2) the management of wildlife and fish using the premises and other U.S. Fish
and Wildlife Service lands.
Transfer of Privileges: This permit is not transferable, and no privileges herein mentioned may be sublet or made available to any person or interest not mentioned in this
permit. No interest hereunder may accrue through lien or be transferred to a third party without the approval of the Regional Director of the U.S. Fish and Wildlife Service and
the permit shall not be used for speculative purposes.
Compliance: The U.S. Fish and Wildlife Service’s failure to require strict compliance with any of this permit’s terms, conditions, and requirements shall not constitute a waiver
or be considered as a giving up of the U.S. Fish and Wildlife Service’s right to thereafter enforce any of the permit’s terms or conditions.
Conditions of Permit not Fulfilled: If the permittee fails to fulfill any of the conditions and requirements set forth herein, the U.S. Fish and Wildlife Service shall retain all money
paid under this permit to be used to satisfy as much of the permittee’s obligation as possible.
Payments: All payment shall be made on or before the due date to the local representative of the U.S. Fish and Wildlife Service by a postal money order or check made
payable to the U.S. Fish and Wildlife Service.
Termination Policy: At the termination of this permit the permittee shall immediately give up possession to the U.S. Fish and Wildlife Service representative, reserving,
however, the rights specified in paragraph 11 below. If he/she fails to do so, he/she will pay the U.S. Fish and Wildlife Service, as liquidated damages, an amount double the
rate specified in this permit for the entire time possession is withheld. Upon yielding possession, the permittee will still be allowed to reenter as needed to remove his/her
property as stated in paragraph 11 below. The acceptance of any fee for the liquidated damages or any other act of administration relating to the continued tenancy is not to
be considered as an affirmation of the permittee’s action nor shall it operate as a waiver of the U.S. Fish and Wildlife Service’s right to terminate or cancel the permit for the
breach of any specified condition or requirement.

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

Revocation Policy: The Regional Director of the U.S. Fish and Wildlife Service may revoke this permit without notice for noncompliance with the terms hereof, or for violation
of general and/or specific laws or regulations governing national wildlife refuges, or for nonuse. It is at all times subject to discretionary revocation by the Director of the
Service. Upon such revocation the U.S. Fish and Wildlife Service, by and through any authorized representative, may take possession of said premises for its own and sole
use, and/or may enter and possess the premises as the agent of the permittee and for his/her account.
Damages: The U.S. Fish and Wildlife Service shall not be responsible for: any loss or damage to property including but not limited to crops, animals, and machinery; injury to
the permittee or his/her relatives or to the officers, agents, employees, or any other(s) who are on the premises from instructions; the sufferance from wildlife or employees or
representatives of the U.S. Fish and Wildlife Service carrying out their official responsibilities. The permittee agrees to hold the U.S. Fish and Wildlife Service harmless from
any and all claims for damages or losses that may arise to be incident to the flooding of the premises resulting from any associated government river and harbor, flood control,
reclamation, or Tennessee Valley Authority activity.
Removal of Permittee’s Property: Upon the expiration or termination of this permit, if all rental charges and/or damage claims due to the U.S. Fish and Wildlife Service have
been paid, the permittee may, within a reasonable period as stated in the permit or as determined by the U.S. Fish and Wildlife Service official in charge, but not to exceed 60
days, remove all structures, machinery, and/or equipment, etc., from the premises for which he/she is responsible. Within this period the permittee also must remove any other
of his/her property including his/her acknowledged share of products or crops grown, cut, harvested, stored, or stacked on the premises. Upon failure to remove any of the
above items within the aforesaid period, they shall become the property of the U.S. Fish and Wildlife Service.

INSTRUCTIONS FOR COMPLETING APPLICATION
You may complete the application portion verbally, in person, or electronically and submit to the refuge for review. Please read instructions carefully as not all information is
required for each activity. Contact the specific refuge where the activity will take place if you have questions regarding the applicability of a particular item. We may add special
conditions or permit stipulations to permit prior to approval.
1a-1c) Identify if permit application is for new, renewal, or modification of an existing permit, whether or not you have or will be applying to another refuge for the same activity,
and for which refuge(s). Permit renewals may not need all information requested. Contact the specific refuge headquarters office where the activity is going to be conducted to
determine applicability of this requirement.
2-3) Provide principal investigator or applicant full name. Attach principal investigator’s Curriculum Vitae or Resume, if required. Permit renewals generally do not require
a Curriculum Vitae or Resume if the project is a continuation of a previously issued permit being conducted by the same investigator. Contact the specific refuge office to
determine applicability of this requirement.
4-9) Provide investigator’s physical and/or mailing address, phone, fax, e-mail, affiliation and/or sponsoring organization, and relationship to affiliation or organization (title,
professor, student, etc.).
10) Provide the names and addresses of assistants, subcontractors, or subpermittees. We may require names and addresses if the assistants, subcontractors, or
subpermittees will be operating on the refuge without the permittee being present. Volunteers, assistants, subcontractors, or subpermittees accompanied by the permittee
need not be identified.
11)Provide title of research or monitoring project.
12a-12b) Attach a full research or monitoring proposal, if required. Permit renewals generally do not require a project proposal if the project is a continuation of a previously
issued permit being conducted by the same investigator. Contact the specific refuge office to determine applicability of this requirement.
13) Provide detailed information on the activity, including timing, frequency, how the project is expected to proceed, etc. Permit renewals may not need activity description, if
the activity is unchanged from previous permit. Most repetitive research projects do not require an activity description for each visit to the refuge. Contact the specific refuge
office to determine applicability of this requirement.
14) Identify specific location (GPS coordinates preferred) if not a named facility and/or attach a map of the location. Permit renewals may not require a location if the project is
essentially unchanged from the previous permit. Contact the specific refuge office to determine applicability of this requirement.
15)Identify species or habitats being studied.
16-17) Specifically identify purpose or hypothesis of the research or monitoring project and describe expected benefits. Permit renewals may not need to identify purpose or
hypothesis if the project is a continuation of a previously issued permit being conducted by the same investigator. Contact the specific refuge office to determine applicability of
this requirement.
18) Briefly describe project history and context. Permit renewals should describe previous research activities as part of a previously issued permit being conducted by the
same investigator. Contact the specific refuge office to determine applicability of this requirement.
19) Briefly describe project’s relationship to other research/monitoring projects either known of or conducted by the applicant, if applicable. Include a brief statement of how
the research or monitoring permit being applied for will add to or supplement other ongoing research or monitoring on the same, or related, species or habitats. Contact the
specific refuge office to determine applicability of this requirement.
20) Identify specimen collections to be taken or types of data to be collected. You may use specimens collected under this permit, any components of any specimens
(including natural organisms, enzymes, genetic materials or seeds), and research results derived from collected specimens for scientific or educational purposes only and not
for commercial purposes unless you have entered into a Cooperative Research and Development Agreement (CRADA) with us. We prohibit the sale of collected research
specimens or transfers to third parties for commercial purposes. Breach of any of the terms of this permit will be grounds for revocation of this permit and denial of future
permits. Furthermore, if you sell or otherwise transfer for commercial purposes collected specimens, any components thereof, or any products or research results developed
from such specimens or their components without a CRADA, you will pay us a royalty rate of 20 percent of gross revenue from such sales. In addition to such royalty, we may
seek other damages and injunctive relief against you. Permit renewals may not need to identify samples taken if the project is a continuation of a previously issued permit
being conducted by the same investigator. Contact the specific refuge office to determine applicability of this requirement.
21) List other cooperators and institutions involved in the project, if applicable. Contact the specific refuge office to determine applicability of this requirement.
22) Generally, identify the anticipated time line for analysis, write-up, and publication of project results. Include whether the project is a single, or multiple year project.
Identification of an actual publication where the results are printed is not necessary. However, applicants should include the anticipated dissemination of project results.
Contact the specific refuge office to determine applicability of this requirement.
23) Check box acknowledging a completed Assurance of Animal Care Form or an Institutional Animal Care and Use Committee (or equivalent) that has granted approval has
been completed and has been submitted to refuge station, if required. Contact the specific refuge office to determine applicability of this requirement.

FWS Form 3-1383-R (Rev. 11/2025)
U.S. Department of the Interior

OMB Control Number 1018-0102
Expires ##/##/20##

24a-24d) Specifically identify types and numbers of licenses, insurance, certifications, and other State, Federal, or Tribal permits if required. Contact the specific refuge
headquarters office where the project is going to be conducted to determine applicability of these requirements and to coordinate the simultaneous applications of any of these
requirements while this Special Use Permit is being processed.
25a-25b) Provide the number of and/or name(s) of any personnel required to stay overnight on the refuge, if applicable.
26) Identify all equipment (including drones) and materials that will be used, if required. Permit renewals may not require a list of equipment if the project is essentially
unchanged from a previously issued permit. Contact the specific refuge office to determine applicability of this requirement.
27a-27e) Identify types and schedule(s) of installation of any instrumentation, data collection, and maintenance schedule of instrumentation, if required. Permit renewals may
not require a list of equipment if the project is essentially unchanged from a previously issued permit. However, schedules of installation of any instrumentation, data collection,
and maintenance schedule of instrumentation may still be required. Contact the specific refuge headquarters office where the project is going to be conducted to determine
applicability of this requirement.
28)Identify logistical arrangements for offsite transportation of samples taken, if applicable.
29a-29d) Describe and provide vehicle descriptions and license plate or identification numbers of all vehicles, including boats and airplanes, if required. Motor vehicle
descriptions are only required for permittee vehicle and/or if the vehicle will be operated on the refuge without the permittee being present. Motor vehicles that are
accompanied by the permittee as part of a group (convoy) activity need not be identified if cleared in advance by refuge supervisor. Specifically describe ship-to-shore,
intersite (between islands, camps, or other sites) and onsite transportation mechanisms, and license plate or identification numbers, if required.
30a-30b) Identify specific location(s) of fuel cache(s) (GPS coordinates preferred), if required.
31a-31b) Attach safety plan, if required. Contact the specific refuge office to determine applicability of this requirement.
32) Specifically describe onsite work and/or living accommodations, if required. Include descriptions and locations (GPS coordinates preferred) of spike camps or other remote
work and/or living accommodations that are not part of the base of operations. Contact the specific refuge office to determine applicability of this requirement.
33)Specifically describe onsite and offsite hazardous material storage, or other onsite material storage space (including on and offsite fuel caches), if required. Contact the
specific refuge office to determine if descriptions of hazardous material storage or other onsite material storage are required.
34) Sign, date, and print the application. Click on the Print button to print the application (if using the fillable version). The refuge official will review and, if approved, fill out the
remaining information, sign, and return a copy to you for signature and acceptance.

THIS APPLICATION FORM IS NOT VALID AS A PERMIT
BUT MAY BE USED AS A REFERENCE DOCUMENT ATTACHED TO THE OFFICIAL PERMIT.
ONLY OFFICIAL REFUGE PERSONNEL MAY ASSIGN A VALID PERMIT NUMBER AND PERMIT TERM
TO THIS APPLICATION FORM AFTER THE PERMIT HAS BEEN APPROVED.