Form DI Form 9011 DI Form 9011 Regional Advisory Council Reference/Key Contact Intervie

DI Form 9011 (Rev. 09/2024) OMB Control No. 1090-New

U.S. Department of the Interior Expires ##/##/20##

APPLICATION/NOMINATION FORM

Regional Advisory Council Reference and Key Contact Interview

Office of Policy, Management, and Budget

Office of Subsistence Management

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 Key Contact (Please check whichever applies)

Name:      

Title:      

Organization:      

Number of Years in the 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.

     

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:

   1. Individuals, small and large groups:      

   2. State, Federal, and Tribal agency staff:      

   3. People in their community:      

   4. People in the region:      

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

     

NOTICES

PRIVACY ACT STATEMENT

Authority: The information requested is authorized by the Alaska National Interest Lands Conservation Act; 36 CFR 242 and 43 CFR 51.

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, et seq.), the Office of Subsistence Management 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. 1090-####.

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 Departmental Information Collection Clearance Officer, 1849 C Street, NW Washington, DC 20240, or via email at [email protected]. Please do not send your completed form to this address.

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