Form DS-4131 Advance Notification Form: Tourist and Other Non-Governm

U.S. Department of State

ADVANCE NOTIFICATION FORM

OMB APPROVAL NO. 1405-0181
EXPIRES: xx/xx/20xx
ESTIMATED BURDEN: 9.0 HOURS

TOURIST AND OTHER NON-GOVERNMENTAL ACTIVITIES IN THE ANTARCTIC TREATY AREA
AUTHORITY: This information is requested in furtherance of U.S. obligations under Article VII(5)(a) of the Antarctic
Treaty of 1959, and consistent with Antarctic Treaty Consultative Meeting Recommendation XVIII-1.
PURPOSE: Responses will facilitate a determination of U.S. jurisdiction over the activity and permit timely dissemination
of expedition information to Treaty Parties and the Antarctic Treaty Secretariat's public Electronic Information Exchange
System.
ROUTINE USES: The Department of State may share information on this form with other federal agencies and with
Treaty Parties to the Antarctic Treaty (AT), to ensure we have fulfilled our obligations under the AT to notify other Treaty
Parties of the specifics of each intended expedition to the Antarctic zone. The information provided will be shared with
the U.S. Environmental Protection Agency to ensure compliance with 40 CFR (Code of Federal Regulations) Part 8,
Environmental Impact Assessment (EIA) of Nongovernmental Activities in Antarctica, the U.S. National Science
Foundation to ensure compliance with the Antarctic Conservation Act (ACA), as amended, 16 U.S.C. § 2401, et seq.,
and with other relevant U.S. and foreign government agencies, including the Antarctic Treaty Secretariat, for law
enforcement, search and rescue, administrative purposes, and/or public awareness.
DISCLOSURE: Providing this information is voluntary. However, failure to provide the information requested on this
form may prevent the United States from being able to comply with a Treaty obligation that mandates notice to other
parties of Antarctic travel plans.
INSTRUCTIONS: All U.S. nationals organizing expeditions to Antarctica, and all persons organizing expeditions
proceeding to Antarctica from the United States, should submit this form to the U.S. Department of State as
indicated below. The information below should be submitted no later than three months prior to intended travel
to the Antarctic Treaty Area. Submit one Advance Notification Form per vessel or aircraft. Include attachments for
responses that require more space than the form provides. If an expedition organizer is planning more than one
expedition per vessel or aircraft, details specific to each individual expedition should be provided as attachments to this
form. The signed completed form should be submitted to the Antarctica Affairs Team in the Office of Ocean and Polar
Affairs, Bureau of Oceans and International Environmental and Scientific Affairs, U.S. Department of State via email to
[email protected].
NOTES: For the purposes of this form, "expeditions to Antarctica" include activities south of sixty degrees South
Latitude, excluding commercial fishing voyages. Crew includes an expedition's captain and officers, aircraft and
helicopter pilots, and deck, engine, and hotel/catering staff. Expedition staff include guides, lecturers, and small boat
drivers who are not otherwise counted as crew. Passengers include other persons accompanying the expedition, but
exclude national representatives or observers.
If you are organizing an expedition that relies upon logistical support from another authorized expedition to Antarctica,
and you are planning different activities than those described in the Initial Environmental Evaluation and the ACA permit
of the supporting expedition, you must complete this form in its entirety, even if the supporting expedition is authorized
by a non-U.S. authority.
Expedition Organizer
1. Name of Expedition Organizer (Company, entity, or person(s) as appropriate)

2. Expedition Organizer's Contact Person

3. Mailing Address of Expedition Organizer

4. Nationality of Expedition Organizer

5. Principal Place of Business (Home office) of Expedition Organizer

6. Email address of Expedition Organizer's Contact Person

7. International Phone (with country code) of Expedition Organizer's Contact
Person

8. International Fax (with country code) of Expedition Organizer's
Contact Person, if available

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9. Explain activities undertaken by the Expedition Organizer, including, for example, acquiring the use of vessel or aircraft, hiring expedition staff, or
planning itineraries.

10. Explain if the Expedition Organizer maintains substantial ties to a country or countries other than the United States, such as a U.S. national who
habitually resides in another country, or a company which is the subsidiary of an entity incorporated in or with other substantial ties to another country.

11a. Is the Expedition Organizer submitting this form also the Expedition
Organizer responsible for the vessel or aircraft that will transport the
submitter's expedition to Antarctica? If yes, skip to question 12a. If no,
complete items 11b-11e.
Yes

11b. Provide the name of the company or individual responsible for the
vessel or aircraft and, if it is a company, the title and name of a point of
contact at the company.

No

11c. Provide the international phone number
(with country code) of the vessel or aircraft
point of contact listed in 11b.

11d. Provide the email address of the vessel or aircraft point of contact listed in 11b.

11e. Identify the country that is expected to handle the Advance Notification process for the vessel or aircraft.

12a. If the Expedition Organizer submitting this form is responsible for providing transport or other logistical support, will the expedition support another
person's or entity's activities that are not covered by this Advance Notification? If yes, complete item 12b. If no, or not applicable, skip to question 13.
Yes

No

Not applicable (Expedition Organizer submitting this form is not responsible for transport or other logistical support)

12b. Please describe the types of transport or other logistical support that the Expedition Organizer will be providing, the people or entities to whom the
support will be provided for activities not covered by this Advance Notification, and the country that is expected to handle the Advance Notification
process for those activities, if known.

Expedition Organization and Transport Details
13. Describe where the organizing/planning activities conducted prior to the expedition will be or are being performed.

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14. Arrangements for self-sufficiency and contingency plans including for medical evacuations and search and rescue in the event of an emergency.

15. Vessel/Aircraft Registered Name

16. Vessel/Aircraft Type

17. Country of Registration of Vessel/Aircraft

18. Vessel Ice Rating and Classification Society (If applicable)

19. Vessel/Aircraft Call Sign

20. (Check one)
Ship

Yacht

Aircraft

Other

21. Maximum Number of Passengers

22. Maximum Number of Expedition Crew and Expedition Staff

23. Radio Frequency(ies) Monitored

24. INMARSAT/Other Number(s)

25. Captain's/Commander's Name(s)
26. Vessel/Aircraft E-mail Address(es)

Expedition Itinerary Details
(if the vessel/aircraft is making multiple expeditions, please use Box 32 or include an attachment along with this form)
27. Planned Port of Embarkation

28. Planned Date of
Embarkation(mm-dd-yyyy)

29. Planned Port of Disembarkation

30. Planned Date of
Disembarkation(mm-dd-yyyy)

31. Planned Cruise/Flight Number or Voyage Name
32. Proposed itinerary with dates and places to be visited. Include a proposed itinerary for all expeditions that will proceed south of 60 degrees South
Latitude, even if there is no intention for individuals to disembark onto land. Include information about activities to be undertaken and the purpose of
those activities.

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33. Use this field for responses that were not able to fit into any of the other spaces on this form. (Attach additional pages if space in not sufficient.)

Signature of Expedition Organizer

Date (mm-dd-yyyy)

Paperwork Reduction Act Statement - Public reporting burden for this collection of information is estimated to average 9.0 hours per response, including time required for searching existing data
sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this
collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to Antarctic Advisor,
Office of Ocean and Polar Affairs, Bureau of Oceans, Environment and Science, U.S. Dept. of State, 2201 C Street NW, Washington DC 20520.

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