Fillable Printable Form DS-4131
Fillable Printable Form DS-4131
Form DS-4131
1. Name of Expedition Organizer
(Company, entity, or person(s) as appropriate)
2. Expedition Organizer's Contact Person
A. Expedition Organizer
3. Mailing Address (Please also provide physical address if using a post office box) 4. Nationality of Expedition Organizer
5. Principal Place of Business (Home office) 6. Total Number of Expedition Staff per Excursion
7. International Phone 8. International Fax
ADVANCE NOTIFICATION FORM
U.S. Department of State
DS-4131
04-2014
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 and Resolution XIX-3. Information below should be submitted no
later than three months prior to intended travel to the Antarctic Treaty Area. Responses will facilitate a determination of U.S.
jurisdiction over the activity and permit timely dissemination to Parties to the Treaty of expedition details. Certain expedition
information may be posted on the National Science Foundation’s and the Antarctic Treaty Secretariat's Web sites in order to facilitate
notification of and access by all Parties to the Treaty. All U.S. nationals organizing expeditions to Antarctica in the United States, or
proceeding to Antarctica from the United States, should submit this form to the U.S. Department of State as indicated below . In
addition to disclosure to other Parties to the Treaty, the information provided may 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, as well as with other relevant U.S. agencies. The information also may be shared with
appropriate domestic or foreign entities for law enforcement, search and rescue, or administrative purposes.
Include attachments for responses that require more space than the form provides. If an organizer is planning more than one
expedition, details specific to each individual expedition should be provided as attachments to this form. Each organizer should
prepare only one Advance Notification form.
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9. Explain activities undertaken by the organizer, including, for example, acquiring the use of vessels or aircraft, hiring expedition staff, or planning
itineraries.
TOURIST AND OTHER NON-GOVERNMENTAL ACTIVITIES IN THE ANTARCTIC TREATY AREA
11. Explain whether any organizing activities will be or are being performed by a party or parties other than the named expedition organizer; e.g., a
sub-charter. Identify the nationality of individuals or commercial entities to whom the expedition organizer has delegated specified organizational
responsibilities.
10. Explain if the organizer maintains substantial ties to a country or countries other than the United States; for example, 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.
12. Describe where the organizing activities conducted prior to the expedition will be or are being performed.
13. Specify the place(s) from which the expedition(s) will depart immediately prior to entering the Treaty Area.
OMB APPROVAL NO. 1405-0181
EXPIRES: 04/30/2018
ESTIMATED BURDEN: 10.5 HOURS
The completed form should be submitted to the Antarctic Advisor, Office of Ocean and Polar Affairs, Bureau of Oceans,
Environment and Science, U.S. Department of State, 2201 C Street NW, Washington DC 20520.
NOTE: 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, 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.
B. Details of Transport and Equipment to be Used for the Tour/Expedition
Complete these panels only once if all Tours/Expeditions planned do not vary in their use of transport or equipment; where these
vary, complete the panel for every Tour or Expedition.
B1. Vessel/Aircraft Used for Transport To/From Antarctica
14. Vessel/Aircraft Registered Name 15. Vessel/Aircraft Type
16. Country of Registration 17. Vessel/Aircraft Passenger Carrying Capacity
18. Vessel Ice Rating and Classification Society (If applicable)
19. 20. Vessel/Aircraft Fuel Capacity 21. Vessel/Aircraft Fuel Type
(Check one)
Ship Yacht Aircraft Other
22. Intended Use of Vessel/Aircraft
23. Vessel/Aircraft Call Sign 25. INMARSAT Number(s)/Fax(es)24. Radio Frequency(ies) Monitored
27. Captain's/Commander's Name(s) 28. Total Number of Crew
B2. Equipment to be Used Within Antarctica
29. Number and Types of Aircraft to be Used
Number Type Use
30. Number and Types of Other Vessels or Vehicles to be Used (e.g., small boats, snowmobiles)
C. Contingency Planning
31. Type and Amount of Insurance Coverage, including Name(s) of Insurer(s)
Number Type Use
DS-4131
04-2014
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26. E-mail Address(es)
32. Arrangements for self-sufficiency and contingency plans including for medical evacuations and search and rescue in the event of an emergency.
D. Expedition Details
33. Planned Port of Embarkation 34. Planned Date of Embarkation (mm-dd-yyyy)
35. Planned Port of Disembarkation 36. Planned Date of Disembarkation
(mm-dd-yyyy)
37. Planned Cruise/Flight Number or Voyage Name
38. Estimated Number of Passengers to be Carried per
Excursion
39. Activities to be Undertaken and Purpose
40. Proposed itinerary with dates and places t o 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.
Certification
Signature of Tour/Expedition Organizer Date (mm-dd-yyyy)
Public reporting burden for this collection of information is estimated to average 10.5 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 Alfred Schandlbauer, Antarctic Advisor, Office of Ocean and Polar
Affairs, Bureau of Oceans, Environment and Science, U.S. Department of State, 2201 C Street NW, Washington DC 20520.
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4-2014
NOTE: If more than one expedition is planned, please provide the information below in an attachment referring to each individual expedition. If more
than one vessel will be used in carrying multiple expeditions, please organize the submission of information on individual expeditions under the name
of the specific vessel that will carry those expeditions.
