Form 3-200-29 Federal Fish and Wildlife Permit Application Form

Expires XX/XX/XXXX
OMB No. 1018-0093

Department of the Interior
U.S. Fish and Wildlife Service

Federal Fish and Wildlife Permit Application Form
Type of Activity:

Return to: Division of Management Authority (DMA)
U.S. Fish and Wildlife Service
4401 N. Fairfax Drive, Room 700
Arlington, VA 22203
1-800-358-2104 or 703-358-2104

Import/Export/Re-Export of Wildlife Samples and/or
Biomedical Samples (CITES)

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.
See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A.

Complete if applying as an individual

1.a. Last name

1.b. First name

1.c. Middle name or initial

1.d. Suffix

2. Date of birth (mm/dd/yyyy)

3. Social Security No.

4. Occupation

5. Affiliation/ Doing business as (see instructions)

6.a. Telephone number

6.b. Alternate telephone number

6.c. Fax number

6.d. E-mail address

B.

Complete if applying on behalf of a business, corporation, public agency or institution

1.a. Name of business, agency, or institution

1.b. Doing business as (dba)

2. Tax identification no.

3. Description of business, agency, or institution

4.a. Principal officer Last name

4.b. Principal officer First name

5. Principal officer title

4.c. Principal officer Middle name/ initial

4.d. Suffix

6. Primary contact

7.a. Business telephone number

7.b. Alternate telephone number

C.

7.c. Business fax number

7.d. Business e-mail address

All applicants complete address information

1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City

1.c. State

1.d. Zip code/Postal code:

1.e. County/Province

1.f. Country

2.a. Mailing Address (include if different than physical address; include name of contact person if applicable)
2.b. City

2.c. State

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

D.

All applicants MUST complete

1.

Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount identified on page 2. Federal, tribal, State, and local
government agencies, and those acting on behalf of such agencies, are exempt from the processing fee – attach documentation of fee exempt status as outlined in
instructions. (50 CFR 13.11(d))
Do you currently have or have you ever had any Federal Fish and Wildlife permits?
Yes
If yes, list the number of the most current permit you have held or that you are applying to renew/re-issue: _________________________________No

2.

3.

Certification: I hereby certify that I have read and am familiar with the regulations contained in Title 50, Part 13 of the Code of Federal Regulations and the other
applicable parts in subchapter B of Chapter I of Title 50, and I certify that the information submitted in this application for a permit is complete and accurate to
the best of my knowledge and belief. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001.
________________________________________________________________________________________________________________________
Signature (in blue ink) of applicant/person responsible for permit (No photocopied or stamped signatures)
Date of signature (mm/dd/yyyy)

Please continue to next page

Form 3-200-29

Rev. <>

Page 1 of 7

E. Import/Export/Re-Export of Wildlife Samples and/or Biomedical Samples (CITES)
For the import/export/re-export of samples from species listed under the Endangered Species Act (50 CFR Part
17), please use application form, 3-200-37 [www.fws.gov/forms].
Note: Please be aware that USFWS may not be able to issue documents for the commercial export of
Appendix-I specimens, unless the specimens were obtained from animals produced at a CITES-registered
Appendix-I commercial breeding operation. For more information on registering an Appendix-I commercial
breeding operation, please contact the Division of Management Authority.
Electronic submission of inventories, photographs, and receipts: Some applications contain long inventories
and/or a large number of photographs or receipts. You may provide electronic versions of these documents.
Such a submission may assist to expedite the processing of your application since it will eliminate the need for
data entry by U.S. Fish and Wildlife Service. You may include a disk containing your information or, if
applicable, please check the following:
 I would like you to contact me at the e-mail address above in order to get an electronic inventory.
Please provide the following information. Complete all questions on the application. Mark questions that are
not applicable with "N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you
submit, please indicate the application question number you are addressing. If you are applying for multiple
specimens, be sure to indicate which specimen you are addressing in each response.
What activity are you requesting authorization to carry out:
 SINGLE SHIPMENT for import/export (Processing Fee = $100)
 SINGLE SHIPMENT for re-export only (Processing Fee = $75)
Provide recipient’s foreign address: ____________________________________________________________
__________________________________________________________________________________________
 ESTABLISHING A MASTER FILE (Processing Fee = $200)
(This application allows you set up a Master File, valid for three years and is renewable, for exports of plant
specimens under CITES. Once the Master File is approved you would need to obtain single-use permits,
valid for 6 months, for each export (50 CFR 13.11))
 RENEWAL OF AN ESTABLISH MASTER FILE, # ___________________ (Processing Fee = $100)
IF establishing a new master file or renewing a previous master file,
How many single-use permits do you anticipate using in the next 6 months? ____________________
(Provide $5 for each 6-month permit.) Additional permits may be requested by submitting form 3-200-74
(http://www.fws.gov/forms/).
1. Are you requesting authorization to import, export, or re-export specimens? _________________________

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2. For EACH animal from which samples are to be shipped, provide the following (You may use the attached
corresponding inventory sheet): Please do NOT include Quarantine, Immunization or Health records
unless they document transfer of ownership.
a. Scientific name (genus, species, and, if applicable, subspecies);
b. Common name;
c. Animal's Identification number or House name;
d. Sex, if known;
e. Birth/hatch date or age class;
f. Source of specimen (Wild or Captive-Born);
g. If this is a re-export, Foreign CITES export permit number and issuance date;
h. Type of sample (e.g., blood samples, cell cultures, tissue samples); and
i. Quantity of samples & how packaged (e.g., 10 1-ml flasks, paraffin blocks, slides).
3. What is the purpose of the export/import? ___________________________________________________
4. Where is/are the specimen(s) currently located? _______________________________________________
5. For wildlife previously imported into the United States from another country (Re-export), provide:
a. Copies of canceled CITES export or re-export documents issued by the appropriate CITES office in the
country from which the wildlife was exported, and
b. Copy of cleared wildlife Declaration for Import (Form 3-177); or
c. If you did not make the original import, provide copies of the importer's documents outlined above and the
invoices or other documents that shows you acquired the wildlife from the original importer or history of
transactions (chain of ownership).
6. For samples collected from animals born in the wild, provide:
a. Specific location of where, when and by whom (name and address) the animal/sample was removed from the
wild;
b. A description of the method(s) of collection, including previous results using this methodology (e.g. mortality
rate, adverse impacts);
c. The qualifications of the individuals collecting the samples;
d. A copy of any applicable State, Federal, or foreign government authorization approving the activity; and
e. Documentation that the applicant legally acquired the animals/samples.
f. In addition, For wild-born animals currently or previously held in captivity, describe the purpose of
removing the animal from the wild, length or approximate length of time the animal was or will be held in
captivity, and, if still in captivity, current location (including a history of where the animal has been
maintained in captivity).
7. For samples collected from animals born in captivity:
a. Have the specimens been collected? If not, when will they be collected?
b. If you are the breeder, please provide a statement that the animal was bred and born at your facility. This
statement must include:
i. Scientific name, birth/hatch date, sex, and, if applicable, band/tag number or other identifier of each
specimen;
ii. Name and address of your facility where the animal was bred and born;
iii. Location (Name of holder, city, State, zip code) of parental stock;
iv. Whether the parental stock was captive-born or wild-collected; and
v. Your signature and date.

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c. If you are NOT the breeder of the specimen, provide a signed statement from the breeder or breeder's record
that includes:
i. Scientific name; birth/hatch date, sex, and, if applicable, band/tag number or other identifier of each
specimen he/she bred;
ii. Complete name and address of the breeder's facility;
iii. Statement that the animal was bred and born at the breeder’s facility;
iv. Location (name of holder, city, State, zip code) of parental stock; and
v. Whether the parental stock was captive-born or wild-caught.
vi. In addition, copies of documentation showing that you acquired the animal from the breeder or
documentation demonstrating the history of transactions (chain of ownership of each animal).
8. For marine mammals samples, please provide a copy of your FWS or NOAA Fisheries authorization.
9. For Appendix-I specimens, answer the following additional questions:
a. Was/is the collection of the requested specimens, either from animals being captured (whether from the wild
or within a captive environment) or sacrificed, incidental to another activity, such as a routine exam or other
research efforts?
b. What are/were the method(s) of collection? If samples have been collected by this same method previously,
what were the results (e.g. mortality rate, adverse impacts)?
c. Do you expect or did the capture and/or holding of animal to obtain specimens result in a loss of animals?
Please explain.
d. What other work/research has been conducted or is being conducted using this species? How will the
proposed use of the requested specimens differ or compliment the previous or current work/research? (Please
reference scientific literature)
e. Provide a copy of the research proposal in which the requested specimens would be utilized.
10. With the exception of re-exported specimens, what are the qualifications of the individuals collecting the
samples? For example, provide information on training and previous experience in applicable blood or tissue
sample collection.
11. For the non-commercial export of Appendix-I species, provide a copy of the CITES import permit, or evidence
one will be issued by the Management Authority of the country to which you plan to export the specimen(s). In
accordance with Article III of the CITES treaty, it is required that import permits are issued before the
corresponding export permit.
12. For import of Appendix-I specimens, provide information to show the import is not for primarily commercial
purposes as outlined in Resolution Conf. 5.10 [www.CITES.org].
13. Enter the U.S. port through which the export/re-export will occur. ___________________________________
(All wildlife, including parts and products, must be declared to and inspected by a Wildlife Inspector from the
U.S. Fish and Wildlife Service Office of Law Enforcement. A list of designated ports (where an inspector is
posted) is available at http://www.fws.gov/le/ImpExp/Contact_Info_Ports.htm.)
14. Address where you wish permit mailed (if different than page 1):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
15. If you wish the permit to be sent to you by means other than regular mail, provide an air bill, pre-paid
envelope, or billing information:
______________________________________________________________________________________
16. Who should we contact if we have questions about the application? (Include name, phone number, and email):
______________________________________________________________________________________

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Import/Export/Re-export of Wildlife Samples (CITES)
Inventory Page

a. Scientific
Name
(genus, species,
subspecies)

b. Common
Name

c. Animal
Number or
House
Name

d.
Sex

e. Source
(Wild or
CaptiveBorn)

f. Birth Date
/ Age Class

g. CITES

h.

Export Permit
No.

Export
Permit
Issuance
Date

i. Type of
Sample
(blood, tissue,
DNA)

j. Quantity of
samples & how
Packaged
(vials, slides,
flask)/size and No.
of samples

If Re-export
EXAMPLE:
Macaca
fascicularis

Crab-eating
macaque

RX7272-09

F

W

5/6/1992

VN0101-1998

07/05/98

Enter column
totals for total
no. animals,
total mls, and
total vials/
flasks/ slides,
etc:

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Liver cells

20 1-ml vials
containing 0.5 mls
each

PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to the standard permit form 3-200 that must be completed as an application for a U.S. Fish and Wildlife Service or CITES
permit. The General Permit Procedures in 50 CFR 13 address the permitting process. For simplicity, all licenses, permits, registrations, and certificates will
be referred to as a permit.
GENERAL INSTRUCTIONS:
•
Complete all blocks/lines/questions in Sections A or B, and C and D. Complete all of Section E.
•
An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are filling in the appropriate
application form for the proposed activity.
•
Print clearly or type in the information. Illegible applications may cause delays.
•
Sign the application in blue ink. Faxes or copies of the original signature will not be accepted.
•
Mail the original application to the address at the top of page one of the application or if applicable on the attached address list.
•
Keep a copy of your completed application.
•
Please plan ahead. Allow at least 60 days for your application to be processed. Some applications may take longer than 90 days to
process. (50 CFR 13.11)
•
Applications are processed in the order they are received.
•
Additional forms and instructions are available from http://permits.fws.gov/ .
COMPLETE EITHER SECTION A OR SECTION B:
Section A. Complete if applying as an individual:
•
Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal information that identifies the
applicant. Fax and e-mail are not required if not available.
•
If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing power of attorney must be
included with the application.
•
Affiliation/ Doing business as (dba): business, agency, organizational, or institutional affiliation directly related to the activity requested in the
application (e.g., a taxidermist is an individual whose business can directly relate to the requested activity). The Division of Management
Authority (DMA) will not accept doing business as affiliations for individuals.
Section B. Complete if applying as a business, corporation, public agency, or institution:
•
Enter the complete name of the business, agency or institution that will be the permittee if a permit is issued. Give a brief description of the type
of business the applicant is engaged in. Provide contact phone number(s) of the business.
•
Principal Officer is the person in charge of the listed business, corporation, public agency, or institution. The principal officer is the person
responsible for the application and any permitted activities. Often the principal officer is a Director or President. Primary Contact is the person
at the business, corporation, public agency, or institution who will be available to answer questions about the application or permitted activities.
Often this is the preparer of the application.
ALL APPLICANTS COMPLETE SECTION C:
•
For all applications submitted to the Division of Management Authority (DMA) a physical U.S. address is required. Province and Country blocks
are provided for those USFWS programs which use foreign addresses and are not required by DMA..
•
Mailing address is address where communications from USFWS should be mailed if different than applicant’s physical address.
ALL APPLICANTS COMPLETE SECTION D:
Section D.1 Application processing fee:
•
An application processing fee is required at the time of application; unless exempted under 50 CFR13.11(d)(3). The application processing fee is
assessed to partially cover the cost of processing a request. The fee does not guarantee the issuance of a permit. Fees will not be refunded for
applications that are approved, abandoned, or denied. We may return fees for withdrawn applications prior to any significant processing
occurring.
•
Documentation of fee exempt status is not required for Federal, tribal, State, or local government agencies; but must be supplied by those
applicants acting on behalf of such agencies. Those applicants acting on behalf of such agencies must submit a letter on agency letterhead and
signed by the head of the unit of government for which the applicant is acting on behalf, confirming that the applicant will be carrying out the
permitted activity for the agency.
Section D.2 Federal Fish and Wildlife permits:
•
List the number(s) of your most current FWS or CITES permit or the number of the most recent permit if none are currently valid. If applying for
re-issuance of a CITES permit, the original permit must be returned with this application.
Section D.3 CERTIFICATION:
•
The individual identified in Section A, the principal officer named in Section B, or person with a valid power of attorney (documentation
must be included in the application) must sign and date the application in blue ink. This signature binds the applicant to the statement of
certification. This means that you certify that you have read and understand the regulations that apply to the permit. You also certify that
everything included in the application is true to the best of your knowledge. Be sure to read the statement and re-read the application and your
answers before signing.

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APPLICATION FOR A FEDERAL FISH AND WILDLIFE PERMIT
Paperwork Reduction Act, Privacy Act, and Freedom of Information Act – Notices
In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and the Privacy Act of 1974 (5 U.S.C. 552a), please be advised:
1.

The gathering of information on fish and wildlife is authorized by:
(Authorizing statutes can be found at: http://www.gpoaccess.gov/cfr/index.html and http://www.fws.gov/permits/ltr/ltr.shtml.)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;
Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50CFR 17;
Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;
Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), 50 CFR 18;
Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15;
Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;
Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), http://www.cites.org/ , 50 CFR 23;
General Provisions, 50 CFR 10;
General Permit Procedures, 50 CFR 13; and
Wildlife Provisions (Import/export/transport), 50 CFR 14.

2.

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. Response is not required unless a currently valid Office of Management and Budget (OMB) control number is displayed on form.

3.

Certain applications for permits authorized under the Endangered Species Act of 1973 (16 U.S.C. 1539) and the Marine Mammal Protection Act of 1972 (16
U.S.C. 1374) will be published in the Federal Register as required by the two laws.

4.

Disclosures outside the Department of the Interior may be made without the consent of an individual under the routine uses listed below, if the disclosure is
compatible with the purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Routine disclosure to subject matter experts, and Federal, tribal, State, local, and foreign agencies, for the purpose of obtaining advice relevant to making a
decision on an application for a permit or when necessary to accomplish a FWS function related to this system of records.
Routine disclosure to the public as a result of publishing Federal Register notices announcing the receipt of permit applications for public comment or
notice of the decision on a permit application.
Routine disclosure to Federal, tribal, State, local, or foreign wildlife and plant agencies for the exchange of information on permits granted or denied to
assure compliance with all applicable permitting requirements.
Routine disclosure to Captive-bred Wildlife registrants under the Endangered Species Act for the exchange of authorized species, and to share information
on the captive breeding of these species.
Routine disclosure to Federal, tribal, State, and local authorities who need to know who is permitted to receive and rehabilitate sick, orphaned, and injured
birds under the Migratory Bird Treaty Act and the Bald and Golden Eagle Protection Act; federally permitted rehabilitators; individuals seeking a permitted
rehabilitator with whom to place a bird in need of care; and licensed veterinarians who receive, treat, or diagnose sick, orphaned, and injured birds.
Routine disclosure to the Department of Justice, or a court, adjudicative, or other administrative body or to a party in litigation before a court or adjudicative
or administrative body, under certain circumstances.
Routine disclosure to the appropriate Federal, tribal, State, local, or foreign governmental agency responsible for investigating, prosecuting, enforcing, or
implementing statutes, rules, or licenses, when we become aware of a violation or potential violation of such statutes, rules, or licenses, or when we need to
monitor activities associated with a permit or regulated use.
Routine disclosure to a congressional office in response to an inquiry to the office by the individual to whom the record pertains.
Routine disclosure to the General Accounting Office or Congress when the information is required for the evaluation of the permit programs.
Routine disclosure to provide addresses obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a debtor to
collect or compromise a Federal claim against the debtor or to consumer reporting agencies to prepare a commercial credit report for use by the FWS.

5. For individuals, personal information such as home address and telephone number, financial data, and personal identifiers (social security number, birth date,
etc.) will be removed prior to any release of the application.
6. The public reporting burden on the applicant for information collection varies depending on the activity for which a permit is requested. The relevant burden
for an Import/Export/Re-Export of Trophies of Wildlife Samples and/or Biomedical Samples application is 70 minutes. This burden estimate includes time
for reviewing instructions, gathering and maintaining data and completing and reviewing the form. You may direct comments regarding the burden estimate
or any other aspect of the form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, Mail Stop 222, Arlington Square, U.S.
Department of the Interior, 1849 C Street, NW, Washington D.C. 20240.
Freedom of Information Act – Notice
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 2.13(c)(4), 43 CFR 2.15(d)(1)(i)].

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