Form 3-200-15a Federal Fish and Wildlife Permit Application Form

Department of the Interior
U.S. Fish and Wildlife Service
EAGLE PARTS FOR NATIVE AMERICAN RELIGIOUS PURPOSES

OMB No. 1018-0022
Ex. Xx/xx/xxxx
Office Use Only
Date Completed Request
rec’d in Regional Office
______/______/______
Initials: _________

Permit Application
& First Order
Please see reverse for instructions
Last Name

First Name

Middle Name

Suffix (Sr., Jr.,
etc.)

Physical address (Street address; Apartment #, Suite #; no P.O. Boxes)
City

State

Zip code/Postal code

State

Zip code/Postal code

Mailing Address (if different than physical address)
City
Date of Birth
Home Phone Number
(
)

Social Security Number

Name of Contact Person (if you have no phone)

Work Phone Number
(
)

-

Permit Number

Phone Number of Contact
(
)
-

-

E-Mail Address

DESCRIPTION OF REQUESTED MATERIAL (You can only make one request at a time.)
(May not exceed parts
of one whole eagle)
” Whole Carcass
” Pair of Whole Wings
” Whole Tail
” Quality Loose Feathers (10)
” Miscellaneous Eagle Feathers (20 mixed)
” Pair of Talons
” Head
” Trunk (body without head, feet, wings,
or tail)

Item

Approximate Waiting Period
2 ½ - 4 years
1 year
2 ½ - 4 years
6 months
90 days
Minimal
Minimal
Minimal

NAME OF YOUR TRIBE:

Species
” Golden
” Bald
” Either

Age
” Adult
” Immature
” Either

(Orders for golden
eagles may take longer
to fill than bald
eagles.)

(Orders for immature
golden eagles take the
longest to fill.)

ENROLLMENT NO.

Name of Religious Ceremony in which these materials will be used. (You may choose not to provide the name of the religious
ceremony if doing so will violate your religious beliefs.)
I hereby certify that I am requesting an eagle items for religious purposes and that the information submitted herein is complete
and accurate to the best of my knowledge. I understand that false statements made here may subject me to criminal penalties.
Signature:

Date:

===== OFFICE USE ONLY BELOW HERE ====
APPLICANT CONTACT NOTE
Date shipping request forwarded to Eagle Repository: :
Date shipping request received at Eagle Repository:
Date of shipment to applicant:

/

/

/
/

/
/

Initials:

Form 3-200-15A (Rev 07/07)

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Initials:
Initials:

Instructions for Applying for a Permit
for Native American Religious Purposes
IMPORTANT: Do not use this application form if you already have a U.S. Fish and Wildlife Service permit for
eagle parts for Native American religious use. If you already have a permit, you must use the Re-Order Request Form
(3-200-15B) to order directly from the Repository. See instructions below under “Re-Ordering Eagle Parts and
Feathers from the Repository.”
The U.S. Fish and Wildlife Service administers the Bald and Golden Eagle Protection Act, the primary Federal
law protecting bald and golden eagles. This law provides for the use of eagle feathers for religious purposes by Native
Americans. Eagles and eagle feathers are accumulated by, and made available to Native Americans through, the
National Eagle Repository. In order to receive material from the Repository, you must first obtain a permit from your
Regional Migratory Bird Permit Office, using this application form. You only need to obtain a single permit. That
one permit will authorize all future shipments you receive from the Repository. Once you have that permit and have
received your first order, you may make future requests directly to the Repository using a Re-Order Request Form
(Form 3-200-15B) (see instructions below under “Re-Ordering Eagle Parts and Feathers from the Repository”.)
Please do not submit re-order requests to your permit-issuing office.
The Repository serves Native Americans throughout the entire 50 States. Shipments of feathers are prioritized
according to the date received. You can avoid delays in the processing of your application by ensuring that your forms
are complete and legible. We must have your current address and telephone number for the Repository to contact you
when your request is ready to be filled. ***IMPORTANT: Notify the Repository at (303) 287-2110 if you change
your address or telephone number. The Repository will not ship any orders without prior telephone contact.
Because the supply of eagle carcasses, parts, and feathers is limited, you may have only one request pending
at a time, and you may not request both a whole bird and additional parts in the same request. Requests for
whole carcasses average 2½ to 4 years to fill (shorter wait for bald eagles, longest wait for immature golden eagles).
Requests for loose feathers can usually be filled in 3 to 6 months. An order for parts may not exceed the
equivalent of a whole bird. A request for 10 quality feathers includes 8 wing feathers, two tail feathers. Please refer
to page 3 for descriptions of different eagle parts and feathers.
To qualify for a permit, you must be a member of a federally recognized tribe, band, nation, or other organized
group or community recognized by, and eligible to receive services from, the Bureau of Indian Affairs. You must
submit with your permit application a Certification of Enrollment in a Federally Recognized Tribe completed by a
tribal official who is authorized to certify that an individual is a duly enrolled member of your tribe. You must be at
least 18 years old to apply for a permit.
Mail your completed application form and Certification of Enrollment to the Regional Migratory Bird Permit Office
that covers the State where you live. The Regional Migratory Bird Permit Offices and their addresses are listed on
page 3. After you have received your permit, any questions about the status of your order should be directed to the
Repository at (303) 287-2110.
Re-Ordering Eagle Carcasses, Parts, and Feathers from the Repository
If you already have a permit and wish to re-order eagle carcasses, parts, or feathers, use a Re-Order Request
Form (3-200-15B) to order directly from the Repository. You can obtain that form online at:
http://permits.fws.gov/mbpermits/birdbasics.html, or contact your Regional Migratory Bird Permit Office to request
that one be mailed to you.

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MIGRATORY BIRD PERMIT OFFICES
FWS
Region

Mailing Address

Area of Responsibility

and Telephone No.

1

California, Hawaii, Idaho, Nevada, Oregon, Washington, Pacific Island
Territories

911 N.E. 11th Avenue
Portland, OR 97232-4181
(503) 872-2715

2

Arizona, New Mexico, Oklahoma, Texas

P.O. Box 709
Albuquerque, NM 87103
(505) 248-7882

3

Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, Wisconsin

One Federal Drive
Ft. Snelling, MN 55111-4056
(612) 713-5436

4

Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North
Carolina, South Carolina, Tennessee, Puerto Rico, U.S. Virgin Islands

P.O. Box 49208
Atlanta, GA 30359
(404) 679-7070

5

Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts,
New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont,
Virginia, West Virginia

P.O. Box 779
Hadley, MA 01035-0779
(413) 253-8643

6

Colorado, Kansas, Montana, Nebraska, North Dakota, South Dakota, Utah,
Wyoming

P.O. Box 25486, DFC
Denver, CO 80225-0486
(303) 236-8171

7

Alaska

1011 East Tudor Road (MS 201)
Anchorage, AK 99503
(907) 786-3693

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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.) & 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:
a.
Bald and Golden Eagle Protection Act (16 U.S.C. 668), Title 50, Code of Federal Regulations, Part 22 [50 CFR 22];
b.
Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50 CFR 17.1 to 17.95(b) , 50 CFR 17.95(c) , 50 CFR 17.96 to 17.99 , and
50 CFR 17.99 to end;
c.
Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;
d.
Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), 50 CFR 18;
e.
Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15;
f.
Lacey Act (18 U.S.C. 42); Injurious Wildlife, 50 CFR 16;
g.
Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249) ; 50 CFR 23;
h.
General Provisions, 50 CFR 10;
i.
General Permit Procedures, 50 CFR 13; and
j.
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 the 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, 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, 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, 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, state, tribal, 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 Eagle Indian Religious Permit Application & First Order application is 1 hour. 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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OMB No. 1018-0022
Expires x/xx/xxxx

Department of the Interior
U.S. Fish and Wildlife Service
Division of Migratory Birds

Eagle Permit Applicant:
(Please print)
Name: ________________________________________________________________________
Address: ______________________________________________________________________
______________________________________________________________________________
TELEPHONE NUMBER: ____________________________________________________________
CERTIFICATION OF ENROLLMENT IN A U.S. FEDERALLY RECOGNIZED TRIBE
(By Certifying Tribal Official)
The U.S. Fish and Wildlife Service administers the Bald and Golden Eagle Protection Act, the
Federal law protecting eagles. This law provides for Native American use of eagle feathers for
religious purposes. Eagles and eagle feathers are accumulated by the Service’s National Eagle
Repository and made available to Native Americans.
Application for a permit to acquire eagle feathers requires certification that the requesting individual
is an enrolled member of an Indian tribe that is federally recognized under the Federally
Recognized Tribal List Act of 1994, 25 U.S.C. 479a-1, 108 Stat. 4791 (1994). The certificate must
be signed by the tribal official who is authorized to certify that an individual is a duly enrolled
member of that tribe, and must include the official title of that certifying official. (50 CFR 22.22)
- - - - - - - - - - - - - - - Name of certifying official (print): __________________________________________________.
is an enrolled member of the

I certify that
Tribe, Enrollment #

.

I understand that making a false statement can make me subject to the criminal penalties of 18
U.S.C. 1001.
Date: __________________

Signature:
Title:

Office phone no. (

)

-___________

NOTE TO CERTIFYING OFFICIAL: Please expedite this completed Certification of
Enrollment to the applicant at the above address.
APPLICANT: Attach this completed certification to your Eagle Permit application and mail them
to the U.S. Fish and Wildlife Service Regional Migratory Bird Permit Office responsible for your
state.
Form 3-200-15A (Rev 07/07)

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