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

Department of the Interior, U.S. Fish and Wildlife Service
National Eagle Repository, Bldg. 128
Rocky Mountain Arsenal
Commerce City, CO 80022
(303) 287-2110

OMB No. 1018-0022
Ex. Xx/xx/xxxx
Office Use Only
Date Completed Request
rec’d in NER
_______/______/______

RE-ORDER REQUEST
EAGLE PARTS FOR NATIVE AMERICAN RELIGIOUS PURPOSES
Please see reverse for instructions
Last Name

First Name

Initials: _________

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

-

Permit Number

Work Phone Number
(
)

Name of Contact Person (if you have no phone)

-

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.

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 of shipment to applicant:

REQUEST #

/

/

Initials:

Form 3-200-15B

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Instructions for Re-Ordering
Eagle Parts for Native American Religious Purposes
IMPORTANT: Use this Re-Order Request (Form 3-200-15B) only if you already have a permit to
possess eagle carcasses, parts, and feathers from the National Eagle Repository (Repository). If you do
not already have a permit, do not use this form. Instead, you need to apply to your Regional Migratory
Bird Office that serves the State where you live. See instructions on page 3 under “Applying for a
Permit.”
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 parts and
feathers for religious purposes by Native Americans. Eagle carcasses, parts, and feathers are
accumulated by, and made available to Native Americans through, the Repository. In order to
receive material from the Repository, you must first obtain a permit from the Service Regional
Migratory Bird Permit Office responsible for your State. You only need to obtain a single permit.
That one permit will authorize all future shipments of eagle carcasses, parts, and feathers from the
Repository. Once you have that permit, you may make future requests directly to the Repository
using this form each time. If you do not have a permit yet, see the instructions on page 3 under
“Applying for a Permit.”
The Repository serves Native Americans throughout the entire 50 states. Shipments are prioritized
according to the date the Repository receives a completed Re-Order Request form. You can avoid
delays in the processing of your Re-Order Request by ensuring that the information you provide is
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 between 3
and 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.
Use this Re-Order Request (Form 3-200-15B) only if you already have a permit. (If you do not
have a permit yet, see instructions below.) When filling it out, make sure you request either a whole
bird or parts. Do not ask for both. Be sure to fill in your permit number. You do not need to
resubmit your Certification of Enrollment. Mail the Reorder Request to:
National Eagle Repository
Building 128
Rocky Mountain Arsenal
Commerce City, CO 80022
IMPORTANT: Notify the Repository at (303) 287-2110 if you change your address or telephone
number. The Repository will not ship any eagles, feathers, or parts without prior telephone
contact.
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Applying for a Permit
If you do not have a permit already, follow the instructions below to apply for one. 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 be at least 18 years old to apply for a permit.
To apply for a permit fill out a Service Form 3-200-15A. 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. The Regional Migratory Bird Permit Offices are:
Region 1 (503) 872-2715
(CA, HI, ID, NV, OR, WA)

Region 5 (413) 253-8643
(CT, DC, DE, ME, MD, MA,, NH, NJ, NY, PA, RI, VA, VT, WV)

Region 2 (505) 248-7882
(AZ, NM, OK, TX)

Region 6 (303) 236-8171
(CO, KS, MT, ND, NE, SD, UT, WY)

Region 3 (612) 713-5436
(IA, IL, IN, MN, MO, MI, OH, WI)

Region 7 (907) 786-3693
(AK)

Region 4 (404) 679-7070
(AR, FL, GA, KY, LA, MS, NC, SC, TN, PR, VI)

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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 – Reorder Request application is 20 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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