Form 3-202-12 Migratory Bird Special Purpose Possession (Education) Pe

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

Migratory Bird Special Purpose Possession (Education) Permit
Acquisition and Transfer Request
Please see page 2 for instructions

1

SPECIES:
Sex: ____ Male ____ Female

Band number or other identification (if applicable): _______________
____ Unknown
Age: ____ Nestling ____ Immature ____ Adult

2 SENDER (person transferring bird)
Telephone No. (

Name: ____________________________________________________

)

Fax No.: (

)________________ E-mail: ______________________
City:

Address:
FWS Permit No.:

State:

Zip:________

Type: ___Rehabilitation ___Special Purpose Possession ___ Other (specify):

Reason for Transfer: ___________________________________________________________________________
If this bird is currently listed on your Special Purpose Possession (Education) permit and is being transferred, or has escaped or
died, do you plan to replace it?

____ Yes

3 RECIPIENT (person acquiring bird)
Telephone No. (

)

Address:

____ No
Name: ____________________________________________________

Fax No. (______)________________ E-mail: _____________________
City:

State:

Zip:_______

FWS Permit No.:____________________ Is this a replacement bird for a bird already on your permit? ___ Yes ___ No
Does your Special Purpose Possession permit already authorize possession of this species?

___ Yes ___ No

4 REASON BIRD IS NON-RELEASABLE
Describe the bird’s condition that renders it non-releasable (and attach a veterinarian’s statement confirming that the bird is nonreleasable and why):
5 ATTACHMENTS
(a) You must attach a veterinarian’s statement confirming that the bird is non-releasable and why.
(b) If you are acquiring a bird and your permit does not already authorize your possession of this bird, attach a
description and photographs of your permanent facilities for housing the bird,
(c) If you are acquiring a bird and your permit does not already list individuals of this species, attach:
(i) A brief outline of the educational program you will deliver regarding the species or similar species, and
(ii) A description of your experience handling this particular species.
6 CERTIFICATION. I certify that the information submitted above is true and correct to the best of my knowledge.
I understand that making a false statement may subject me to the criminal penalties of 18 U.S.C. 1001.
Your signature: _____________________________________________

Date:_______________________________

U.S. FISH & WILDLIFE SERVICE APPROVAL / DISAPPROVAL
Approved: ___________________________________
Signature of FWS official

Concurrence: ___________________________________
Signature of FWS official

Denied:

___________________________________
Signature of FWS official

_____________________________________________
Title/Region

Date

______________________________________________
Title/Region

Date

______________________________________________
Title/Region

Date

Reason denied _____________________________________________________________________________________
__________________________________________________________________________________________________
Form 3-202-12

(rev 7/2007)

OMB No. 1018-0022; Expires x/xxxx

INSTRUCTIONS
This form is for use of holders of Federal Migratory Bird Special Purpose Possession Live (Education) permits.
It must be completed and approved for each transfer, acquisition, release, or loss of a migratory bird held under
your special purpose possession permit.
If a transfer is proposed between two Special Purpose Possession (Education) permittees, both permittees
must complete a form and submit it to their issuing U.S. Fish and Wildlife Service Migratory Bird Permit Office.
If a transfer is proposed from a permittee other than a Special Purpose Possession (Education) permittee, such
as a Rehabilitation permittee, the form must be submitted only by the receiving Special Purpose Possession
(Education) permittee.
You must submit the completed form to your issuing office for approval prior to receiving or transferring a bird.
These forms may be faxed to the issuing office provided the original follows by mail. If the requested
transaction necessitates amendment of your permit, the completed form will serve as your amendment request.
The authorizing Service official will approve or deny the transaction at the bottom of the form and mail a copy to
you for your records. If your request is approved, you may take possession or transfer the bird once you
receive your copy. If your request is denied, you may not conduct the requested activity (see 50 CFR 13.29 for
reconsideration procedures).
1.
If you wish to:
A. transfer a bird to another permittee (or to another permit you hold,
or to an institution exempt from the permit requirement under
50 CFR 21.12),
B. release a bird or you lost a bird due to its escape, theft, or death,
C. acquire a bird from another permittee (or from another permit
you hold),

then you must complete these
sections on the front of this form
1, 2, 3, 4, 5, and 6.

1, 2, and 6.
1, 2, 3, 4, 5, and 6.

2.

A veterinarian’s statement of non-releasability is required for A or C. Attach a veterinarian’s statement
describing the injury/illness that renders the bird non-releaseable.

3.

If you are acquiring a migratory bird and your Federal permit does not already include authorization to
possess this individual, you must provide your permitting office with a description and photographs of your
permanent facilities for housing this bird. This information is required before your permit can be amended
to authorize your possession and acquisition of this bird. Your permit will specify the number of birds of
this species you are authorized to possess, based in part on the adequacy of your facilities.

4.

If you are acquiring a bird that is a new species for you (i.e., your permit does not already authorize
possession of individuals of this species), you must provide (a) a brief outline of the educational program
you will deliver regarding this species, and (b) a description of your experience handling this particular
species. This information is required before your permit can be amended to authorize your possession
and acquisition of this bird.

5.

Sign and date the form.

6.

Mail the completed form and any required attachments to the U.S. Fish and Wildlife Service Migratory Bird
Permit Office that issued your permit.

Notice
Privacy Act (5 U.S.C.552a): The gathering of information on fish and wildlife is authorized by the Migratory Bird Treaty Act (16 U.S.C. 703
et seq.), and Parts 13 and 21 of Title 50 of the Code of Federal Regulations. Disclosure of the requested information is necessary for
administration of permits under MBTA and is a condition of your permit. Failure to disclose all of the requested information may be
sufficient cause for revocation of your permit. The information will be used to monitor disposition of captive birds and the take of birds from
the wild. Routine use disclosures outside the Department of the Interior may be made without the consent of an individual if the
disclosure is compatible with the purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003)
Paperwork Reduction Act (44 U.S.C.3501): An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The public reporting burden estimate for reviewing
instructions, gathering and maintaining data, and completing this form is 1.5 hours. Comments on the form, including the burden estimate,
should be mailed to the Information Collection Clearance Officer (Ref 1018-0022), Mail Stop 222-ARLSQ, Fish and Wildlife Service, U.S.
Department of the Interior, 1849 C Street, NW, Washington, D.C. 20240.