Form 3-200-37 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
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

Type of Activity:

EXPORT/IMPORT/INTERSTATE AND
FOREIGN COMMERCE/TAKE OF ANIMALS
(LIVE/ SAMPLES/PARTS/PRODUCTS) (CITES and/or ESA)

(circle/highlight proposed activity)

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 of $100. 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?
If yes, list the number of the most current permit you have held or that you are applying to renew/re-issue: _________________________________No
Yes

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 3-200-37

Rev. <>

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E. EXPORT/IMPORT/INTERSTATE AND FOREIGN COMMERCE/TAKE OF ANIMALS (LIVE/
SAMPLES/PARTS/PRODUCTS) (CITES and/or ESA)
Allow at least 90 days for the application to be processed. Applications for endangered species permits must
be published in the Federal Register for a 30-day public comment period.
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.
1.

What activity are you requesting authorization to carry out (Circle appropriate activities):
 EXPORT

 IMPORT

 INTERSTATE COMMERCE

 FOREIGN COMMERCE

 TAKE

2. For EACH animal involved in the proposed activity provide:
a. Scientific name (genus, species, and, if applicable, subspecies) and common name:

b. Description (e.g., birth date; sex, if known; and identifying features, if any, such as tattoo, identification
number, microchip number and location of microchip1, or scars; if biological samples, size of sample, total
amount or number of samples, and size/type of container):

3. The current location of the specimen(s) (address and
country):_________________________________________
__________________________________________________________________________________________
4. Recipient/Sender:
• If export, provide name and address of the recipient in the foreign country.
• If import, provide name and address of the exporter in the foreign country.
• If interstate or foreign commerce, provide name and address of recipient.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

1

If a microchip is used to identify the animal, the exporter may be asked to have a microchip reader on hand to read the
microchip at the time of export. Border officials must be able to verify that the permit and the animal correspond.

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SOURCE OF SPECIMEN (answer question 5 or 6 for each specimen involved, as appropriate):
5. For each specimen born in captivity:
a. If you are the breeder of the specimen(s), please provide a signed and dated statement that includes the
following:
i. That each animal was bred and born at your facility;
ii. Scientific name (genus, species, and, if applicable, subspecies) and common name;
iii. Birth/hatch date, and, if applicable, identification information (as described in question 2b above);
iv. Name and address of your facility where each animal was bred and born; and
v. Location (Name of facility, address, city, State/province, postal code) of parental stock.
b. If you are NOT the breeder of the specimen(s), provide 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) and a signed and dated statement from the breeder or breeder's record that
clearly includes the following:
i. That each animal was bred and born/hatched at his/her facility;
ii. Scientific name (genus, species, and, if applicable, subspecies) and common name;
iii. Birth/hatch date, and, if applicable, identification information (as described in question 2b above);
iv. Name and address of the breeder’s facility; and
v. Location (name of facility, address, city, State/province, postal code) of parental stock.
6. For each specimen taken from the wild, provide the following (please use a separate sheet of paper):
a. Scientific name (genus, species, and, if applicable, subspecies) and common name;
b. Specific location of where, when, and by whom (name and address) the specimen was removed from the
wild;
c. Purpose of removal and length or approximate length of time held in captivity;
d. Describe your efforts to use captive specimens (e.g., captive-born, captive-held), or parts thereof, in lieu of
taking animals from the wild.
e. Copies of your foreign or domestic collecting permit, license, contract or agreement;
f. Documentation showing that the specimen(s) was legally obtained by the applicant; and
g. Copies of any applicable State permits or licenses that are required to house, maintain, breed, and/or sell
these specimens (contact your State for information).

JUSTIFICATION FOR REQUESTED ACTIVITY:
7. Provide a full statement justifying the permit including details of the activities, particularly the following (please
use a separate sheet of paper):
a. Description of the purpose of your proposed activity. If your purpose is for scientific research, attach a copy
of your research proposal which outlines the purpose, objectives, methods (e.g., specific information on
survey/collection methods, sampling regime, equipment to be used), and whether similar work has already
been done or is currently being done.
b. Description of the technical expertise of each person, as it relates to the proposed activities. If the proposed
activity involves the import of live animals, include the experience of each animal caretaker working with the
species.
c. Copies of contracts, agreements or other documents that identify persons involved and dates of activities for
which authorization is being requested.
d. A statement on how the activities will enhance or benefit the wild population (in-situ and ex-situ projects). If
your activities include conservation education, provide copies of educational materials (e.g., handouts, text of
signage or public presentations). Educational material must discuss the ecological role and conservation
needs for the species involved in the proposed activity.

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8. If live specimens are to be held in captivity as part of the proposed activity:
a. Provide a detailed description (e.g., size, construction materials, protection from the elements) and
photographs or diagrams (no blueprints, please) clearly depicting the existing facilities where the wildlife will
be maintained. If the specimens will be housed at multiple facilities, either immediately or within the next
year, provide a full description of each facility. If you are unsure of which facilities may be receiving
specimens (e.g., SSP has not made final decision), please indicate likely candidates and the mechanism that
will be used to determine recipient facilities.
b. A statement of the specific technical experience available to the recipient(s) for maintaining and propagating
live specimens of the same or similar species, including:
i. The number of years each species has been maintained;
ii. A list of the number of successful births by year for each species for the last 5 years; and
iii. Mortalities resulting from your activities with these or similar species in the last 5 years, causes of such
mortalities, and steps taken to avoid or decrease such mortalities.
IMPORTS, EXPORTS, OR RE-EXPORTS:
9. If import or export specimens:
a. Provide a copy of any required foreign permits (for CITES Appendix-I specimens provide a copy of import
permit or evidence one will be issued).
b. The transport conditions for live animals must comply with the CITES Guidelines for Transport of Live
Animals or, in the case of air transport, with the International Air Transport Association (IATA) live animal
regulations (contact airline for information). As such, describe:
a. The type, size, and construction of any shipping container; and
b. The arrangements for watering or otherwise caring for the wildlife during transport.
10. For import of CITES Appendix-I species provide information to show the import is not for primarily commercial
purposes as outlined in Resolution Conf. 5.10 (www.cites.org).
11. For export of Appendix I listed 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. If the specimen is being re-exported (exporting a specimen that was previously imported into the United States)
provide:
a. A copy of the canceled CITES export or re-export document issued by the appropriate CITES office in the
country from which the wildlife was imported (if applicable); and
b. A cleared copy of Form 3-177, wildlife Declaration for Import (hard copy or electronic release); or
c. If you did not make the original import, provide a copy of the importer's documents outlined above and the
invoice or other documentation that shows you acquired the wildlife from the original importer or history of
transactions which demonstrate chain of ownership.
13. Enter the U.S. port through which the [export/re-export/import] 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:
__________________________________________________________________________
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16. Who should we contact if we have questions about the application? (Include name, phone number, and email):
__________________________________________________________________________________________

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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 Export/Import/Interstate and Foreign Commerce/Take of Animals application is 2 hours. 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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