Form 3-200-11 Federal Fish and Wildlife Permit Application Form

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OMB No. 1018-0022

Department of the Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form

Return to: U.S. Fish and Wildlife Service (USFWS)
or

Type of Activity:

Falconry Permit

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, tribe, or institution

1.a. Name of business, agency, tribe, 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

D.
1.

2.

3.

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

All applicants MUST complete
Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount $100.00.. 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
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 3-200-11

Rev. 9/2010

Page 1of 4

E.
FALCONRY PERMIT
(Migratory Bird Treaty Act, 50 CFR 21.28)

Note: A falconry permit is required to possess and train raptors for falconry and to practice the sport of falconry. To become a falconer,
you should begin by contacting your State wildlife agency and meet the requirements for the State falconry permit. We also recommend
that you contact your State falconry association (http://www.n-a-f-a.com/StateClubs.htm).
A falconer begins as an Apprentice, then may graduate to a General falconer, then a Master falconer. If you wish to become an
Apprentice falconer, you will need to find a Master falconer to be your sponsor. Your State wildlife agency or falconry association can
provide more information.
Until recently, both a State and a Federal falconry permit were required for falconry. However, the U.S. Fish and Wildlife Service
(Service) and the States are in the process of shifting to new regulations under which a falconry permit would only be needed from the
State. States that have adopted the new Federal regulations are posted at http://www.fws.gov/migratorybirds/mbpermits.html (see
“Revised Falconry Regulations”). If you live in a State that has adopted the new Federal regulations, you do not need a Federal permit
and do not need to complete this application. Contact your State wildlife agency to obtain your State falconry permit.
The Service will approve States that meet the requirements of the new Federal regulations near the end of each year. The Federal permit
requirement will be eliminated in those States beginning January 1 of the following year. The new Federal regulations are posted at
http://www.fws.gov/policy/library/2008/E8-23226.pdf.
If you do not live in a State that has adopted the new regulations, the old regulations apply. They are in two sections:
http://edocket.access.gpo.gov/cfr_2007/octqtr/pdf/50cfr21.28.pdf and http://edocket.access.gpo.gov/cfr_2007/octqtr/pdf/50cfr21.29.pdf. In
most of these States, the issuance of a falconry permit is a joint State/Federal process. In such States, you need only apply to your State
for a falconry permit; the Service will cosign the State permit. (Note: You may be required to file a Federal permit application with your
Federal Migratory Bird Permit Office if your State falconry application does not meet Federal information requirements.)
In States that do not issue a joint State/Federal permit you must obtain your State permit before you apply for a Federal permit. Your
State falconry permit is not valid until your Federal falconry permit is issued. Contact your State wildlife agency for information about
the required examination and facility inspection.
This application is the Federal permit application. Complete and submit this application only if your State has not adopted the new
Federal regulations and does not participate in the joint State/Federal permitting process. If you are under 18 years of age, your parent
or guardian must sign beside your signature on page 1 of this application. Once completed, submit the form to the Fish and Wildlife
Service Migratory Bird Permit Office responsible for your State (see attached list of permit offices).
Please provide the following information:
1.

The address where your raptors will be housed, if different from your residence.
___________________________________________________________________________________________
___________________________________________________________________________________________

2.

A copy of your State raptor facilities and equipment inspection report.

3.

If you are applying for an Apprentice falconry permit, provide a letter from your sponsor indicating his or her willingness to
sponsor you. The letter must include your sponsor’s name, address, telephone number, and Federal falconry permit number.

4.

You must retain records relating to the activities conducted under your permit for at least 5 years after the date of expiration of your
permit. Is the physical address you provided in Section C on page 1 of this application the address where your records will be
kept? ____ Yes
____ No If “no”, provide the physical address.
____________________________________________________________________________________________

5.

A copy of your State permit to conduct this activity, if available.

.

Form 3-200-11

Rev. 9/2010

Page 2 of 6

PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to 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 are referred to as a permit.
GENERAL INSTRUCTIONS:

Complete all blocks/lines/questions in Sections A or B, and in C, D, and 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, tribe, or institution:

Enter the complete name of the business, agency, tribe, 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, tribe, 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, tribe, 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.
ALL APPLICANTS COMPLETE SECTION E.

Please continue to next page
Form 3-200-11

Rev. 9/2010

Page 3 of 6

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. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays
a currently valid OMB control number.

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 a Falconry permit application is 1 hour and 15 minutes for recordkeeping. 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

Form 3-200-11

Rev. 9/2010

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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)].

Form 3-200-11

Rev. 9/2010

Page 5 of 6