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

Department of the Interior, U.S. Fish and Wildlife Service
National Eagle Repository
5650 Havana Street, RMA, Bldg. 128
Commerce City, CO 80022
(303) 287-2110

OMB No. 1018-0022
Expires.
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
MB

Name of Contact Person (if you have no phone)

Work Phone Number
(
)

Phone Number of Contact
(
)
-

-

Cellular Phone Number
(
)
-

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 – Golden Eagle
Whole Carcass – Bald Eagle
Pair of Whole Wings
Whole Tail – Golden Eagle
Whole Tail – Bald Eagle
Quality Loose Feathers (8 wing; 2 tail)
Miscellaneous Loose Feathers (lower
quality mixed)
Pair of Talons
Head
Trunk (body without head, feet, wings or tail)

Approximate
Waiting Period
4 ½ - 5 years
2 - 2 ½ years
1 year
4 ½ - 5 years
2 - 2 ½ years
6 months
90 days

Item

Age
Adult
Immature
Either

Species
Golden
Bald
Either

See page 3 for examples

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

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

Minimal
Minimal
Minimal

NAME OF YOUR TRIBE:

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 (Rev 09/2010)

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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 first need to apply to the U.S. Fish and Wildlife Service Migratory Bird Permit Office that serves the State where you live to
obtain a permit. See instructions for “Applying for a Permit” below.
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, which authorizes 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 Reorder Request form each time. If you do not have a permit yet, see the instructions for “Applying
for a Permit” below.
The Repository serves Native Americans of federally recognized tribes throughout the United 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 your form is signed and the information you provide is complete and legible. We must have
your current address and telephone number so the Repository can contact you when your request is ready to be filled.
***IMPORTANT: Please notify the Repository at (303) 287-2110 if you change your address or telephone number. The
Repository will not ship any orders without prior address verification.
Due to the limited supply of eagle carcasses, parts and feathers, all applicants are allowed only one pending order at a
time. Each order for parts may not exceed the quantity of one whole bird. Applicants ordering a whole bird may not order
additional parts. Requests for a whole carcass average 2-2½ years to fill for a bald eagle and 4½ - 5 years to fill for a golden eagle.
Feather orders are as follows: Ten “quality loose feathers”, which usually consist of 8 wing feathers and 2 tail feathers, are filled
within 6 months. Twenty “miscellaneous loose feathers” usually consist of a mixture of lower quality feathers that are not
exchangeable or returnable and are filled within 90 days. Please refer to page 3 for descriptions of eagle 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. Make sure your re-order
form is completed with all information, including permit number, and signed. If your form is incomplete, it will be returned to
you and your order will be delayed. You do not need to resubmit your Certification of Enrollment. Mail your completed and
signed Reorder Request to:
USFWS National Eagle Repository
5650 Havana Street
RMA, Building 128
Commerce City, CO 80022
Applying for a Permit.
Applying for a Permit. If you do not already have a permit, complete a “Permit Application & First Order” form (Service form
3-200-15A) available online at www.fws.gov/forms/3-200-15a.pdf or contact the Service Regional Migratory Bird Permit Office
that serves the state where you live to request one be mailed to you. Submit your complete application to your Migratory Bird
Permit Office (see addresses below). If it is approved, the Permit Office will send you a permit and forward your First Order to the
Repository to fill.
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.

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REGIONAL MIGRATORY BIRD PERMIT OFFICES
FWS
Region
1

2

3

4

5

6

7

8

Area of Responsibility

Mailing Address

Telephone Number
& Email Address

911 N.E. 11th Avenue
Portland, OR 97232-4181

(503) 872-2715

P.O. Box 709
Albuquerque, NM 87103

(505) 248-7882

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

One Federal Drive
Ft. Snelling, MN 55111-4056

(612) 713-5436

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

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

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

P.O. Box 25486, DFC
Denver, CO 80225-0486

(303) 236-8171

Alaska

1011 East Tudor Road (MS 201)
Anchorage, AK 99503

(907) 786-3693

2800 Cottage Way
Sacramento, CA 95825

(916) 978-6183

Hawaii, Idaho, Oregon, Washington, Pacific Island Territories

Arizona, New Mexico, Oklahoma, Texas

California, Nevada

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[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

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. 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.
b. 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.
c. 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.
d. 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.
e. 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.
f.
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.
g. 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.
h. Routine disclosure to a congressional office in response to an inquiry to the office by the individual to whom the record pertains.
i.
Routine disclosure to the General Accounting Office or Congress when the information is required for the evaluation of the permit programs.
j.
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 30 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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