Form 3-200-30a Annual Report for Exhibition Permittees

Expires XX/XX/XXXX
OMB No. 1018-XXXX

Annual Report for Exhibition Permittees Calendar Year ________
(due by March 31 of following year)
This information includes activities of all animals that have been permitted by our office for the past five years, whether or not they are in the U.S. or outside of the U.S. This form
may be copied. Use of this form is not mandatory; however, the same information must be submitted if using an alternate form. Additional information may be attached to the
report.
Permittee __________________________________________ Address (If location/address has changed since last year, indicate new location and date of change):

CITES
and/or ESA
Permit #

Species

Identifying
information

Date
animal
last left
U.S.

Most recent
country to
which animal
traveled

Date
returned (if
applicable)

If animal has
not returned,
expected date
of return

Employee with
whom animal is
traveling

Circus/Exhibition with
which the animal is
traveling

MAIL YOUR REPORT TO: Exhibition Annual Report, USFWS, Division of Management Authority, 4401 N. Fairfax Drive, Rm. 212, Arlington, Virginia 22203

Form 3-200-30a

Rev. <>

Attach photos of
conservation
education material
presented to
audience

Expires XX/XX/XXXX
OMB No. 1018-XXXX

FEDERAL FISH AND WILDLIFE PERMIT
Paperwork Reduction Act – Notice
In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.), 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. Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;
b. Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50CFR 17;
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: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;
g. Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), http://www.cites.org/ , 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.

Use of this form is not mandatory; however, the same information must be submitted if using an alternate form.

3.

The relevant burden for the report conditioned by an issued Export/Re-Export/Re-import of Circuses and Traveling Animal Exhibitions permit is 30 minutes. This burden
estimate includes time for reviewing instructions, gathering and maintaining data and completing and reviewing the report. You may direct comments regarding the burden
estimate 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.

Form 3-200-30a

Rev. <>