Form 3-200-32 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 212
Arlington, VA 22203
1-800-358-2104 or 703-358-2104

Type of Activity:

EXPORT/RE-EXPORT OF PLANTS (CITES)
 Renewal of Permit # ______________ (check box if
applicable)

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, tribe, 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 identified on page 2. 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

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
Please continue to next page E.

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Rev.

EXPORT/RE-EXPORT OF PLANTS (CITES)
Page 1 of 6

You may use this form for a single shipment, personal or household plants, or to establish a Master File. If you
wish to request authorization for multiple commercial exports of artificially propagated plants, please use form 3200-33 (www.fws.gov/forms).
Provide the following information. Complete all questions on the application. If needed, use a separate sheet of
paper. On all attachments or separate sheets you submit, indicate the number of the application question you are
addressing. Mark questions that are not applicable with "N/A". Indicate which plants are being addressed in each
response.
Electronic submission of inventories, photographs, and receipts: Some applications contain long inventories and/or
a large number of photographs or receipts. You may provide electronic versions of these documents. Such a
submission may assist to expedite the processing of your application since it will eliminate the need for data entry
by U.S. Fish and Wildlife Service. You may include a disk containing your information or, if applicable, please
check the following:  I would like you to contact me at the email address above in order to get an electronic
inventory.
1.

What activity are you requesting?
a.
 SINGLE SHIPMENT for export/re-export (processing Fee = $100)
b.
 PRE-CONVENTION/SINGLE SHIPMENT (processing Fee = $75)
c.
 PERSONAL/HOUSEHOLD PLANTS/SINGLE SHIPMENT (processing Fee = $50)
d.
 ESTABLISHMENT OF A MASTER FILE (processing Fee = $200) (This application allows you
set up a Master File, valid for three years and is renewable, for exports of plant specimens under CITES. Once the
Master File is approved you would need to obtain single-use permits, valid for 6 months, for each export (50 CFR
13.11))
.
e.
 Renewal and/or Amendment of an Established Master File, # ________ (processing Fee = $100)
2.

IF establishing a new master file or renewing a previous master file, how many single-use permits do you
anticipate using in the next 6 months? ____________ (Provide $5 for each 6-month permit.) For future
shipments, additional permits may be requested using form 3-200-74;.
http://www.fws.gov/forms/display.cfm?number1=200

3.

On a separate page, please list all specimens, sorted by Appendices (I, II, or III) and sorted by native species
versus non-native species. For EACH plant specimen, indicate:
a.
Scientific name (genus, species, and if applicable, hybrid, variety, cultivar, or subspecies) and common
name;
b.
General description (e.g., whole plant, seeds, raw product, parts and derivatives; size)*
* For Plant Products (e.g., timber, medicinal products, nutritional supplements), the general
description (example: bottles of Hoodia gordonii, 30 capsules in each bottle, each capsule contains 100
mg of H. gordonii) should include:
i.
Form of product (e.g., plywood, tablet, capsule, fruit bar);
ii.
Form of packaging (if applicable);
iii. Quantity, including the amount/percentage of listed plant species in each package, in metric
units; and
iv. Product name, if applicable.
c.
Quantity;
d.
Country where the plant was acquired; and
e.
Source of the specimen (e.g., removed from the wild or artificially propagated).

4.

If you are requesting a single shipment, provide recipient’s foreign address:
________________________________________________________________________________
________________________________________________________________________________

5.

Current location of specimens ________________________________________________________

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6.

What is the purpose of the export? ____________________________________________________

7.

Is this shipment a sample collection being exported for temporary exhibition or display purposes and
accompanied by a valid ATA carnet?  NO  YES; If available, provide ATA carnet document number
________________.

8.

For Plants Collected From the Wild in the United States, on a separate page, provide the following for
each species collected from the wild:
a.
Number of specimens collected;
b.
Specific location, and date of collection for each specimen;
c.
Who (name and address) collected the specimens;
d.
Copies of documents that indicate that the plants were legally collected (e.g., State permits or licenses,
landowner's permission). Be sure to correlate each document to the corresponding plant;
e.
Approximate density (such as number of plants per acre) and distribution of the species at the
collection site(s);
f.
Collection methodology (e.g., whether the specimens were removed from one clump in an area of
several clumps or from more than one clump or patch at a specific location); AND
g.
Ratio of how many collected to how many remain.
h.
If you purchased the plants/seeds, provide the invoice or other document that shows the name, address
and telephone number of the person from whom you purchased the plants and the date of purchase for
each specimen (such documentation should trace back to the original collector).

9.

For wild-collected Appendix-I plants, provide a copy of the CITES import permit issued by the
Management Authority of the country to which you plan to export the plant.

10.

For Artificially Propagated Plants provide:
a.
If you purchased the plants from a propagator that is currently holding a valid Certificate of Artificially
Propagated Plants (CAPP), provide a signed statement from the propagator attesting that the specimens
were artificially propagated that their facility AND provide the invoice or other document that shows
the name, address and telephone number of the person from whom you purchased the plants and the
date of purchase for each specimen.
b.
If you purchased the plants from a propagator that is not currently holding a valid CAPP, you will need
to provide sufficient information to determine if the specimens meet the criteria under Resolution Conf.
11.11 (rev. CoP13) to qualify as Artificially Propagated under CITES. You may either contact our
office or refer to Section E, Parts I, II, and III, of application form 3-200-33
(http://www.fws.gov/forms/display.cfm?number1=200).

11.

For Re-Export (the export of plants that were previously imported), provide evidence the specimen(s) was
legally imported:
a.
Copies of canceled CITES export or re-export document issued by the appropriate CITES office in the
country from which the plant was imported. The copies must be stamped by Customs and Border
Protection or USDA’s Animal and Plant Health Inspection Service (APHIS); AND
b.
If you did not make the original import, a copy of the invoice or other document that shows you
purchased the plant from the original importer or history of transactions. (Be sure to correlate each
document to the corresponding plant.)

12.

For Plants Obtained Prior to their Listing under CITES (i.e., pre-Convention) (no CITES import permit
is required for an Appendix-I specimen that qualifies as pre-Convention), provide documents, signed
statement or other evidence that the plant was obtained prior to the date CITES applied to it (e.g., bill of sale,
USDA or foreign phytosanitary certificate). The listing date can be found in the CITES Species Database at
http://www.cites.org/eng/resources/species.html.

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13.

Brazilian rosewood (Dalbergia nigra) Complete one of the following certification statements:
a.
Vintage guitar purchaser and exporter. Provide a catalog or inventory of your pre-Convention
Brazilian rosewood stock of guitars, if applicable.
I certify that all the guitars to be exported are made from pre-convention Brazilian rosewood (Dalbergia
nigra), harvested prior to 6/11/92, as documented by the guitars' serial numbers. If applying for multiple
shipments, I anticipate that I will need to export _____ guitars in the next three years.
Applicant's signature: _______________________________________

Date: ___________

b.
Guitar manufacture/exporter/lumber exporter. Provide a catalog or inventory of your preConvention Brazilian rosewood stock of wood and/or guitars.
I certify that all the guitars/guitar pieces/lumber to be re-exported, and identified in my catalog or inventory,
are made from my pre-Convention supply of Brazilian rosewood (Dalbergia nigra), harvested prior to
6/11/92. If applying for multiple shipments, I anticipate that I will need to export _______ guitars/pieces of
wood in the next four years.
Applicant's signature: _______________________________________

Date: ___________

14.

For Export of plants by a Plant Society for Exhibition provide:
a.
A list of the names of the plant society members who would be exporting the society’s plants;
b.
The names and dates of the show(s) and the approximate dates of export and re-import of the plants;
AND
c.
A signed and dated certification statement from the current society president similar to:
“This certifies that the plants, transported to [country where show occurs] through the port of [USDA
designated port], under a CITES permit to be issued to [your society’s name], are for exhibition at
[name of plant show]. None of the plants being exported will be sold. These same plants will be
returned to the United States through the port of [USDA designated port] at the conclusion of the
show.”

15.

For Commercial shipments, provide a copy of your State nursery license and U. S. Department of
Agriculture (USDA) Protected Plant Permit (formerly known as General Permit).

16.

For living plants: (a) describe type of shipping container and (b) arrangements for care during shipping:
________________________________________________________________________________

17.

Address where you wish permit mailed (if different than page 1):
_______________________________________________________________________________________
_________________________________________________________________________

18.

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:
________________________________________________________________________________

19.

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 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, 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://www.fws.gov/forms/display.cfm?number1=200.
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, tribe, 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, 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 U.S. FWS programs which use foreign addresses and are not required by DMA..

Mailing address is address where communications from U.S. FWS 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 CFR 13.11(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 FRS 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. 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.html
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), 50 CFR 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 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 an Export/Re-Export of Plants application is 60 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 nonconfidential 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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