Form 3-200-87 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:

Transfer/Transport of Live Captive-held Marine Mammals
(MMPA)

Complete Sections A or B, 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

7.a. Business telephone number

C.

4.c. Principal officer Middle name/ initial

4.d. Suffix

6. Primary contact

7.b. Alternate telephone number

Applicant address

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.

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 $0 (no fee required). 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

3.

2.d. Zip code/Postal code:

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

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E. Notification for and Transfer/Transport of Live Captive-held Marine Mammals under the
Marine Mammal Protection Act (MMPA)
Note: This application is for the transfer of live captive-held marine mammals under the jurisdiction of the
Fish & Wildlife Service (sea otters, polar bears, and walrus). The current holder of the animal should use this
application to EITHER: (1) provide NOTIFICATION of transfer/transport and/or sale/purchase of an
animal that qualifies as public display under the MMPA; OR (2) request a LETTER OF
AUTHORIZATION (LOA) to transfer/transport an animal that was originally stranded and needs long-term
care at another facility.
Please provide the following information. Complete all pages of the application. If needed, use a separate
sheet of paper. On all attachments or separate sheets that you are submitting, please indicate the application
question number you are addressing.
1. Type of activity requested (check appropriate box):
a.  Notification (must be provided at least 15 days prior to any proposed transfer/transport, sale, or
purchase)
i. Provide a copy of the original permit and/or the most recent DMA transfer/transport confirmation letter (if not
available, provide information about the animal’s lineage); and

ii. Indicate the purpose of the proposed activity (public display, scientific research, or enhancement).
b.

 Letter of Authorization (For non-emergency placements, please allow a minimum of 30 days to process
your request)

2. Provide the date of the proposed activity.

3. Provide the following for the subject animal:
a.

Scientific name (genus, species, and, if applicable, subspecies) and common name.

b.

Name and sex of the marine mammal.

c.

Other identification (e.g., I.D. #, tattoo #, microchip # (provide manufacturer and location of microchip),
distinguishing marks/features).

d.

Estimated or actual birth date of the marine mammal and place of birth or location of take from the wild.

4. Provide the name and address of the receiving facility and the primary contact’s name, title, and information (phone,
fax, and e-mail).
5. If the animal will be under public display, provide a letter from the receiving facility that contains the following
information:

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a.

The marine mammal will be used in a conservation and/or education program based on professionally recognized
standards of the public display community. Please identify which standards are followed: AZA, Alliance, or other
professionally recognized standards;

b.

The exhibitor’s USDA license/registration number issued under the Animal Welfare Act and expiration date; and

c.

The facility is open to the public on a regularly scheduled basis and access to the facility is not limited or restricted
other than by charging an admission fee.

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6. If the animal will be used for scientific research provide either the FWS scientific research permit number or
the following information for research that will be done in a non-invasive manner:
a.

Explain how the research meets the MMPA definition of “bona fide research,” i.e., scientific research on
marine mammals, the results: (i) are likely to be accepted for publication in a referred scientific journal; (ii)
are likely to contribute to the basic knowledge of marine mammal biology or ecology; or (iii) are likely to
identify, evaluate, or resolve conservation problems.

b.

Attach a copy of the formal research proposal or a detailed description of the proposed project, objectives,
methods, anticipated results, and disposition of the animal.

c.

Provide the expected research schedule (clearly specify the proposed start and end date(s) of your research
and overall duration of the project).

d.

Provide a statement with the names and qualifications of the researcher(s) (curricula vitae may be
submitted).

7. If the animal will be used for the purpose of enhancing the survival or recovery of the species, provide the
FWS permit number.

FOR LETTERS OF AUTHORIZATION ANSWER QUESTIONS 9 THROUGH 11.

8. Provide the number of animals of this marine mammal (include age and sex) presently maintained at the
receiving facility, and whether there is space for additional animals without exceeding USDA/APHIS standards.
9.

For placement of a stranded animal at the receiving facility:
a.

If this is the initial placement for long-term care and maintenance, provide:

.
i. A description of the circumstances regarding the animal’s removal from the wild and the permit or
authorization number; and
ii. The information as specified in your permit/authorization if you are requesting that the FWS determine
the animal to be non-releasable.
b.

If this is a subsequent placement, provide a copy of the LOA that placed the animal at your current holding
facility.

10. Provide a draft transport plan that documents compliance with USDA regulations for transport and care of live
marine mammals (7 U.S.C. 2131-2159; 9 CFR 3, Part E) and includes the following information. A description
of:

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a.

the means and duration of the transportation used to move the animal;

b.

the type, size, and construction of all shipping containers used to transport the animal;

c.

the arrangements for watering or otherwise caring for the animal during transport;

d.

the transport contingency plan; and

e.

the qualifications of each person and their responsibilities while accompanying the animal that
demonstrates their ability to address the specimen’s needs during transport.

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FOR ALL APPLICANTS
11. If this species is new to the receiving facility, provide:
a.

A complete description, including photographs and/or diagrams (no blueprints), of the area and facilities
where the animal will be held (including the dimensions of pools and haul-out areas);

b.

A statement (or attach curricula vitae) about the animal caretakers, which describes their specific
experience in the care, handling, and maintenance of this species; and

c.

A description of all deaths of FWS marine mammal species at the facility within the past five years and the
steps taken to prevent or decrease similar mortalities.

12. Address where you wish letter mailed (if different than page 1):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
13. If you wish the letter to be sent to you by means other than regular mail, provide an air bill, pre-paid envelope,
or billing information:
_______________________________________________________________________________________
14. Who should we contact if we have questions? (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, 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, 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, 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.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), 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 ollection 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 Transfer/Transport of Live Captive-held Marine Mammals 1 hour. 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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