Form 3-200-86 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:

Photography of Marine Mammals (MMPA)
 Requesting Renewal/Amendment of 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, 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.
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 $150 ($75 amendmnet/renewal). 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 3-200-86

Rev.

Page 1 of 6

E. Photography of Marine Mammals for Educational or Commercial Purposes under the Marine
Mammal Protection Act (MMPA)
Allow at least 90 days for the application to be processed. Applications for marine mammal permits must
be published in the Federal Register for a 30-day public comment period.
Note: This application is for a permit for photography of marine mammals under the jurisdiction of the Fish
& Wildlife Service (sea otters, polar bears, walrus, and manatees) in the United States. A permit may be
issued for educational or commercial photography activities in the wild which are limited to Level B
harassment. Under the MMPA, Level B harassment includes activities that have the potential to disturb a
marine mammal or marine mammal stock in the wild by causing disruption of behavioral patterns, including,
but not limited to, migration, breathing, nursing, breeding, feeding, or sheltering. Level B harassment does
not include any activities that have the potential to injure a marine mammal or marine mammal stock in the
wild.
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 you are submitting, please indicate the application
question number you are addressing. If you are applying for multiple species, be sure to indicate which
species you are addressing in each response.
1. Type of activity requested (mark all that apply):
 PHOTOGRAPHY (Commercial)
 PHOTOGRAPHY (Educational)
 AMEND* current permit
 RENEW* current/expired permit
(If you are requesting renewal or amendment* of an existing permit between reporting dates, include an
update of any activity that has occurred under the permit since the last report)
2. Provide the time periods over which the requested activities will be conducted, including start date,
approximate dates and/or field seasons if appropriate, and the duration of the overall photography project.

3. List the scientific name (genus, species, and, if applicable, subspecies), and common name.

4. Provide:
a. the number of target animals that may be photographed and the number of times these target animals
may be approached and photographed within a specified time period; and

b. an estimate of the number of non-target animals of the same species that could be incidentally harassed
during the photographic activities.

3-200-86

Rev.

Page 2 of 6

5. Describe the geographic location(s) in which the photography is to be conducted. Locations should be
identified as specifically as possible within a general area (e.g., specific islands, bays, and latitude/longitude,
within a specified geographic region or state). Include a map of the area if available. Indicate whether the
location you will be working in has been given any special status (e.g., National Marine Sanctuary, State
Reserve, etc.).

6. Describe the type of photography or filming to be performed and methods to be used. This information must
include, but is not limited to the following: platforms to be used (e.g., small boat, blind, helicopter), description
of photographic equipment (e.g., digital camera with telephoto lens and size of lens), deployment techniques if
applicable, and proposed approach distances to animals.

7. Provide a justification of how your photography activities will result in only taking by Level B harassment of
the target marine mammals.

8. If this species is protected under the Endangered Species Act (ESA), attach a justification for taking an ESAlisted species, and explain why your activities are not appropriate for a similar non-ESA-listed species.

9. Describe the rationale and objectives for your activities and how the products will be made available to the
public.

10. For each person, provide a summary of activities that they will be performing and a copy of their curriculum
vitae, resume, or summary of qualifications that includes their accomplishments and experience relevant to the
proposed activities.

11. Provide a list and estimate of the number of animals of each non-target marine mammal species or other
Federally-protected species that may be unintentionally harassed during the photography activities.

3-200-86

Rev.

Page 3 of 6

12. Address where you wish permit mailed (if different than page 1):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
13. 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:
_______________________________________________________________________________________
14. Who should we contact if we have questions about the application? (Include name, phone number, and email):
_______________________________________________________________________________________

3-200-86

Rev.

Page 4 of 6

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 90 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.

3-200-86

Rev.

Page 5 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.html)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

2.

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.

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 Photography of Marine Mammals application is 1.5 hours. 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)].

3-200-86

Rev.

Page 6 of 6