Form 3-200-2 Designated Port Exception Permit

OMB Control No. 1018-0092
Expires:

Department of the Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form

Return to:

Type of Activity: Designated Port Exception Permit*

U.S. Fish and Wildlife Service
Office of Law Enforcement
Send to the appropriate Issuing Office listed on
Page 4 for the State you listed in Block B.1.c.

New - $100.00
Requesting Renewal of Permit #LE-___________- $100.00
Requesting Change/Amendment of Permit #LE-__________ $50.00
*If you import/export through a Designated Port, you do not need this permit.
Go to: http://www.fws.gov/le/designated-ports.html for current list of Designated Ports.

Complete all sections of this application.
See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A.

All applicants MUST complete

1. Name of Business or Name of Person (Last, First, Middle) (as shown on your invoice and other shipping documents)
2. Federal Tax Identification No. or Social Security No. 3. Date of Birth (mm/dd/yyyy)
5.a. Principal Officer Last Name

5.b. Principal Officer First Name

6. Principal Officer Title
8.a. Telephone Number

4. Description of Business (if applicable)
5.c. Principal Officer Middle Name

5.d. Suffix

7. Primary Contact Name
8.b. Alternate Telephone Number

8.d. E-mail Address

8.c. Fax Number

B.
All applicants MUST complete
1.a. Address (No P.O. Boxes, Retail Postal or Mail Service Center) Normally where you will receive all official notices sent from the Service.
1.b. City

1.c. State

1.d. Zip code/Postal Code

1.e. County/Province

1.f. Country (If not US)*

*See Page 2; Question 1
2.a. Mailing Address (include ONLY if different than above and this is where you want to receive all official notices sent from the Service).
Include name of contact person.
2.b. City

2.c. State

2.d. Zip code/Postal Code 2.e. County/Province

2.f. Country (If not US)*
*See Page 2; Question 1

C.

All applicants MUST complete

1.

Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount listed above. Application fees are nonrefundable. 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)]

2.

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: ________________________
No

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)
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DESIGNATED PORT EXCEPTION APPLICATION CONTINUATION SHEET
SECTION D: ALL APPLICANTS MUST COMPLETE

NOTE: U.S. Persons/Businesses continue to Question 3.
U.S. address (not a P.O. Box, Retail Postal or Mail Service Center) for foreign applicant. (50 CFR 13.12
requires this information for issuance). This is the mailing address where you will receive all official notices sent
from the Service. Question 2 must also be completed. NOTE: No Designated Port Exception Permit will be
issued without this information.
_________________________________________________________________________________________________

1.

_________________________________________________________________________________________________
_________________________________________________________________________________________________
2.

Applicants residing or located outside the United States. The name, physical address (no P.O. Box, Retail
Postal or Mail Service Center address) telephone and fax numbers of your agent that is located in the United
States who will maintain your records for five (5) years from the expiration of the permit. If the location is the
same as Question 1, then indicate “same as Question 1". (50 CFR 13.12 and 13.46 requires this information for
issuance). NOTE: No Designated Port Exception Permit will be issued without this information.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Certification of U.S. Agent:
I hereby agree to be U.S. Agent for __________________________________________________________________.
(Print name of Person or Business listed in Block A on Page 1 of this application)
Acting in the capacity of U.S. Agent includes maintaining complete and accurate records of any taking, possession, transportation,
sale, purchase, barter, exportation or importation of wildlife for the above mentioned entity for a period of five (5) years from the
date of the expiration of this Designate Port Exception Permit. Such records shall be kept current and shall include names and
addresses of persons with whom any wildlife has been purchased, sold, bartered, or otherwise transferred, and the date of such
transaction, and other information as may be required or appropriate. Such records shall be legibly written or reproducible in
English. The name, address and telephone number listed above in #2 is complete and accurate and is not a retail postal or mail
service center.

____________________________________________________________________
Printed Name of Responsible Person from #2 Above

___________________________________________________________________
Signature

Date

NOTE: You must notify the U.S. Fish and Wildlife Service immediately of any change in U.S. Agent

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3.

Location of the U.S. Fish and Wildlife Service Port of Entry you wish to import/export your goods through
(check all that apply):
Blaine, Washington
Dunseith, North Dakota
Port Huron, Michigan
Brownsville, Texas
El Paso, Texas
San Diego, California
Champlain, New York
Laredo, Texas
Sweetgrass, Montana
Denver, Colorado
Minneapolis, Minnesota
Tampa, Florida
Detroit, Michigan
Nogales, Arizona
Guaynabo, Puerto Rico
Dulles, Virginia
Pembina, North Dakota
Tamuning, Guam
Other (list all requested) _____________________________________________________________________
___________________________________________________________________________________________

4.

If this request is for commercial shipment(s), provide a copy of your valid Import/Export License.

5.

Address one of the following as the primary reason for your request to be allowed an exception from the
designated port requirement. Supporting documentation should be attached to this application. All supporting
documentation that is attached will be considered a part of the application.
_____ Scientific Purposes (50 CFR 14.31): Provide a very detailed written statement of the scientific purpose
or use of the wildlife to be imported or exported outlining the benefits to the bona fide research project.
_____ To minimize deterioration or loss (50 CFR 14.32): Provide a very detailed written statement for the
purpose or use of the wildlife to be imported or exported, and satisfactorily explain how import or export
at a designated port would result in substantial deterioration or loss of wildlife.
_____ To alleviate undue economic hardship (50 CFR 14.33): Provide a very detailed written statement to
show the monetary difference between the cost of importation or exportation at the port requested and the
lowest cost of importation or exportation at a designated port.

6.

General description of the wildlife or wildlife products to be imported/exported. (Choose all that apply)

a.

Live

Dead
Products (Describe: sport hunted trophies, jewelry, footwear, carvings, etc.)__________________
______________________________________________________________________________
Other (Describe)_________________________________________________________________

b.

Fish
Mammals

c.

Venomous

Coral
Birds

Reptiles
Insects/Arachnids

Amphibians
Other________________

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Office of Law Enforcement Regional Permit Offices
Region 1: Guam, Hawaii, Idaho, Oregon, & Washington

Region 2: Arizona, New Mexico, Oklahoma, & Texas

U.S. Fish & Wildlife Service
Office of Law Enforcement
911 NE 11th Ave.
Portland, OR 97232
Tel: (503) 231-6899
Fax: (503) 231-2193
Email: [email protected]

U.S. Fish & Wildlife Service
Office of Law Enforcement
2545 W. Frye Road
Suite 8
Chandler, AZ 85224-6273
Tel: (480) 967-2007
Fax: (480) 966-9766
Email: [email protected]

Region 3: Illinois, Indiana, Iowa, Michigan, Minnesota,
Missouri, Ohio, & Wisconsin

Region 4: Alabama, Arkansas, Florida, Georgia,
Kentucky, Louisiana, Mississippi, North Carolina,
South Carolina, Puerto Rico, & Tennessee

U.S. Fish & Wildlife Service
Office of Law Enforcement
5600 American Blvd, West, Suite 990
Bloomington, MN 55437-1458
Tel: (612) 713-5356
Fax: (612) 713-5283
Email: [email protected]

U.S. Fish & Wildlife Service
Office of Law Enforcement
1875 Century Blvd, Suite 380
Atlanta, GA 30345
Tel: (404) 679-7195
Fax: (404) 679-7065
Email: [email protected]

Region 5: Connecticut, District of Columbia, Delaware,
Maine, Maryland, Massachusetts, New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island,
Vermont, Virginia, & West Virginia
U.S. Fish & Wildlife Service
Office of Law Enforcement
70 E. Sunrise Hwy, Suite 419
Valley Stream, NY 11580
Tel: (516) 825-3950
Fax: (516) 825-3597
Email: [email protected]

Region 6: Colorado, Kansas, Montana, Nebraska, North
Dakota, South Dakota, Utah, & Wyoming
U.S. Fish & Wildlife Service
Office of Law Enforcement
P.O. Box 492098
Attn: Wildlife Inspector (DIA)
Denver, CO 80249
Tel: (303) 342-7430
Fax: (303) 342-7433
Email: [email protected]

Region 7: Alaska

Region 8: California and Nevada

U.S. Fish & Wildlife Service
Office of Law Enforcement
P.O. Box 190045
Anchorage, AK 99519-0045
Tel: (907) 786-3311
Fax: (907) 786-3313
Email: [email protected]

U.S. Fish & Wildlife Service
Office of Law Enforcement
2800 Cottage Way, W-2928
Sacramento, CA 95825
Tel: (916) 414-6660
Fax: (916) 414-6715
Email: [email protected]

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PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to the form 3-200-2 that must be completed as an application for a U.S. Fish and Wildlife Service permit. The
General Permit Procedures in 50 CFR 13 address the permitting process.
GENERAL INSTRUCTIONS:

Complete all blocks/lines/questions in Sections A through D.

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 appropriate address on the attached address list. The application is to be submitted to the issuing office
address in the Region your company is located.

Keep a copy of your completed application.

Please plan ahead. Allow at least 60 days for your application to be processed. (50 CFR 13.11)

Applications are processed in the order they are received.
COMPLETE SECTION A:

Enter the complete name of the business (or person if non-commercial shipment) who will be the Permittee if a Designated Port Exception
Permit is issued. If no company name exists, then enter the Name (Last, First, Middle) of the owner of the business in Block A.1. Enter
personal information that identifies the applicant.

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.

If applicable, give a brief description of the type of business in which the applicant is engaged (Taxidermy, Jewelry, Apparel, etc.).

Doing business as (dba): dba’s are not accepted. The name on the Designated Port Exception Permit must match the Import/Export
License (if applicable), invoice and other shipping documents that accompany the shipment to or from the United States.

Principal Officer is the person in charge of the listed business. The principal officer is the person responsible for the application and any
permitted activities. Often the principal officer is a Director or President. This will be the same person on the company’s Import/Export
License (if applicable). Primary Contact is the person at the business who will be available to answer questions about the application or
permitted activities. Often this is the preparer of the application.
COMPLETE SECTION B:

Mailing address: This is the address where you will receive all official notices sent from the Service (ONLY if different than address
listed in Block 1.a.).
COMPLETE SECTION C:
Application processing fee:

An application processing fee is required at the time of application. 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 if no
significant processing has occurred.

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, confirming that the applicant will be carrying out the permitted
activity for the agency.
Federal Fish and Wildlife permits:

List the number(s) of your most current Service permit or the number of the most recent permit if none are currently valid.
CERTIFICATION:

The individual identified in Section A 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 the application.
COMPLETE SECTION D:

Question 1. Foreign Applicant ONLY: Enter the complete U.S. address. This is the address where you will receive all official notices
sent from the Service. 50 CFR 13.12 requires this information for issuance.

Question 2. Foreign Applicant ONLY: Enter the complete name, physical address, telephone and fax numbers of your agent located in
the United States where your records (as defined in 50 CFR 13.46) will be maintained for five (5) years from the date of expiration of the
designated port exception permit. This can be a customshouse broker, relative, etc. It cannot be a retail postal or mail service center. 50
CFR 13.12 requires this information for issuance.
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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.shtml.)
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. 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.
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 Government Accountability 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 Designated Port Exception Permit application is 1.25 hours. This burden estimate includes time for reviewing instructions,
gathering and maintaining data and completing and reviewing the form. Comments on this form should be mailed to the Service Information
Collection Clearance Officer, U.S. Fish and Wildlife Service, MS 2042-PDM, 4401 North Fairfax Drive, Arlington, VA 22203 (mail); or
[email protected] (email). Please include “1018-0092” in the subject line of your comments.
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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