Form 3-200-55 Scientific Purposes, Enhancement of Propagation or Survi

Expires XXX, XX, XXXX
OMB No. 1018-0094

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

Return to: U.S. Fish and Wildlife Service (USFWS)

Type of Activity: Native Endangered and Threatened Species –
Scientific Purposes, Enhancement of Propagation or Survival
Permits (i.e., Recovery Permits) &
Interstate Commerce Permits

(see attached list)

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, 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 indicated on pages 2-3. 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

Form 3-200-55

Rev. October 2010

Page 1 of 16

** See page 15 for additional instructions on completing the above form. See page 16 for information on the Paperwork
Reduction Act, Privacy Act, and Freedom of Information Act aspects of this application form.

Section E. ALL APPLICANTS COMPLETE SECTION E. Provide the information outlined in Section E. on the following
pages. Be as complete and descriptive as possible. Please do not send pages that are over 8.5” x 11”, videotapes, or DVDs.
SCIENTIFIC PURPOSES, ENHANCEMENT OF PROPAGATION OR SURVIVAL
PERMITS (i.e., RECOVERY PERMITS) &
INTERSTATE COMMERCE PERMITS
What type of permit are you requesting?



Recovery (see instructions and requirements on pp. 2-10 and 15-16 of this application form)
OR
 Interstate Commerce (see instructions and requirements on pp. 2-4, 11-12 and 15-16 of this application form)
Have you obtained all required Federal, tribal, State, county, municipal or foreign government approval to conduct the
activity you propose? Please be aware that there may be other requirements necessary to conduct this activity such as an import
permit, collection permit, permission to work on Federal or tribal lands, Federal bird banding permit, Corps of Engineers permits,
Environmental Protection Agency NPDES permits, tribal, State, county or municipal permits, etc.
 Yes. Provide a copy of the approval(s). List the Federal agency, tribe, State, county, municipality or foreign countries
involved and type of document required. Include a copy of these documents with the application.
 I have applied. List the Federal agency, tribe, State, county, municipality or foreign countries involved and type of
documents required. Provide the reasons why the permits have not been issued.
_________________________________________________________
 Not required. The proposed activity is not regulated.
Application Processing Fees
You may update your name, address, telephone number, fax number, or e-mail address in your current application package on file at
any time. These changes are considered an administrative change, and no application processing fee is required. If you wish to make
an administrative change, please fill out page 1 and indicate the information that you are updating. Then check the box below, provide
your permit number, and send the completed pages 1-2 to the appropriate Regional Office (see attached list).
 Administrative change for permit number: ________________________.
If you wish to make changes other than an administrative change, then an application processing fee is required as described below.
The application processing fee for a new Recovery or Interstate Commerce permit, or to renew/substantively amend an existing valid
permit (with major changes) is $100. If permit amendment (with minor changes) is required at a time other than renewal, the
processing fee is $50. For additional information on the application processing fee and the requirements to qualify for a fee
exemption, please see the instructions for section D. on page 15.
If the information in your current application package on file has changed in a manner that triggers a substantive amendment or a
change not otherwise specified in the permit, then you must apply for substantive amendment to your valid permit. For example, such
major changes may include changes in study plan or research proposal, location, activity, amount or type of take, or species to be
covered by the permit. Please contact the Regional Endangered Species Program located within the U.S. Fish and Wildlife Service
(Service) Region of your proposed activity for technical assistance in making this determination (see attached list).
Check the appropriate box below and enclose check or money order payable to the U.S. Fish and Wildlife Service in the amount of
 $100 [or  fee exempt (attach justification if required)] for a new permit. Use Option III. below to provide the required
information.
OR
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 $100 [or  fee exempt (attach justification if required)] to renew or substantively amend my existing valid permit (with
major changes) using my current application package on file. Use Options II. and III. below to provide the required
information. Please indicate the information that you are changing.
OR
 $100 [or  fee exempt (attach justification if required)] to renew/re-issue my existing valid permit (without changes) using
my current application package on file. Use Option I. below to provide the requested information.
OR
 $50 [or  fee exempt (attach justification if required)] to amend my existing valid permit (with minor changes) at a time
other than permit renewal. Use Options II. and III. below to provide the required information. Please indicate the
information that you are changing.
Please check the type of amendment you are requesting - add species (specify) ________________________________________________________________________________
 add new activity with previously permitted species (specify) _________________________________________________
 add a geographic area

 change in personnel

 other (specify) ____________________________________________________________________________________
Referral of a Recovery permitte’s contact information (optional)
The U.S. Fish and Wildlife Service often receives requests for lists of Recovery permittees who could conduct contract work for
endangered and threatened species (e.g., presence/absence surveys). In accordance with our Privacy Act System of Records Notice
(Permits System, Interior – FWS-21), we may release the name and work address or work telephone number of those who wish to be
contacted by third parties to do commercial survey activities. Such information is not normally released under the Freedom of
Information Act - unless a compelling need on the part of the general public can be cited.
Please be aware that this list does not represent an endorsement by us of any particular permittee. This referral is provided at the
discretion of each U.S. Fish and Wildlife Service Regional Office as time and workload allow.
Please indicate below your preference for the release of your information to third parties.
 Yes, I authorize the U.S. Fish and Wildlife Service to release my name, work address and/or work telephone
number to third parties as a referral for contract work for endangered and threatened species.
 No, I do not authorize the U.S. Fish and Wildlife Service to release my name and work address and/or work
telephone number to third parties.
Application Processing
To expedite a final decision on your application, you are urged to coordinate with us as soon as possible for guidance in
assembling a complete application package, and to send us your complete permit application package at least three months
prior to the start of your proposed activities. If you are renewing or amending a valid permit, your complete application
package must be received at least 30 days prior to the expiration of the valid permit. These time periods begin with our
acceptance of a complete permit application package and does not include any time required for requesting clarification or
additional information about your application, or the length of time between our request and your response.
The information provided in your permit application will be used to evaluate your application for compliance with the Endangered
Species Act, its implementing regulations (which may require a 30 day public comment period), and with U.S. Fish and Wildlife
Service policy. Receipt and possession of a permit under the Endangered Species Act should be regarded as a privilege, as we must
balance permit issuance with our duties to protect and recover listed species.
Up-to-date annual reports and any other required reports under your valid permit(s) must be on file before a permit will be considered
for renewal, re-issuance or amendment.
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Rev. October 2010

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If your activities may affect species under the authority of the National Marine Fisheries Service (NMFS/NOAA Fisheries), then you
may need to obtain a separate permit from that agency. In addition we share jurisdiction with NMFS/NOAA Fisheries for sea turtles
(e.g., we evaluate applications for permits to conduct activities impacting sea turtles on land, and NMFS/NOAA Fisheries evaluates
applications for permits to conduct activities impacting sea turtles in the marine environment). To apply for a permit to conduct
activities with sea turtles in the marine environment or other species under NMFS/NOAA Fisheries jurisdiction, please contact them
via their permit web page at http://www.nmfs.noaa.gov/pr/permits/

****************************************************************************************************************
If you are not applying as an individual but as a business, corporation, tribe, institution, or non-Federal public agency (block B. on
page 1 of the application), the person to whom the permit will be issued (e.g., the landowner, president, director, executive director, or
executive officer) is legally responsible for implementing the permit. Although other people under the direct control of the permittee
(e.g., employees, contractors, consultants) receive third party take authorization in their capacity as designees of the permittee, the
individual named as the permittee ultimately is legally responsible for the permit and any activities carried out under the permit except
as otherwise limited in the case of permits issued to State or local government entities under 50 CFR 13.25(e).
****************************************************************************************************************

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Rev. October 2010

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RECOVERY PERMIT APPLICATION INSTRUCTIONS
(see pp. 11-12 for Interstate Commerce permit application instructions)
You have 3 options for providing the required information for a Recovery permit application.
Recovery Permit Application: Option I. Renew/Re-issue of an Existing Valid Recovery Permit (Without Changes) Using My
Current Application Package On File.
Up-to-date annual reports and any other required reports under your valid permit(s) must be on file before a permit will be considered
for renewal or re-issue.
Sign the following statement if you are applying to renew or re-issue an existing valid Recovery permit without changes. If you are
proposing changes to your Recovery permit, you must use Options II. and III. below.
The individual signing box D. on page 1 of the application must also sign (in blue ink) the following statement. This certification
language is required under 50 CFR 13.22(a).
I certify that the statements and information submitted in support of my original application for a U.S. Fish and Wildlife
Service Recovery permit # _________________ are still current and correct and hereby request (please check either
G renewal or G re-issuance) of that permit without changes.

_________________________
signature (in blue ink)

__________________
date

_________________________
please print name legibly
* Please note: If you have signed the above statement, then your renewal/re-issue request is complete. Please submit
completed pages 1- 5 of this application to our Regional Office (see attached list) covering the location of your proposed
activity. Requests for renewals/re-issuance must complete and accepted by the Service no later than 30 days prior to permit
expiration to ensure that your current permit remains in effect while we process your request.
___________________________________________________________________________________________________________

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Rev. October 2010

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Recovery Permit Application: Option II. Renewal or Amendment of an Existing Valid Recovery Permit (With Changes)
Up-to-date annual reports and any other required reports under your valid permit(s) must be on file before a permit will be considered
for renewal or amendment.
Sign the following statement if you are proposing to renew or amend an existing valid Recovery permit, including making major
changes. Such major changes may include changes in study plan or research proposal, location, activity, amount or type of take, or
species to be covered by the permit.
The individual signing box D. on page 1 of the application must also sign (in blue ink) the following statement. This certification
language is required under 50 CFR 13.22(a).
I certify that the statements and information submitted in support of my original application for a U.S. Fish and Wildlife
Service Recovery permit # ________________ are still current and correct, except for the changes listed in Option III.
below, and hereby request (please check either G renewal or G amendment) of that permit.

_________________________
signature (in blue ink)

__________________
date

__________________________
please print name legibly

Provide a brief description of the changes to your valid permit (answer the appropriate questions for these changes requested under
Recovery Permit Application Option III. below). Please submit this page and completed pages 1- 3 of this application form (along
with the changed information relative to Option III. below) to our Regional Office (see attached list) covering the location of your
proposed activity.
___________________________________________________________________________________________________________

Form 3-200-55

Rev. October 2010

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Recovery Permit Application: Option III. New Recovery Permit & Supplementary Information for Renewal or Amendment
of an Existing Valid Permit (With Changes)
General permit regulations for the U.S. Fish and Wildlife Service can be found at 50 CFR 13. Regulations for Recovery and Interstate
Commerce permits under the Endangered Species Act can be found at 50 CFR 17.22(a)(1) for endangered wildlife species, 50 CFR
17.32(a)(1) for threatened wildlife species, 50 CFR 17.62 for endangered plant species, and 50 CFR 17.72 for threatened plant species.
Applications for a Recovery permit must provide the following specific information (relevant to the activity) in addition to the general
information on pages 1-4 of this application. Please attach separate pages. In order to assist us in processing your request, please
provide the item number (A.1.a., etc.) of the required information before each of your responses. Thank you.
A.

Identify species and activity:
1.

2.

3.

B.

For a new Recovery permit:
a.

Provide the common and scientific names of the species being requested for coverage in the permit and
their status (endangered (E) or threatened (T)).

b.

Provide the number, age, and sex of such species to the extent known.

c.

Identify the activity sought to be authorized (i.e., presence/absence survey, nest monitoring, bird banding,
etc.) for each species.

For an amended Recovery permit:
a.

Identify the activities and/or species to be added to your valid permit (provide both the scientific, to the
most specific taxonomic level, and common names) as well as the species’ status (see 1.a. above).

b.

Provide the number, age, and sex of such species to the extent known.

c.

If any activities requested in this application differ from those authorized in your valid permit, then for each
species state the currently authorized activity, the requested new activity, and how the new activity will
impact each species.

d.

Identify the activity sought to be authorized (i.e., presence/absence survey, nest monitoring, banding, etc.)
for each species.

e.

Quantify any anticipated effects to the habitat of each added species.

f.

Identify activities and/or species to be deleted from your valid permit and the reason(s) for the deletion.

If you are applying for a permit for the collection of plants from the wild:
a.

Describe what plant part(s), and the number(s) or other type(s) of indication of material you plan to collect
(i.e., whole plant, leaves, pollen, seeds, etc.).

b.

If the proposed activity involves the collection of seeds taken from the wild, provide information that
evaluates the effects of the seed collection on the reproductive potential of the species at the collection
location.

Identify location of the proposed activity:
1.

Provide the name of the State, county, tribal land, and the specific location of the proposed activity site(s). Include a
formal legal description, section/township/range information, county tax parcel number, local address, or any other
identifying property designation that will precisely place the location of the proposed activity site(s).

2.

If the specific study area is known at the time of application, attach a U.S. Geological Survey map of the study area
in 7.5 minute quadrangle (1:24,000) scale, or other appropriately scaled map. If you plan to conduct surveys on a

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Rev. October 2010

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contract basis in the future, these maps can be provided once the specific area is known (the counties in which you
will work must be provided at this time).
3.

C.

If your request is for aquatic species, identify the aquatic system (river/lake/stream name, river mile information, and
drainage basin).

Describe the proposed activity:
1.

Provide a statement justifying the permit request, including the following: [A copy of a research or study proposal
that provides this information can be attached in lieu of the information requested below.] Use additional sheets as
necessary.
a.

b.

c.

d.

Describe in detail the purpose(s) and objective(s) of the project.
i.

Include study design, sampling methodologies and equipment to be used.

ii.

Identify any null hypothesis or other anticipated results from the project that will support the
reasoning why the project is justified for enhancement of propagation or survival of the affected
species.

iii.

Include planned disposition of specimens upon completion of project.

Describe how the proposal will help recover each species.
i.

If there is an approved recovery plan, identify the recovery tasks by number and name, if
applicable. Include any additional recovery tasks identified in a Spotlight Species Action Plan, or
in a 5-year status review of the species.

ii.

Identify, or provide copies of any previous or similar research conducted on this species.

iii.

If this information exists, explain how the project will answer questions not answered by earlier
research.

iv.

Explain how you will coordinate your efforts with past and ongoing research studies.

Can this project result in the injury, death, or removal from the wild of any individuals of the species?
i.

If yes, describe all that apply (i.e., injury, death, removal from the wild).

ii.

For each species, please state the maximum number of individuals that would be injured, killed, or
removed from the wild: [If applicable, please identify, based on a reasonable expectation, the
number of individuals likely to be injured or killed per activity.]

iii.

Please state what will be done to minimize the possibility of injury to or death of individuals.

iv.

If the proposed activity would cause the death of individuals from the wild or remove individuals
from the wild, describe your attempts to obtain the wildlife or plant specimens currently held in
captivity/nurseries/museums, or produced in captivity. You must demonstrate conclusively that
existing specimens are unavailable or your study objectives require new/additional specimens.
[Provide the identity and phone number of each contact made in this regard.]

Identify contracts and agreements held for the proposed activities (attach copy or give title, funding
organization name and address, date of signature, duration of contract).
i.

e.
Form 3-200-55

State whether full funding will be available for the completion of the proposed activity. [If you do
not hold a contract at this time, but foresee receiving one, you may apply for a permit contingent
upon receiving the contract(s).]

If live wildlife or plants to be covered by the permit are to be held in captivity:
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[Note: Under our regulations at 50 CFR 17.22(a)(3) and 17.32(a)(3), escape of wildlife held in captivity
must be reported immediately to our appropriate Regional Office (see attached list)].

D.

Give a complete description, attaching photographs and/or diagrams, of the area and facilities
where wildlife or plant(s) will be held and/or maintained in captivity and describe arrangements for
care during transportation and maintenance. Include the name and address of the area and
facilities. [A separate discussion specific for each species must be provided, if applicable.]

ii.

Provide the full names of person(s) who will care for live specimens, including a resume of their
experience in raising, caring for, and propagating similar wildlife or plants.

iii.

Provide any contract or agreement you have secured for care of any live specimens collected under
this permit request if the identified facility is not affiliated with you. Attach a copy or give title,
funding organization name and address, date of signature, and duration of contract. [A joint
application may be appropriate in situations where one entity will collect the specimens and
another entity will conduct the propagation/maintenance activities.]

iv.

List mortalities resulting from your activities with these or similar species in the last 2 years.

v.

Provide an explanation of each mortality event and the procedures employed or modified to
eliminate any future mortality events.

vi.

Indicate your willingness to participate in a cooperative breeding or propagation program or to
contribute data to a database or studbook. Holding wildlife and plants in captivity must comply
with our Policy Regarding Controlled Propagation of Species Listed Under the Endangered
Species Act. This policy can be found on the U.S. Fish and Wildlife Service’s Endangered
Species web page at http://www.fws.gov/endangered/laws-policies/policy-controlledpropagation.html. Briefly describe how the proposed activity will comply with this policy.

vii.

State the planned disposition of the collected and/or propagated species after termination of the
project/activity.

Identify the persons who will conduct the proposed activity:
1.

E.

i.

Provide the full name of all individuals, including first name, middle initial, and last name, who you propose will
work under this permit.
a.

If more than one activity is included in the permit application, indicate which activity(ies) will be completed
by each individual.

b.

For each listed individual, please also provide a copy of each person’s resume and/or curriculum vitae, plus
specific information on previous professional training and experience working with the species affected by
the permit request. Information must include: the approximate number of hours of focused activity with
each species in occupied habitat; approximate number of each species the applicant has worked with at each
site (e.g., how many pair of birds at a specific site); names, dates, and location of areas surveyed; and
experience with similar species. Please provide the names and phone numbers of at least two references
who can verify experience with the species (reference letters are always appreciated).

Identify the location of the affected species, to the extent known:
1.

Form 3-200-55

For each species indicate whether, at the time of the application, the organism was:
a.

Still in the wild;

b.

Had been removed from the wild (provide State, county, and specific location of removal); and

c.

Was born in captivity or artificially propagated (provide State, county, specific location, and name of the
institution where born or propagated).
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2.

If you are applying for a permit for the collection of plants from the wild, list the lands from which you plan to
collect the plants.
a.

If these lands are under Federal jurisdiction, identify the Federal land management agency(ies) that have
jurisdiction for the lands. Include the name, title (District Ranger, Field Supervisor, etc.), address, and
telephone number of the person in charge of the Federal lands.

___________________________________________________________________________________________________________

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INTERSTATE COMMERCE PERMIT APPLICATION INSTRUCTIONS
General permit regulations for the U.S. Fish and Wildlife Service can be found at 50 CFR 13. Regulations for Recovery and Interstate
Commerce permits under the Endangered Species Act can be found at 50 CFR 17.22(a)(1) for endangered wildlife species, 50 CFR
17.32(a)(1) for threatened wildlife species, 50 CFR 17.62 for endangered plant species, and 50 CFR 17.72 for threatened plant species.
Interstate Commerce permits authorize the sale of native endangered and threatened species across State lines, but only for activities
that will contribute to the species’ recovery by enhancing their propagation or survival.
PLEASE NOTE:


Interstate commerce activities for wildlife require the buyer to obtain a permit prior to the sale (50 CFR 17.21(f) and
17.31(a)).



In addition, our regulations at 50 CFR 17.62(a) for endangered plant species and 17.72(a) for threatened plant species require
that –
- Interstate commerce activities for plants taken from the wild require the buyer to obtain a permit prior to the sale.
- Interstate commerce activities for plants taken from cultivated stock require the seller to obtain a permit prior to the
sale.

Unlike other permits for native endangered and threatened species (which are issued by the U.S. Fish & Wildlife Service Regions
according to where the proposed activity will take place), Interstate Commerce permits are issued by the Region having the lead
responsibility for the affected species. To determine the lead Region for a species, follow the instructions at the top of our Endangered
Species permit web page at http://www.fws.gov/endangered/permits/how-to-apply.html.
Applications for an Interstate Commerce permit must provide the following specific information (relevant to the activity) in addition to
the general information on pages 1-3 of this application. Please attach separate pages. In order to assist us in processing your request,
please provide the item number (A.1., etc.) of the required information before each of your responses. Thank you.
A.

For Wildlife:
1.

Provide the common and scientific names of the species being requested for coverage in the permit and their status
(endangered (E) or threatened (T)).

2.

Identify the activity sought to be authorized for each species.

3.

Provide the sex, birth date, birth place, age, number of specimens, and identifying features (e.g., band number, collar
number, scars, tattoo number, etc.).

4.

Provide the name, address and telephone number of the seller.

5.

State whether the wildlife has been captively bred or removed from the wild.

6.

Provide the expected time needed to complete transaction(s).

7.

Provide a complete description with photographs and/or diagrams of the area and facilities where wildlife will be
held in captivity, and description of arrangements for care during transportation and maintenance. [Note: Under our
regulations at 50 CFR 17.22(a)(3) and 17.32(a)(3), escape of wildlife held in captivity must be reported immediately
to our Regional Office (see attached list)].

8.

Describe experience with breeding this or similar species in the past.

9.

Provide the full names of person(s) who will care for live specimens, including any experience in raising, caring for,
and propagating similar wildlife.

10.

List mortalities resulting from your activities with these or similar species in the last 2 years. Provide an explanation
of each mortality event and the procedures employed or modified to eliminate any future mortality events.

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B.

11.

Indicate your willingness to participate in a cooperative breeding or propagation program or to contribute data to a
database or studbook. Holding wildlife in captivity must comply with our Policy Regarding Controlled Propagation
of Species Listed Under the Endangered Species Act. This policy can be found on the U.S. Fish and Wildlife
Service’s Endangered Species web page at http://www.fws.gov/endangered/laws-policies/policy-controlledpropagation.html. Briefly describe how the proposed activity will comply with this policy.

12.

Provide a statement from the wildlife breeder that the wildlife was bred at their home/facility. This statement must
include the name and address of the breeder, date of birth or hatch, band number or any other identifying marks or
characteristics.

13.

Please provide detailed information on how you propose to manage your breeding stock to uniquely identify all
progeny, and to ensure that the genetic diversity and integrity of your breeding stock are maintained to the maximum
extent possible.

For Plants:
1.

Provide the common and scientific names of the species being requested for coverage in the permit and their status
(endangered (E) or threatened (T)).

2.

Identify the activity sought to be authorized for each species.

3.

Provide the location where plants will be cultivated for sale.

4.

Provide the full names of person(s) who will care for live specimens, including any experience in raising, caring for,
and propagating similar plants.

5.

State whether the breeding stock is of cultivated or wild origin.

6.

If you are applying a permit to buy plants taken from the wild, provide the name, address and telephone number of
the seller. If you are applying for a permit to sell plants taken from cultivated stock, provide the name, address, and
telephone number of the buyer.

7.

Indicate your willingness to participate in a cooperative breeding or propagation program or to contribute data to a
database. Holding plants in captivity must comply with our Policy Regarding Controlled Propagation of Species
Listed Under the Endangered Species Act. This policy can be found on the U.S. Fish and Wildlife Service’s
Endangered Species web page at http://www.fws.gov/endangered/laws-policies/policy-controlled-propagation.html.
Briefly describe how the proposed activity will comply with this policy.

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USFWS Regional Contacts for Native Endangered & Threatened Species Permits
Pacific Region (Region 1): HI, ID, OR, WA, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and
the Pacific Trust Territories
U.S. Fish and Wildlife Service
Endangered Species Permit Office
911 NE 11th Avenue
Portland, Oregon 97232-4181
Web: http://www.fws.gov/pacific/ecoservices/endangered/index.html
Phone: (503) 231-2071
email: [email protected]
Fax: (503) 231-6243

Southwest Region (Region 2): AZ, NM, OK, and TX
U.S. Fish and Wildlife Service
Endangered Species Permit Office
500 Gold Avenue S.W. (street address)
P.O. Box 1306 (mailing address)
Albuquerque, New Mexico 87103-1306
Web: http://www.fws.gov/southwest/es/EndangeredSpecies/
Phone: (505) 248-6649
email: [email protected]
Fax: (505) 248-6788

Midwest Region (Region 3): IA, IL, IN, MI, MN, MO, OH, and WI
U.S. Fish and Wildlife Service
Endangered Species Permit Office
B.H. Whipple Federal Building
One Federal Drive
Fort Snelling, Minnesota 55111-4056
Web: http://www.fws.gov/midwest/Endangered/
Phone: (612) 713-5343
email: [email protected]
Fax: (612) 713-5292

Southeast Region (Region 4): AL, AR, FL, GA, KY, LA, MS, NC, PR, SC, TN, and U.S. Virgin Islands
U.S. Fish and Wildlife Service
Endangered Species Permit Office
1875 Century Blvd., Suite 200
Atlanta, Georgia 30345
Web: http://www.fws.gov/southeast/es/#
Phone: (904) 731-3191 (10(a)(1)(A) permit coordinator) or (404) 679-7140 (R4 Endangered Species main office)
email: [email protected]
Fax: (904) 731-3045 or (404) 679-7081

Form 3-200-55

Rev. October 2010

Page 13 of 16

Northeast Region (Region 5): CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, and WV
U.S. Fish and Wildlife Service
Endangered Species Permit Office
300 Westgate Center Drive
Hadley, MA 01035-9589
Web: http://www.fws.gov/northeast/endangered/
Phone: (413) 253-8628
email: [email protected]
Fax: (413) 253-8482

Mountain-Prairie Region (Region 6): CO, KS, MT, NE, ND, SD, UT, and WY
U.S. Fish and Wildlife Service
Endangered Species Permit Office
Denver Federal Center
P.O. Box 25486
Denver, Colorado 80225-0489
Web: http://www.fws.gov/mountain%2Dprairie/endspp/
Phone: (303) 236-7400
email: [email protected]
Fax: (303) 236-0027

Alaska Region (Region 7): AK
U.S. Fish and Wildlife Service
Endangered Species Permit Office
1011 E. Tudor Road
Anchorage, Alaska 99503-6199
Web: http://alaska.fws.gov/fisheries/endangered/index.htm
Phone: (907) 786-3323
email: [email protected]
Fax: (907) 786-3350
Pacific Southwest Region (Region 8): CA and NV
U.S. Fish and Wildlife Service
Endangered Species Permit Office
2800 Cottage Way, Suite W-2606
Sacramento, California 95825
Web: http://www.fws.gov/cno/es/
Phone: (916) 414-6464
email: [email protected]
Fax: (916) 414-6486

Form 3-200-55

Rev. October 2010

Page 14 of 16

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, and in 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, 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.
ALL APPLICANTS COMPLETE SECTION E.

Please continue to next page
Form 3-200-55

Rev. October 2010

Page 15 of 16

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. We may not conduct or sponsor and you are not required to respond to a 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 a Recovery and Interstate Commerce permit application is 4 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)].

Form 3-200-55

Rev. October 2010

Page 16 of 16