Form 3-202-12 Migratory Bird Special Purpose Possession (Education) Pe

Department of the Interior
U.S. Fish and Wildlife Service

Migratory Bird and Eagle
Acquisition and Transfer Request
(Please see page 2 for instructions)

If you:
A. wish to transfer a live bird to: another permittee; another permit you hold; or to an
institution exempt from the permit requirement under 50 CFR 21.12,
B. lost a bird due to its escape; theft; or death,

complete these sections
1, 2, 3, 4, 5, and 6.

C. wish to acquire a live bird from another permittee (or from another permit you hold),

1, 2, 3, 4, 5, and 6.

1

SPECIES:
Sex:  Male  Female Unknown
SENDER (person transferring bird)
Telephone: (

1, 2, and 6.

Band number or other identification (if applicable): ______________________
Age:  Nestling  Immature  Adult
Source:  Wild Captive-bred
Name: ____________________________________________________________

)

Fax: (

)________________ E-mail: ____________________________________

Address:

City:

State:

Zip:______________

Type:  Rehabilitation Education  Eagle Exhibition  Other-specify:___________

2 Permit #:

Is this bird being:  Transferred

 Released

 Died - date & cause of death: __________________________________

 Escaped - date & explanation:__________________________________________________________________________
 Other - date & explanation:____________________________________________________________________________
RECIPIENT (person acquiring bird)
Telephone: (

)

Name: _________________________________________________________
Fax: (______)________________ E-mail: ____________________________________

3 Address:

City:

Permit #:_____________________

Permit Type:

State:

 FWS Education

 FWS Native American Eagle Aviary  FWS Exempt Institution

Zip:______________

 FWS Eagle Exhibition

 State Falconry

 Other (specify): ____________________________

 NONRELEASABLE  RELEASABLE* *Releasable birds must be released to the wild, except that
releasable raptors (excluding eagles) may be transferred to falconers permitted to hold the species for falconry.

4 BIRD IS:

ATTACHMENTS (See instructions on reverse to determine which attachments are required and the information that must be
included in each attachment. Check the attachments below that apply.)
5
 Veterinarian’s statement

 Enclosure information

 Experience information

 Program information

CERTIFICATION. I certify that the information submitted above is true and correct to the best of my knowledge.
I understand that making a false statement may subject me to the criminal penalties of 18 U.S.C. 1001.
6
______________________________________________________________________

__________________________

Signature (in blue ink) of permittee /principal officer (No photocopied or stamped signatures)

Date of signature (mm/dd/yyyy)

U.S. FISH & WILDLIFE SERVICE APPROVAL / DISAPPROVAL
Approved:

___________________________________
Signature of FWS official

Concurrence: ___________________________________
Signature of FWS official

Denied:

___________________________________
Signature of FWS official

_____________________________________________
Title/Region

Date

______________________________________________
Title/Region

Date

______________________________________________
Title/Region

Date

Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________
Form 3-202-12

(rev 9/2013)

OMB Control No. 1018-0022; Expires xx/xx/xxxx

INSTRUCTIONS
This Acquisition and Transfer Request Form is for the use of holders of Federal Migratory Bird Special Purpose Possession
Live (Education), Eagle Exhibition (Live), Rehabilitation, and Native American Eagle Aviary permits, in requesting
authorization to acquire live migratory birds from other permittees, or to transfer live migratory birds to possession
permittees. (Contact your permit office if your Transfer From/To scenario is not listed below.) This form must be
completed and submitted to your Regional Migratory Bird Permit Office, and it must be approved by the appropriate
permit office prior to you receiving or transferring a bird. Allow at least 30 days from the date the approving permit
office receives a complete request.
If this request necessitates amendment of your permit, the completed form will serve as your amendment request. The
authorizing Service official will approve or deny the transaction at the bottom of the form and provide a copy to you for
your records. If your request is approved, you may take possession or transfer the bird once you receive your copy. (You
may also require authorization from your State.) If your request is denied, you may not conduct the requested activity (see
50 CFR 13.29 for reconsideration procedures).
1. Who completes and signs the Acquisition and Transfer Request form, and where do they submit it?
For a Transfer
From
Rehabilitation
permit

To
Rehabilitation
permit

the 3-202-12 is
submitted by
No transfer form
required

to

and must include
(attachments)

Comment

NA

NA

Include in annual report

Rehabilitation
permit

Education/Eagle
Exhibition
permit

Educator/Eagle
Exhibitor

Educator’s
permit office

Veterinarian
statement, caging,
experience &
education information.

Rehabilitation
permit

Native
American Eagle
Aviary permit

Eagle Aviary

Eagle Aviary’s
permit office

Veterinarian statement

Rehabilitation
permit

Exempt
Institution

Rehabilitator

Rehabilitator’s
permit office

Veterinarian statement
& caging information

Rehabilitation
permit

Falconry permit

Rehabilitator

Rehabilitator’s
permit office

Education
permit

Education
permit

Both permittees

Their respective
permit office

Copy of State
Falconry permit
Veterinarian
statement, caging,
experience &
education information.

Rehabilitator sends veterinarian
statement to Education/Eagle
Exhibition permittee to submit with
their package to their permit office
Native American Eagle aviaries
have priority for nonreleasable
eagle acquisition.
Exempt institution sends caging
information to Rehabilitator to
submit with their package.
No institution is exempt from
permit requirement for eagles
Falconry permittee must complete
electronic 3-186A
Sending educator sends vet
statement to Receiving educator to
submit with their package to their
permit office

Education
permit

Educator

Educator’s
permit office

Caging, experience &
education information

Propagator must submit a
completed 3-186A.

Permitted
facility

NA

NA

NA

Transfer of birds from exempt to
permitted facilities is prohibited

Raptor
propagation
permit
Exempt
Institution

2. ATTACHMENTS
This information is required by your permitting office before your permit can be amended to authorize your acquisition and
possession of this bird.
a. Veterinarian’s statement –Must be on letterhead and signed by the veterinarian. Must fully describe the injury,
illness or other medical or behavioral condition of the bird, and why it renders the bird non-releasable to the wild. The
Service may require an independent evaluation prior to approving transfers of nonreleasable birds.
b. Enclosure information -- If you are acquiring a bird, you must attach recent photographs and a diagram (including
length, width, height) of your permanent enclosure for the bird. Include a description of interior and exterior construction
materials, such as flooring and netting. State whether this is a previously existing enclosure or a new enclosure.
c. Experience Information -- If you are acquiring a bird that is a new species for you (i.e., your permit does not already
authorize possession of individuals of this species), describe your experience handling this species.
d. Educational program -- If you are acquiring a bird that is a new species for you (i.e., your permit does not already
authorize possession of individuals of this species), provide a brief outline of the educational program you will deliver
regarding this species.
3. The permittee/principal officer must sign (in blue ink) and date the form.
4. Mail the completed form and any required attachments to the appropriate Regional Migratory Bird Permit Office
indicated in the table above.
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FEDERAL FISH AND WILDLIFE PERMIT REPORT
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.

Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;
Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;
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 a condition of your permit
under the above laws. Failure to provide all requested information may be sufficient cause for the U.S. Fish and Wildlife Service to
revoke your permit. Response is not required unless a currently valid Office of Management and Budget (OMB) control number is
displayed on form.

3.

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.

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 an FWS function related to this system
of records.
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 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.

4. 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.
5. The public reporting burden for information collection varies depending on the type of permit held. The relevant burden estimate for a
Migratory Bird and Eagle Acquisition and Transfer Request is 1.5 hours. This includes 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 nonconfidential summary and remaining documents may be made available to the public under FOIA [43 CFR 2.26 – 2.33].

3

Migratory Bird Regional Permit
Offices
FWS
REGION

AREA OF
RESPONSIBILITY

MAILING
ADDRESS

CONTACT
INFORMATION

Region 1

Hawaii, Idaho, Oregon,
Washington

911 N.E. 11th Avenue
Portland, OR 97232-4181

Tel. (503) 872-2715
Fax (503) 231-2019
Email [email protected]

Region 2

Arizona, New Mexico,
Oklahoma, Texas

P.O. Box 709
Albuquerque, NM 87103

Tel. (505) 248-7882
Fax (505) 248-7885
Email [email protected]

Region 3

Iowa, Illinois, Indiana,
Minnesota, Missouri,
Michigan, Ohio, Wisconsin

5600 American Blvd. West
Suite 990
Bloomington, MN
55437-1458
(Effective 5/31/2011)

Tel. (612) 713-5436
Fax (612) 713-5393
Email [email protected]

P.O. Box 49208
Atlanta, GA 30359

Tel. (404) 679-7070
Fax (404) 679-4180
Email [email protected]

Region 4

Region 5

Alabama, Arkansas, Florida,
Georgia, Kentucky, Louisiana,
Mississippi, North Carolina,
South Carolina, Tennessee,
Virgin Islands, Puerto Rico
Connecticut, District of
Columbia, Delaware, Maine,
Maryland, Massachusetts,
New Hampshire, New Jersey,
New York, Pennsylvania,
Rhode Island, Virginia,
Vermont, West Virginia

P.O. Box 779
Hadley, MA 01035-0779

Tel. (413) 253-8643
Fax (413) 253-8424
Email [email protected]

Region 6

Colorado, Kansas, Montana,
North Dakota, Nebraska,
South Dakota, Utah, Wyoming

P.O. Box 25486
DFC(60154)
Denver, CO 80225-0486

Tel. (303) 236-8171
Fax (303) 236-8017
Email [email protected]

Region 7

Alaska

1011 E. Tudor Road
(MS-201)
Anchorage, AK 99503

Tel. (907) 786-3693
Fax (907) 786-3641
Email [email protected]

2800 Cottage Way
Room W-2606
Sacramento, CA 95825

Tel. (916) 978-6183
Fax (916) 414-6486
[email protected]

Region 8

California, Nevada

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