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)

1

SPECIES:
Sex: ____ Male

____ Female

Band number or other identification (if applicable): _______________
____ Unknown
Age: ____ Nestling ____ Immature
____ Adult

2 SENDER (person transferring bird)
Telephone No. (

Name: ____________________________________________________
Fax No.: (

)

Address:

)________________ E-mail: ______________________
City:

State:

Zip:________

Type: ___Rehabilitation ___Special Purpose Possession ___ Other (specify): ____________

FWS Permit No.:

Reason for Transfer: ___________________________________________________________________________
If this bird is currently listed on your Special Purpose Possession (Education) permit & is being transferred, or has escaped or
died, do you plan to replace it?

____ Yes

3 RECIPIENT (person acquiring bird)
Telephone No. (

)

____ No
Name: ____________________________________________________

Fax No. (______)________________ E-mail: _____________________
City:

Address:

State:

Zip:_______

FWS Permit No.:________ Type: ___Rehabilitation ___Special Purpose Possession ___ Other (specify): _____________
Is this a replacement bird for a bird already on your permit? ___ Yes ___ No
Does your Federal permit already authorize possession of this species?

___ Yes ___ No

4 BIRD IS: RELEASABLE * NONRELEASABLE  IF NON-RELEASABLE, WHY? Describe the bird’s
condition that renders it non-releasable (& attach a veterinarian’s statement confirming that the bird is non-releasable & why):
*Releasable birds must be released except raptors may be transferred to permitted falconers (see 50 CFR 21.31(e)(4)(ii)).

5 ATTACHMENTS
(a) You must attach a veterinarian’s statement confirming that the bird is non-releasable & why.
(b) If you are acquiring a bird & your permit does not already authorize this species or number of birds, attach a
description & photographs of your permanent facilities for housing the bird.
(c) If you are acquiring a bird & your permit does not already list individuals of this species, attach:
(i) A brief outline of the educational program you will deliver regarding the species or similar species (educators, only), &
(ii) A description of your experience handling this particular species.
6 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.
Your signature: _____________________________________________

Date:_______________________________

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

Reason denied _____________________________________________________________________________________
__________________________________________________________________________________________________
Form 3-202-12

(rev 9/2010)

OMB No. 1018-0022; Expires x/xxxx

INSTRUCTIONS
This form is for use of holders of Federal Migratory Bird Special Purpose Possession Live (Education), Eagle Exhibition,
and Rehabilitation permits.
Educators/Exhibitors: This form it must be completed and approved for each transfer, acquisition, release, or loss of a
migratory bird held under the permit. Both the transferring and the receiving permittees must complete a copy of this form
and submit it to their issuing U.S. Fish and Wildlife Service Migratory Bird Permit Office(s).
Rehabilitators: a) This form is required for transfer of nonreleasable birds from a permitted rehabilitator to another
permittee or to another type of permit the rehabilitator holds. Both the transferring rehabilitator and the intended recipient
must complete and submit copies of this form. b) This form is also required for transfer of a raptor to a permitted falconer.
The falconer must complete a form 3-186A rather than this form. c) Rehabilitators must also use this form prior to
transferring any live bird to a public institution that is exempt from the permit requirement. A receiving exempt institution
does not need to submit a form.
You must submit the completed form to your issuing office for approval prior to receiving or transferring a bird. These
forms may be faxed to the issuing office provided the original follows by mail. If the requested transaction 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. If your request is denied, you may
not conduct the requested activity (see 50 CFR 13.29 for reconsideration procedures).
1.
If you:
then you must complete these
sections on the front of this form
A. wish to transfer a bird to another permittee (or to another permit
1, 2, 3, 4, 5, and 6.
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,
1, 2, and 6.
C. wish to acquire a bird from another permittee (or from another
permit you hold),

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

2.

A veterinarian’s statement of non-releasability is required to transfer all birds from rehabilitation permits- except for
releasable raptors being transferred to permitted falconers. Attach a veterinarian’s statement describing the
injury/illness that renders the bird non-releaseable.

3.

If you are acquiring a migratory bird and your Federal permit does not already include authorization to
possess this individual, you must provide your permitting office with a description and photographs of your
permanent facilities for housing this bird. This information is required before your permit can be amended to
authorize your possession and acquisition of this bird. Your permit will specify the number of birds of this species
you are authorized to possess, based in part on the adequacy of your facilities.

4.

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), you must provide (a) a brief outline of the educational program you will deliver regarding
this species, and (b) a description of your experience handling this particular species. This information is required
before your permit can be amended to authorize your possession and acquisition of this bird.

5.

Sign and date the form.

6.

Mail the completed form and any required attachments to the U.S. Fish and Wildlife Service Migratory Bird Permit
Office that issued your permit.
Notice
Privacy Act (5 U.S.C.552a): The gathering of information on fish and wildlife is authorized by the Migratory Bird Treaty
Act (16 U.S.C. 703 et seq.), and Parts 13 and 21 of Title 50 of the Code of Federal Regulations. Disclosure of the
requested information is necessary for administration of permits under MBTA and is a condition of your permit. Failure
to disclose all of the requested information may be sufficient cause for revocation of your permit. The information will be
used to monitor disposition of captive birds and the take of birds from the wild. Routine use disclosures outside the
Department of the Interior may be made without the consent of an individual if the disclosure is compatible with the
purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003)

Paperwork Reduction Act (44 U.S.C.3501): An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting
burden estimate for reviewing instructions, gathering and maintaining data, and completing this form is 1.5 hours.
Comments on the form, including the burden estimate, should be mailed to the Information Collection Clearance Officer
(Ref 1018-0022), Mail Stop 222-ARLSQ, Fish and Wildlife Service, U.S. Department of the Interior, 1849 C Street, NW,
Washington, D.C. 20240.