Form 3-200-52 Federal Fish and Wildlife Permit Application Form

	Department of the Interior U.S. Fish and Wildlife Service Federal Fish and Wildlife Permit Application Form		OMB No. 1018-0093 Expires XX/XX/2017
Return to: U.S. Fish and Wildlife Service (Enter address from pages 4 and 5 of application)		Type of Activity: REISSUANCE, RENEWAL, OR AMENDMENT OF A PERMIT (For this application, all permits, registrations, and certificates are referred to as a permit.)

Complete Sections A or B, C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.

See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A.	Complete if applying as an individual
1.a. Last name			1.b. First name		1.c. Middle name or initial	1.d. Suffix
2. Date of birth (mm/dd/yyyy)		3. Social Security No.	4. Occupation		5. Affiliation/ Doing business as (see instructions)
6.a. Telephone number		6.b. Alternate telephone number		6.c. Fax number	6.d. E-mail address

B.	Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution				1.b. Doing business as (dba) 
2. Tax identification no.			3. Description of business, agency, Tribe, or institution
4.a. Principal officer Last name			4.b. Principal officer First name				4.c. Principal officer Middle name/ initial		4.d. Suffix
5. Principal officer title 						6. Primary contact name
7.a. Business telephone number		7.b. Alternate telephone number			7.c. Business fax number			7.d. Business e-mail address

C.		Applicant 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 6 and 7. 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 or that you are applying to renew/re-issue: _________________________________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)

E. REISSUANCE, RENEWAL, OR AMENDMENT OF A PERMIT (For this application, all permits, registrations, and certificates are referred to as a permit.)

NOTE 1: If you are renewing your Designated Port Exemption permit, use form 3-200-2 (http://www.fws.gov/forms/3-200-2.pdf) and submit to appropriate Office of Law Enforcement address. If you are renewing your Import/Export license (required for commercial activities), use form 3-200-3 (http://www.fws.gov/forms/3-200-3.pdf) and submit to appropriate Office of Law Enforcement address.

NOTE 2: This form cannot be used for lost or damaged permit. If you need to replace a lost or damaged permit, please use form 3-200-66, http://www.fws.gov/international/pdf/permit-application-form-3-200-66-replacement-document.pdf. The application must be submitted to the office that issued the initial permit. Lost or damaged permit

NOTE 3: Some activities, such as all master files for multiple shipments, Certificate of Scientific Exchange (COSE), circus/traveling exhibits, and artificially propagated plants, can only be re-issued, renewed, or amended by submitting a new application for permits for those activities. Please refer to http://www.fws.gov/international/permits/by-form-number/index.html to determine if another application form would be more appropriate or contact the Division of Management Authority for more information.

1. Permit number. Enter the permit number to be reissued/renewed/amend _________________.

2. Submit the original permit with this application.

3. Past activities.

a. Provide copies of all cleared documents and form 3-177 (FWS declaration of wildlife) associated with this permit.

b. Provide a summary detailing activities conducted under this permit, as well as a brief statement of why you are seeking reissuance/renewal.

4. Annual Report. If required by your permit, provide an annual report as conditioned (Please disregard if you have already submitted your annual report.)

5. Sport-hunted trophies: If you did not hunt during the hunting season stated in your original application, you are not eligible for a renewal. Please submit a new application form.

6. Certification - Complete one of the statements below and supply any additional documentation requested: (original signature is required)

a. For NO CHANGES to original application:

I certify that the information submitted in support of my original application for the permit indicated above has not changed and is still currently correct. I hereby request reissuance or renewal of this permit.

Permittee’s signature: ____________________________________ Date: ___________

b. For CHANGES to original application:

On an attached page(s), provide a complete description of any changes (e.g., change in principal officer, personnel, address, location of activities, types of activities). Please sign each attached page. Also note that we need to request additional information regarding the changes after reviewing your initial request.

I certify that the information submitted in support of my original application for the permit indicated above is still currently correct EXCEPT for the changes noted on the attached, signed page(s). I hereby request re-issuance or renewal of this permit with the indicated changes.

Permittee’s signature: ____________________________________ Date: ___________

7. All international shipment(s) must be through a designated port, unless otherwise authorized. A list of designated ports (where an inspector is posted) is available from http://www.fws.gov/le/designated-ports.html. If you wish to use a port not listed, please contact either the Office of Law Enforcement for a Designated Port Exemption Permit (form 3-200-2) or the Division of Management Authority.

8. Name and address where you wish the permit to be mailed, if different from page 1 (All permits will be mailed via the U.S. Postal Service, unless you identify an alternative means below):

9. If you wish the permit to be delivered by means other than USPS regular mail, provide an air bill, pre-paid envelope, or billing information. If you do not have a pre-paid envelope or air bill and wish to pay for a courier service with your credit card, please check the box below. Please DO NOT include credit card number or other information; you will be contacted for this information.

□ If a permit is issued, please send it via a courier service to the address on page 1 or question 8. I understand that you will contact me for my credit card information once the application has been processed.

11. Who should we contact if we have questions about the application? (Include name, phone number, and email):

12. Disqualification Factor. A conviction, or entry of a plea of guilty or nolo contendere, for a felony violation of the Lacey Act, the Migratory Bird Treaty Act, or the Bald and Golden Eagle Protection Act disqualifies any such person from receiving or exercising the privileges of a permit, unless such disqualification has been expressly waived by the Service Director in response to a written petition. [50 CFR 13.21(c)]. Have you or any of the owners of the business, if applying as a business, been convicted, or entered a plea of guilty or nolo contendere, forfeited collateral, or are currently under charges for any violations of the laws mentioned above?

___ Yes ___ No If you answered “Yes” provide: a) the individual’s name, b) date of charge, c) charge(s),

d) location of incident, e) court, and f) action taken for each violation.

CITES Permit Offices

NOTE: The application must be submitted to Division of Management Authority or to the Office of Law Enforcement in the region where the applicant is located.

Division of Management Authority (DMA)

4401 N. Fairfax Drive, Room 212

Arlington, VA 22203

Phone: 1-800-358-2104 or 703-358-2104

Office of Law Enforcement (OLE)

Region 1: Guam, Hawaii, Idaho, Oregon, & Washington

Guam U.S. Fish & Wildlife Service Office of Law Enforcement 415 Chalan San Antonio Road, Suite 209 Tamuning, Guam 96913-3620 Phone: (671) 647-6064 Fax: (671) 647-6068	Honolulu U.S. Fish & Wildlife Service Office of Law Enforcement 3375 Koapaka St., #B296 Honolulu, HI 96819-1867 Phone: (808) 861-8525 Fax: (808) 861-8515
Portland U.S. Fish & Wildlife Service Office of Law Enforcement P.O. Box 55206 Portland, OR 97238 Phone: (503) 231-6135 Fax: (503) 231-6133	Blaine U.S. Fish & Wildlife Service Office of Law Enforcement 9925 Pacific Highway, Room 136 Blaine, WA 98230 Phone: (360) 332-5388 Fax: (360 )332-3010
Seattle U.S. Fish & Wildlife Service Office of Law Enforcement 19639 28th Avenue South, Bldg. A Seattle, WA 98188 Phone: (206) 429-2198 Fax: (206) 429-2673

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

U.S. Fish & Wildlife Service

Office of Law Enforcement

2545 W. Frye Road, Suite 8
Chandler, AZ 85224-6273
Phone: (480) 967-2007
Fax: (480) 966-9766

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

U.S. Fish & Wildlife Service

Office of Law Enforcement

10600 Higgins Road, Suite 200

Rosemont, IL 60018

Phone: (847) 298-3250 Ext. 110

Fax: (847) 298-7669

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

Atlanta U.S. Fish & Wildlife Service Office of Law Enforcement 4341 International Parkway, Suite #104 Atlanta, GA 30354 Phone: (404) 763-7959 Fax: (404) 366-7031 New Orleans Mail: U.S. Fish & Wildlife Service Office of Law Enforcement 61387 Hwy 434 Lacombe, LA 70445 Physical: U.S. Fish & Wildlife Service Office of Law Enforcement 2424 Edenborn, Room 100 Metairie, LA 70001 Phone: (504) 219-8870 Fax: (504) 219-8868

Miami Mail: U.S. Fish & Wildlife Service Office of Law Enforcement 10426 NW 31 Terrace Miami, FL 33172 Physical: U.S. Fish & Wildlife Service Office of Law Enforcement 6105 NW 18th St., Room 405 Miami, FL 33122 Phone: (305) 526-2994 or 2620 Fax: (305) 526-7480

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

Phone: (516) 825-3950

Fax: (516) 825-3597

Region 6: Colorado, Kansas, Montana, Nebraska, North Dakota, South Dakota, Utah, & Wyoming

U.S. Fish & Wildlife Service

Office of Law Enforcement

Denver International Airport

P.O. Box 492098

Denver, CO 80249

Phone: (303) 342-7430

Fax: (303) 342-7433

Region 7: Alaska Anchorage U.S. Fish & Wildlife Service Office of Law Enforcement P.O. Box 190045 4600 Postmark Drive, Suite NB207 Anchorage, AK 99519 Phone: (907) 271-6198 Fax: (907) 271-6199

Fairbanks U.S. Fish & Wildlife Service Office of Law Enforcement 1412 Airport Way Fairbanks, AK 99701 Phone: (907) 456-2335 Fax: (907) 456-2356

Region 8: California and Nevada

Los Angeles U.S. Fish & Wildlife Service Office of Law Enforcement 370 Amapola Ave., #114 Torrance, CA 90501 Phone: (310) 328-6307 Fax: (310) 328-6399

San Francisco 1633 Old Bayshore Highway, Suite 248 Burlingame, CA 94010 Phone: (650) 876-9078 Fax: (650) 876-9701

PERMIT FEES – EXCERPTS FROM 50 CFR 13 November 2010

d) Fees. (1) Unless otherwise exempted under this paragraph (d), you must pay the required permit processing fee at the time that you apply for issuance or amendment of a permit. You must pay in U.S. dollars. If you submit a check or money order, it must be made payable to the “U.S. Fish and Wildlife Service.” The Service will not refund any application fee under any circumstances if we have processed the application. However, we may return the application fee if you withdraw the application before we have significantly processed it.

(2) If regulations in this subchapter require more than one type of permit for an activity and the permits are issued by the same office, the issuing office may issue one consolidated permit authorizing the activity in accordance with §13.1. You may submit a single application in such cases, provided that the single application contains all the information required by the separate applications for each permitted activity. Where more than one permitted activity is consolidated into one permit, the issuing office will charge the highest single fee for the activity permitted.

(3) Circumstances under which we will not charge a permit application fee are as follows:

(i) We will not charge a permit application fee to any Federal, Tribal, State, or local government agency or to any individual or institution acting on behalf of such agency. Except as otherwise authorized or waived, if you fail to submit evidence of such status with your application, we will require the submission of all processing fees prior to the acceptance of the application for processing.

(ii) As noted in paragraph (d)(4) of this section.

(iii) We may waive the fee on a case-by-case basis for extraordinary extenuating circumstances provided that the issuing permit office and a Regional or Assistant Director approves the waiver.

(4) User fees. The following table identifies specific fees for each permit application or amendment to a current permit. If no fee is identified under the Amendment Fee column, this particular permit either cannot be amended and a new application, and application fee, would need to be submitted or no fee will be charged for amending the permit (please contact the issuing office for further information).

Type of permit	Renewal/Reissuance Fee	Amendment fee
Eagle Transport—Scientific or Exhibition	75
Eagle Transport—Native American Religious Purposes	No fee	No fee
ESA Interstate Commerce	100	50
ESA and CITES Import/Export and Foreign Commerce	100	50
ESA and CITES Museum Exchange	100	50
ESA Captive-bred Wildlife Registration	200	100
—Renewal of Captive-bred wildlife registration	100
CITES Import (including trophies under ESA and MMPA)	100	50
CITES Export	100	50
CITES Pre-Convention	75	40
CITES Certificate of Origin	75	40
CITES Re-Export	75	40
CITES Personal Effects and Pet Export/Re-Export	50
CITES Appendix II Export (native furbearers and alligators—excluding live animals)	100	50
CITES Master File (includes files for artificial propagation, biomedical, etc. and covers import, export, and re-export documents)	200	100
—Renewal of CITES Master File	100
—Single-use permits issued on Master File	5 each
CITES Annual Program File	50
—Single-use permits issued under Annual Program	5 each
CITES replacement documents (lost, stolen, or damaged documents)	50	50
CITES Passport for Traveling Exhibitions and Pets	75 per animal
CITES/ESA Passport for Traveling Exhibitions	100 per animal
CITES Introduction from the Sea	100	50
CITES Participation in the Plant Rescue Center Program	No fee	No fee
CITES Registration of Commercial Breeding Operations for Appendix-I wildlife	100
CITES Request for Approval of an Export Program for a State or Tribe (American Ginseng, Certain Furbearers, and American Alligator)	No fee	No fee
Import/Export License	100	50
Designated Port Exception	100	50
Injurious Wildlife Permit	100	50
—Transport Authorization for Injurious Wildlife	25
Personal Pet Import	50
WBCA Scientific Research, Zoological Breeding or Display, Cooperative Breeding	100	50
WBCA Approval of Cooperative Breeding Programs	200	100
—Renewal of a WBCA Cooperative Breeding Program	50
WBCA Approval of a Foreign Breeding Facility	250 per species

(5) We will charge a fee for substantive amendments made to permits within the time period that the permit is still valid. The fee is generally half the original fee assessed at the time that the permit is processed; see paragraph (d)(4) of this section for the exact amount. Substantive amendments are those that pertain to the purpose and conditions of the permit and are not purely administrative. Administrative changes, such as updating name and address information, are required under 13.23(c), and we will not charge a fee for such amendments.

(6) Except as specifically noted in paragraph (d)(4) of this section, a permit renewal is an issuance of a new permit, and applicants for permit renewal must pay the appropriate fee listed in paragraph (d)(4) of this section.

(e) Abandoned or incomplete applications. If we receive an incomplete or improperly executed application, or if you do not submit the proper fees, the issuing office will notify you of the deficiency. If you fail to supply the correct information to complete the application or to pay the required fees within 45 calendar days of the date of notification, we will consider the application abandoned. We will not refund any fees for an abandoned application.

[70 FR 18317, Apr. 11, 2005, as amended at 72 FR 48445, Aug. 23, 2007; 73 FR 29083, May 20, 2008; 73 FR 42281, July 21, 2008; 74 FR 46875, Sept. 11, 2009]

APPLICATION FORM INSTRUCTIONS

The following instructions pertain to an U.S. Fish and Wildlife Service (FWS) permit applications. 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 relevant questions in Sections A or B, C, D, and E.

• An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are filling in the appropriate application form for the proposed activity.

• Print clearly or type in the information. Illegible applications may cause delays.

• Sign the application in blue ink. Faxes or copies of the original signature will not be accepted.

• Mail the original application to the address at the top of page one of the applications 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, however, some applications may take longer than 90 days to process (50 CFR 13.11).

• Applications are processed in the order they are received.

SECTION A OR SECTION B:

Section A. Complete if applying as an individual [do not complete this section if applying for Import/Export License (3-200-3)]:

• 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, while helpful in processing, are not required.

• If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing power of attorney must be included with the application.

• Affiliation/ Doing business as (dba): business, agency, organizational, Tribe, or institutional affiliation directly related to the activity requested in the application (e.g., a taxidermist is an individual whose business can directly relate to the requested activity). The Division of Management Authority (DMA) and the Office of Law Enforcement (OLE) do not accept doing business as affiliations for individuals (complete Section B)..

Section B. Complete if applying as a business, corporation, public agency, Tribe, or institution:

• Enter the complete name of the business, agency, 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. If you are applying on behalf of a client, a document evidencing power of attorney must be included with the application.

• Principal Officer is the person in charge of the listed business, corporation, public agency, Tribe, 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) and Office of Law Enforcement (OLE), a physical U.S. address is required. Province and Country blocks are provided for those USFWS programs that use foreign addresses and are not required by DMA.

• Mailing address is the address to which communications from USFWS should be mailed if different from 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. 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, nor will fees be refunded for applications for which processing has begun.

• Documentation of fee exempt status is not required for applications submitted by Federal, Tribal, State, or local government agencies; but must be supplied by those applicants acting on behalf of such agencies. Such applications must include 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 recent issued USFWS permit. 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 legally binds the applicant to the statement of certification. You are certifying that you have read and understand the regulations that apply to the permit. You are also certifying that all information 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.

Please continue to next page. DO NOT RETURN THIS PAGE WITH THE APPLICATION

APPLICATION FOR A FEDERAL FISH AND WILDLIFE PERMIT

Paperwork Reduction Act, Privacy Act, and Freedom of Information Act – Notices

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and the Privacy Act of 1974 (5 U.S.C. 552a), please be advised:

1. The gathering of information on fish and wildlife is authorized by:

(Authorizing statutes can be found at: http://www.gpoaccess.gov/cfr/index.html and http://www.fws.gov/permits/ltr/ltr.html.)

a. Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;

b. Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50CFR 17;

c. Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;

d. Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), 50 CFR 18;

e. Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15;

f. Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;

g. Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), http://www.cites.org/, 50 CFR 23;

h. General Provisions, 50 CFR 10;

i. General Permit Procedures, 50 CFR 13; and

j. 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. 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.

b. 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.

c. 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.

d. 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.

e. 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.

f. 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.

g. 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.

h. Routine disclosure to a congressional office in response to an inquiry to the office by the individual to whom the record pertains.

i. Routine disclosure to the Government Accountability Office or Congress when the information is required for the evaluation of the permit programs.

j. 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 Reissuance or Renewal of a Permit application is 15 minutes. 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 2042-PDM, 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)].

DO NOT RETURN THIS PAGE WITH THE APPLICATION

Form 3-200-52 Rev. 02/2014 Page 11 of 11