Form 3-200-30 Federal Fish and Wildlife Permit Application Form

Expires XX/XX/XXXX
OMB No. 1018-0093

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

Federal Fish and Wildlife Permit Application Form
Type of Activity:

Return to: Division of Management Authority (DMA)
U.S. Fish and Wildlife Service
4401 N. Fairfax Drive, Room 212
Arlington, VA 22203
1-800-358-2104 or 703-358-2104

Export/Re-export/Re-import of Circuses and Traveling Animal
Exhibitions (and Reissuance) (CITES/ESA)

 New Application
 Master File Permit #: _______________
 Requesting Re-issuance/Amendment of Permit#__________

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, tribe, 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 identified on page 2. 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 3-200-30

Rev. <>

Page 1 of 8

E. Export/Reexport/Reimport of Circuses and Traveling Animal Exhibitions (and Reissuance) (CITES/ESA)






This form is only for the purpose of temporary travel of animals that are not changing ownership (e.g.,
not being bought or sold while outside the United States). If you are intending for your animal(s) to be in
another country to transfer ownership or for long term, submit form 3-200-37.
If you are applying on behalf of a client, provide documentation to show that you have a Power of Attorney
authorizing you to act on behalf of the client.
For activities involving marine mammals, use form 3-200-53
(http://www.fws.gov/forms/display.cfm?number1=200).
There are three scenarios under which circus and traveling exhibition animals could fall.
For Re-issuance and Amendments requests: PLEASE RETURN THE ORIGINAL PERMIT

Scenario 1. Traveling Exhibition Certificate (Resolution Conf. 12.3(Rev. CoP13)). This applies only to an animal
that qualifies as pre-Convention1 or bred in captivity as defined in Resolution Conf. 10.16 (Rev.). A CITES
certificate may be issued up to 3 years for a single animal. Follow instructions in Part I below, and complete one
application per animal. If the animal does not qualify for the traveling-exhibition certificate, follow instructions in
Part II. Processing fee: $100 for a species listed on both CITES and ESA; $75 for a species listed on CITES only.
Scenario 2. For animals that do not qualify under Scenario 1, a Master File can be established that is valid for up to
three years for one or more animals. Once a Master File is approved, you must obtain single-use permits, valid for 6
months or until the expiration of the master file, whichever is sooner, for each export/re-export (50 CFR 13.11
[http://ecfr.gpoaccess.gov]). Processing fees: $200 to establish a Master file; $100 for Master file renewal; $5 single
use documents. Follow instructions in Part II.
Scenario 3. For animals that do not qualify under Scenario 1 and you do not need/want to conduct multiple
shipments, you may apply for a Single Use Permit for multiple animals. Processing fee: $100. Follow instructions in
Part II.
Provide the following information. Complete all questions on the application. Mark questions that are not applicable
with "N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you submit, indicate the
application question number you are addressing. Please do not submit video tapes.
Complete either Part I or Part II, as appropriate, AND Part III and IV.
Part I. Traveling Exhibition Certificate (Scenario 1)
1. Provide the following for this animal (a separate permit application is needed for each animal).
Scientific name
Sex Date Source
Current Country of last
Description (e.g., I.D. #, band #,
(genus, species,
of
(Wild or
location re-export
tattoo #, tag #, size, microchip #,
and if
Birth Born in
house name, distinguishing
applicable,
captivity)
marks/features). If microchip #,
subspecies) and
provide manufacturer and location of
Common name
microchip2. (Border officials must
be able to verify that the permit and
the animal correspond.)

1

Specimen was acquired (removed from the wild or held in captivity or a controlled environment) before the date CITES applied to it.
The listing date can be found http://www.cites.org.
2
The exporter may be asked to have a microchip reader on hand to read the microchip at the time of export.
3-200-30

Page 2 of 8

2. If this animal qualifies as pre-Convention1, provide documents, signed statements or other evidence that the
wildlife was born or removed from the wild prior to the date CITES applied to it (e.g., bill of sale, ISIS record,
breeder's record).
Part II. Animals that do not qualify for a Traveling-exhibition Certificate.
3. Please indicate which you are requesting (check appropriate box):
a Master File (individual CITES documents, valid for up to six months, are issued from the Master File)
How many single-use permits do you anticipate using in the next six months upon review of this application?
_________. Additional CITES documents may be requested via form 3-200-74
(http://www.fws.gov/forms/display.cfm?number1=200).
OR
a Single Use Permit, valid for a single shipment in a six-month period. Indicate country and location(s) of exhibition:
______________________________________________________________________________________
4. Provide the following for each animal (multiple animals may appear on a single document).
Scientific name
(genus, species,
and if
applicable,
subspecies) and
Common name

Sex Date
of
Birth

Source
(Wild or
Born in
captivity)

Current
location

Last Country of
last re-export

Description (e.g., I.D. #, band #, tattoo #,
tag #, size, microchip #, house name,
distinguishing marks/features). If
microchip #, provide manufacturer and
location of microchip3. (Border officials
must be able to verify that the permit and
the animal correspond.)

Part III (All applicants complete). For EACH animal, provide the following. If your application covers more than
one animal (i.e., you completed part II), be sure to answer questions 1 and 2 for each animal being addressed in the
application.
5. Was this animal born in captivity? Yes _______ No ________. If YES, provide responses to a and b.
below:

3

If a microchip is used to identify the animal, the exporter may be asked to have a microchip reader on hand to read the
microchip at the time of export.

3-200-30

Page 3 of 8

a. Are you the breeder? If so, please provide a statement that the animal was bred and born at your facility. This
statement must include:
i.
Birth/hatch date, and if applicable band/tag number, and sex of each specimen;
ii.
Name and address of your facility where the animal was bred and born;
iii. Location of parental stock; and
iv. Your signature and date.
b. If you are NOT the breeder of the specimen(s), provide copies of documentation showing that you acquired
the animal from the breeder or documentation demonstrating the history of transactions (chain of ownership
of each animal) and a signed statement from the breeder or breeder's record that includes:
i. That the animal was bred and born/hatched at his/her facility;
ii. Birth/hatch date, and, if applicable, band/tag number, or other identifiers;
iii. Sex of each specimen;
iv. Location (Name, Street address, City, State) of Parental Stock;
v. Complete name and address of the breeder's facility.
c.
a.
b.
c.
d.
e.

If NO, provide:
Specific location of where, when, and by whom (name and address) the specimen was removed from the wild;
Purpose of removal and length or approximate length of time held in captivity;
Copy of any permits or other documents from the State or local wildlife authorities approving the activities;
Documentation showing that the specimens were legally acquired by the applicant; and
Copies of any applicable State permits or licenses that are required to house, maintain, and breed these
specimens (contact your State for information).

6. If this animal is protected by the U.S. Endangered Species Act (ESA):
Is the animal pre-Act wildlife? ___No. ___Yes.
a. If yes, provide evidence that the animal was acquired or held in a controlled environment on or before (a)
December 28, 1973 or the date when the species was listed, and (b) has not entered into commerce (e.g., been
bought, sold, or offered for sale by you or anyone else) since December 28, 1973, or the date when listed.
b. If no, you must be able to show that your proposed activity would meet the issuance criteria under ESA. One
way is to provide educational material (e.g., brochures, photographs of signage, script used to verbally inform
the public) that will be presented to your target audience that discusses the ecological role and conservation
needs for the species being presented. We need sufficient information within our files to support any
decisions we make regarding your application.
i. In what type of presentation are you proposing to use the specimen (e.g., live performance, movie,
television)?
ii. Provide a copy of the actual script or material that will be presented to the audience at each performance,
show, or viewing of the specimen(s). This material must be original in nature (e.g., photocopies from a
reference book are not appropriate) and must be the actual material that will be presented each time the
animal is viewed by the target audience.
iii. In what media will the message be presented? Will it be an oral presentation, fact sheets, brochures, or
will posters be used? If it is written material, will it be available free-of-charge?
iv. When will the material be presented? If the material will be presented orally, when will this presentation
be given? What activities will be occurring at the same time the presentation of the message is being
provided and could the activity diminish the effectiveness of the presentation? If the material will be
presented in a written form, will an oral announcement be made regarding the availability of this
material? If the material is in poster form, will the posters be placed so that the material will be accessible
by the public?
v. When exhibiting in countries where English is not the primary language, explain how the conservation
education information will be presented to the non-English speaking audience.
c. If you are unable to present educational material during each presentation of your specimen, what activities
will you be conducting to demonstrate that your proposed activity “enhances” the survival of the species or
meets the issuance criteria under the ESA? If you need more explanation on this question, please contact the
Division of Management Authority.
3-200-30

Page 4 of 8

7. Is the animal a non-human primate? If so, provide a copy of your current Centers for Disease Control (CDC)
registration.

3-200-30

Page 5 of 8

Part IV (all applicants complete). If you are submitting more than one application at this time, you may submit the
following information only once.
8. Facilities.
a. Provide address of the permanent facility where the animal(s) is/are maintained.
Name of Facility:
Address
City, State, Zip Code
b. A detailed description, including size, construction materials, protection from the elements, and photographs
or detailed diagrams clearly depicting the permanent facilities;
c. Provide the same as above for transportation units used while traveling within the United States and abroad.
The transport conditions must comply with 50 CFR Part 13, the CITES Guidelines for Transport of Live
Animals, as well as the Animal Welfare Act and, in the case of air transport, with the International Air
Transport Association (IATA) (www.iata.org/cargo/live.htm) live animal regulations. Your description
must include:
i. The type, size, and construction of any shipping container; and
ii. The arrangements for watering or otherwise caring for the wildlife during transport.
d. Description of the qualifications of the individuals to train and care for the animal, including the number of
years experience with this species or similar species, and names of current caretakers.
9. List mortalities of ESA listed species which occurred at your facility during the past five years, and explain the
cause of the mortalities and measures taken to prevent future mortalities if appropriate.
10. Provide copies of any applicable permits, licenses and registrations (State Fish and Game, U.S. Department of
Agriculture Animal Welfare Act (AWA), Center for Disease Control and Prevention).
11. Enter the U.S. port through which export/re-export/import will probably occur: ___________________________
(All wildlife must be declared to and inspected by a Wildlife Inspector from the U.S. Fish and Wildlife Service
Office of Law Enforcement prior to leaving the United States. A list of designated ports (where an inspector is
posted) is available from http://www.fws.gov/le/ImpExp/Contact_Info_Ports.htm.)
12. Address where you wish permit mailed (if different than page 1):
_____________________________________________________________________________________
_____________________________________________________________________________________
13. If you wish the permit to be sent to you by means other than regular mail, provide an air bill, pre-paid envelope,
or billing information:
_________________________________________________________________________
14. Who within your organization should we contact if we have questions about the application? (Include name,
phone number, and email):
__________________________________________________________________________

3-200-30

Page 6 of 8

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, 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://www.fws.gov/forms/display.cfm?number1=200
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, 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) 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, 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) a physical U.S. address is required. Province and Country blocks are provided for
those U.S. FWS programs which use foreign addresses and are not required by DMA..

Mailing address is address where communications from U.S. FWS 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.

3-200-30

Page 7 of 8

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.
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), 50 CFR 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 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 an Export/Re-Export/Re-import of Circuses and Traveling Animal Exhibitions (and Reissuance) application is 60 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 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)].

3-200-30

Page 8 of 8