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pdfOMB Control No. 1018-0092
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Department of the Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form
Return to:
Type of Activity: Import/Export License – Foreign Entities*
New - $100.00
Renewal of I/E License #LE______________________________ $100.00
Amendment to I/E License #LE ____________________________$50.00
Name/Address Change ONLY of Permit #LE________________ (no fee)
U.S. Fish and Wildlife Service
Office of Law Enforcement
Send to the appropriate Issuing Office listed on
Page 4 for the State your U.S. Agent is located.
Complete all sections of this application.
See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.
A.
All applicants MUST complete
Name of Business (must match Company’s invoice and other permits/shipping documents)
Complete Tax Identification No. from Your Country
Owner or Principal Officer
Date of Birth (mm/dd/yyyy)
Owner or Principal Officer Last Name Sole Owner? Yes
Description of Business
Owner or Principal Officer First Name
Principal Officer Email Address
URL/Web Address
Principal Officer Title
Primary Contact Name
Principal Officer Telephone Number
Alternate Telephone Number
Owner or Principal Officer Middle Name
Primary Contact Telephone Number
Primary Contact Email Address
B.
All applicants MUST complete
Address (No P.O. Boxes, Retail Postal, or Mail Service Center) (as shown on Company’s invoice and other permits/shipping documents)
City
State
C.
Postal Code
Country
All applicants MUST complete
1.
Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount listed above. Application fees are nonrefundable.
2.
Do you currently have or have you ever had any Federal Fish and Wildlife license/permits?
Yes
If yes, list the number of the most recent license/permit you have held: ________________________
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 of Principal Officer or U.S. Agent** (No photocopied or stamped signatures)
Date of Signature (mm/dd/yyyy)
**(Foreign applicants only – A copy of the Power of Attorney naming foreign entity and U.S. Agent must accompany this application.)
* This application is for foreign businesses located outside the United States (no U.S. presence at all) who commercially import (bring into the U.S.
from a foreign country) or export (carry out of the U.S. to a foreign country) fish or wildlife (including parts and products). Foreign businesses
must designate a U.S. Agent.
Businesses located inside the United States that import or export FWS regulated items for commercial purposes should complete 3-200-3a.
Please continue to next page
3-200-3b Revised December 2016
Page 1 of 6
IMPORT/EXPORT LICENSE (Foreign Entities)
APPLICATION CONTINUATION SHEET
SECTION D: ALL APPLICANTS MUST COMPLETE
NOTE: An Import/Export License is required ONLY if a foreign entity commercially imports (brings into the U.S.
from another country) or exports (takes out from the U.S. to another country). No I/E License is required if a
foreign entity ships (via common carrier) items to U.S. buyer(s).
1.
Is foreign applicant the sole owner? Yes
No
(must check one)
2.
Additional Partner(s) or Additional Principal Officer(s) Information (list all – use additional pages as necessary)
Name: _____________________________________________________________________________________
Complete Tax Identification Number from the Country where Additional Partner(s)/Principal Officer(s) are
located (list all that apply):_____________________________________________________________________
Date of Birth: _______________________________________________________________________________
Address/City/State/Zip (No P.O. Box, Retail Postal, or Mail Service Center):_____________________________
___________________________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email address: _______________________________________________________________________________
3.
Are you keeping any wildlife inventories in the U.S.? Yes
No
(must check one)
50 CFR 14.93 describes the requirements regarding wildlife inventory.
If yes, provide location of wildlife inventories (list all – use additional pages as necessary):
Name: _____________________________________________________________________________________
Primary Contact Name: _______________________________________________________________________
Address/City/State/Zip (No P.O. Box, Retail Postal or Mail Service Center):______________________________
___________________________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email address: _______________________________________________________________________________
4.
General description of the wildlife or wildlife products you wish to import/export. (Choose all that apply)
Perishable
Live (50 CFR 13.41 requires that wildlife possessed under a license must be maintained under humane and
healthful conditions)
Venomous
Dead
Products (Describe: food, sport hunted trophies, jewelry, footwear, carvings, etc.)_______________
___________________________________________________________________________________
Other (Describe)___________________________________________________________________
5.
Type of animal to be used as described in #4 above. (Choose all that apply)
Fish
Mammals
Coral
Birds
Reptiles
Insects/Arachnids
Amphibians
Molluscs (Shells)
Other_________________________________
Please continue to next page
3-200-3b Revised December 2016
Page 2 of 6
IMPORT/EXPORT LICENSE (Foreign Entities)
APPLICATION CONTINUATION SHEET
6.
Disqualification Factor. An applicant with 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
(must check one)
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 (list all – use additional pages as necessary).
7.
U.S. Agent Designation
An Import/Export Licensee is required to maintain complete and accurate records of any taking, possession,
transportation, sale, purchase, barter, exportation or importation of wildlife for a period of five (5) years from the
date of the expiration of their Import/Export License. Such records shall be kept current and shall include names
and addresses of persons with whom any wildlife has been purchased, sold, bartered, or otherwise transferred, and
the date of such transaction, and other information as may be required or appropriate. Such records shall be
legibly written or reproducible in English. The name, address and telephone number of U.S. Agent must be
complete and accurate and cannot be a retail postal or mail service center.
Name of U.S. Agent __________________________________________________________________________
(This name will show up as c/o on the face of the I/E License)
Date of Birth: _______________________________________________________________________________
Address/City/State/Zip (No P.O. Box, Retail Postal, or Mail Service Center):_____________________________
___________________________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email address: _______________________________________________________________________________
I hereby agree to be U.S. Agent for ____________________________________________________________.
(Printed Name of Applicant Listed on Page 1 of this Application)
I acknowledge the above responsibilities and will comply with the above requirements on behalf of the
applicant.
___________________________________________________________________________________________
Printed Name of U.S. Agent
___________________________________________________________________________________________
Signature of U.S. Agent (No photocopied or stamped signatures)
Date of Signature (mm/dd/yyyy)
NOTE: You must notify the U.S. Fish and Wildlife Service immediately of any change in U.S. Agent
Please continue to next page
3-200-3b Revised December 2016
Page 3 of 6
Office of Law Enforcement Permit Offices
https://www.fws.gov/le/regional-permit-offices.html
Please send your application to the appropriate office.
If foreign applicant’s U.S. Agent is located in the following states, send your application to the address below:
Alabama, Arkansas, Connecticut, District of Columbia, Delaware, Florida, Georgia, Illinois, Indiana, Iowa,
Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New
Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Puerto Rico, Rhode Island, South
Carolina, Tennessee, U.S. Virgin Islands, Vermont, Virginia, West Virginia, Wisconsin
U.S. Fish & Wildlife Service
Office of Law Enforcement
1875 Century Boulevard, Suite 380
Atlanta, GA 30345-3324
Phone: (404) 679-7195
Fax: (404) 679-7065
Email: [email protected]
If foreign applicant’s U.S. Agent is located in the following states, send your application to the address below:
Alaska, Arizona, California, Colorado, Guam, Hawaii, Idaho, Kansas, Montana, Nebraska, Nevada, New
Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyomin,the Pacific Trust
Territories
U.S. Fish & Wildlife Service
Office of Law Enforcement
2800 Cottage Way, W-2928
Sacramento, CA 95825-1846
Phone: (916) 414-6660
Fax: (916) 414-6715
Email: [email protected]
Please continue to next page
3-200-3b Revised December 2016
Page 4 of 6
PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to the Form 3-200-3b that must be completed as an application for a U.S. Fish and Wildlife Service
Import/Export License (Foreign Entities). Reminder: It is a violation to import or export fish and wildlife commercially prior to
obtaining an Import/Export License.
GENERAL INSTRUCTIONS:
Complete all blocks/lines/questions in Sections A through D.
An incomplete application may cause delays in processing or may be returned to the applicant.
Be sure you are completing the appropriate application form for the proposed activity.
o 3-200-3a for U.S. Entities; 3-200-3b for Foreign Entities (U.S. Agent required)
Print clearly or type in the information. Illegible applications may cause delays.
Sign the application. Scans, faxes or copies of the original signature will not be accepted.
No Import/Export License will be issued if any information is missing from the application.
Mail the original application to the appropriate address on the attached address list.
Keep a copy of your completed application.
Allow at least 60 days for your application to be processed. (50 CFR 13.11)
Applications are processed in the order they are received.
COMPLETE SECTION A:
Enter the complete name of the foreign entity who will be the Licensee if an Import/Export License is issued. If no company name
exists, then use the name (Last, First, Middle) of the owner of the business. Enter personal information that identifies the applicant.
Enter the Tax Identification Number issued by your country (if applicable).
The U.S. Agent declared in Question 7 can apply on behalf of the foreign entity and sign the application. The personal information
must pertain to the foreign entity, and a document evidencing the power of attorney must be submitted with the application.
Give a brief description of the type of business in which the applicant is engaged (Taxidermy, Jewelry, Apparel, etc.).
Doing business as (dba): dbas are not accepted. The name on the Import/Export License must match the invoice and other
shipping documents that accompany the shipment to or from the United States.
Principal Officer is the person in charge of the listed business. 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 U.S. Agent who will
answer questions about the application or business activities and can be the preparer of the application.
COMPLETE SECTION B:
This is the foreign address of the applicant, which must match the invoice and other shipping documents that accompany the
shipment to or from the United States. This is not the address that will show up on the I/E License, if issued. The U.S. Agent’s
address will be used to send the I/E License and all other official notices from Service. Your I/E License will read: Foreign Entity
c/o U.S. Agent Name, U.S. Agent Address, City, State, Zip Code.
COMPLETE SECTION C:
Application processing fee:
An application processing fee is required at the time of application. The fee does not guarantee the issuance of an I/E License.
Fees will not be refunded for applications that are approved, abandoned, or denied. We may return fees for withdrawn
applications if no significant processing has occurred.
Federal Fish and Wildlife permits:
List the number(s) of your most recent Import/Export License even if it is no longer valid.
CERTIFICATION:
Either the U.S. Agent (with power of attorney) or the individual identified in Section A as sole owner or Principal Officer
can sign and date the application. 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 the application.
COMPLETE SECTION D:
All questions must be answered. Provide additional pages as necessary.
Question 7 – U.S. Agent declared in this section will be where you will receive all official notices sent from the Service. Your I/E
License will read: Foreign Entity c/o U.S. Agent Name, U.S. Agent Address, City, State, Zip Code.
Please continue to next page
3-200-3b Revised December 2016
Page 5 of 6
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.ecfr.gov/ and https://www.fws.gov/le/laws-regulations.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. Response is not required unless a currently valid Office of Management and Budget (OMB) control number is
displayed on the form.
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 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.
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 Import/Export license application is 1.25 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 Collection Clearance Officer, U.S. Fish and Wildlife Service, MS BPHC, 5275 Leesburg Pike, Falls Church, VA
22041–3803 (mail). Please include “1018-0092” in the subject line of your comments.
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)].
3-200-3b Revised December 2016
Page 6 of 6
File Type | application/pdf |
File Title | Microsoft Word - 3-200-3b IE license application 2016 DRAFT.docx |
Author | slynn |
File Modified | 2016-11-21 |
File Created | 2016-11-21 |