Form 3-200-68 Federal Fish and Wildlife Permit Application Form

OMB Control No. 1018-0022
Expires <>

Department of the Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form

Return to: U.S. Fish and Wildlife Service (USFWS)
or

Type of Activity:

Renewal of a Migratory Bird
or Eagle 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, or institution

4.a. Principal officer Last name

4.b. Principal officer First name

5. Principal officer title

4.d. Suffix

6. Primary contact name

7.a. Business telephone number

C.

4.c. Principal officer Middle name/ initial

7.b. Alternate telephone number

Applicant address

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 [Fee varies. See attached fee schedule.] 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 3-200-68

Rev. 12/2013

Page 1of 6

SECTION E. Renewal of a Migratory Bird or Eagle Permit
(Migratory Bird Treaty Act, 50 CFR 21; Bald and Golden Eagle Protection Act, 50 CFR 22)
Note: You may use this form to request renewal of a Federal migratory bird or eagle permit that is due to expire and is not a
depredation permit or eagle/eagle nest take permit by signing the renewal statement below. (To renew a depredation or
eagle/eagle nest take permit, use forms 3-200-13, 3-200-18, 3-200-71, or 3-200-72 respectively and refer to your permit
number.) You do not need to complete the front of this form (page 1) as long as your renewal request is received by our office
before your permit expires. If we receive your request for renewal at least 30 days prior to the expiration of your permit, you
may continue the activities currently authorized by the permit until the Service has acted on your renewal request (50 CFR
13.22).
If you wish to amend the authorization on your permit or update information submitted with your original application, in addition
to renewing your permit, please specify the changes at the bottom of this form. (If there is a change in any of your personal
information at any time (i.e., changes in your name or business name, address, telephone number, etc.), you are required to notify
your permit office in writing within 10 calendar days of such a change (50 CFR 13.23).)
Regulations at 50 CFR part 13 (General Permit Regulations) and 50 CFR parts 21 or 22 are the Federal regulations governing the
activities authorized by your permit. You are responsible for understanding and complying with these regulations, which were
provided with your initial permit application. If you no longer have these regulations, you can let us know and we will provide
additional copies or you can access them at http://www.fws.gov/permits/ltr/ltr.html.
Instructions: Submit the following to our office: (1) this form, signed, (2) any new information, (3) your application processing
fee (if applicable), and (4) a copy of your current State permit.
I request renewal of my Federal migratory bird (or eagle) permit.
Permittee:______________________________________________________________

My current permit number is MB-

for _______________________
(type of permit)

(Complete address/phone only if you do not complete page 1)
Street/P.O.: ______________________________________________________________
City/State/Zip Code: _______________________________________________________
Telephone number: (________)_____________
Alternate telephone number: (________)_____________
E-mail: __________________________________________________
I certify that the information submitted in support of my original application for the permit indicated above is still current and correct
except as changed previously and as indicated below, and I hereby request renewal of that permit. I understand that any false statement
may subject me to criminal penalties of 18 U.S.C. 1001.
Permittee’s signature (in blue ink):

Date: _______________________
(No photocopied or stamped signatures

Provide a description of changes (i.e., change in principal officer, subpermittees, species or quantity, project, activity or location of
activity, holding facilities, location of facilities, etc.) Attach a separate sheet if necessary. If changes involve a change in location of
activities and/or new facilities, you need to attach a description and photographs or diagrams of the new facilities.

Is your Annual Report attached?

Form 3-200-68



Yes

Rev. 12/2013



No



Not Applicable

Page 2 of 6

Migratory Bird & Eagle Permit
Application Processing Fee Table (50 CFR 13.11(d))1
The fee to process a renewal is the same as the fee to process a new permit.
Application #
Fee2
Amendment Fee2, 3
Permit Type
Import / Export
3-200-6
$75
$0
Scientific Collecting

3-200-7

$100

$50

Taxidermy

3-200-8

$100

$0

Waterfowl Sale/Disposal

3-200-9

$75

$0

Special Purpose-Salvage

3-200-10a

$75

$0

Rehabilitation

3-200-10b

$50

$0

Special Purpose-Education (Live)

3-200-10c

$75

$0

Special Purpose-Education (Dead)

3-200-10d

$75

$0

Special Purpose-Game Bird Propagation

3-200-10e

$75

$0

Special Purpose-Miscellaneous

3-200-10f

$100

$0

Special Purpose-Miscellaneous-Abatement
Activities Using Raptors

3-200-79

$100

$0

Special Purpose – Utility

2-202-81

$100

$0

Raptor Propagation

3-200-12

$100

$0

Depredation – Regular

3-200-13

$100

$50

Depredation – Homeowner

3-200-13

$50

$0

Special Canada Goose

3-200-67

no fee

no fee

Eagle Exhibition

3-200-14

$75

$0

Eagle-Indian Religious

3-200-15

no fee

no fee

Eagle Depredation

3-200-16

$100

$50

Golden Eagle Nest Take for Resource
Development or Recovery

3-200-18

$100

$50

Eagle Take for Indian Religious Purposes

3-200-77

no fee

no fee

Live Eagle Possession for Indian Religious
Purposes

3-200-78

no fee

no fee

Eagle Transport into and out of the U.S.

3-200-82

$75

$0

1

These fees are effective May 11, 2005. The processing fee final rulemaking may be viewed at
http://www.fws.gov/policy/library/2005/05-7127.pdf
2
Federal, Tribal, state, and local government agencies, and individuals and institutions acting on behalf
of such agencies, are exempt from the processing fee. Documentation of fee exempt status is not
required for Federal, State, Tribal or local government agencies but must be supplied by those
applicants acting on behalf of such agencies. 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.
3
A processing fee is required for substantive amendments of certain permit types. A substantive
amendment is one which pertains to the purpose and conditions of the permit and is not purely
administrative. Administrative changes, such as updating name and address information, do not require
a fee.
(9/2010)

Form 3-200-68

Rev. 12/2013

Page 3 of 6

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, and 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://permits.fws.gov/.
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, 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, Tribe, 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 USFWS programs which use foreign addresses and are not required by DMA.

Mailing address is address where communications from USFWS 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.
ALL APPLICANTS COMPLETE SECTION E.

Please continue to next page
Form 3-200-68

Rev. 12/2013

Page 4 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.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), 50CFR 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 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.
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 an 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 a Renewal of a Migratory Bird or Eagle Permit application is 1 hour and 30 minutes for recordkeeping. 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 2.26 – 2.33].

Form 3-200-68

Rev. 12/2013

Page 5 of 6

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]

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]

Alabama, Arkansas, Florida,
Georgia, Kentucky, Louisiana,
Mississippi, North Carolina,
South Carolina, Tennessee,
Virgin Islands, Puerto Rico

P.O. Box 49208
Atlanta, GA 30359

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

Region 3

Region 4

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]

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]

Region 8

California, Nevada

2800 Cottage Way
Room W-2606
Sacramento, CA 95825

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

Region 5

Region 6

Form 3-200-68

Rev. 12/2013

Page 6 of 6