Form 3-200-43 Application - Take/Import/Transport/Export of Marine Mam

	Department of the Interior U.S. Fish and Wildlife Service Federal Fish and Wildlife Permit Application Form		OMB Control No. 1018-0093 Expires ##/##/####
Return to: U.S. Fish and Wildlife Service Division of Management Authority (DMA) Branch of Permits, MS: IA 5275 Leesburg Pike Falls Church, VA 22041-3803 1-800-358-2104 or 703-358-2104		Type of Activity: Take/Import/Export of Marine Mammals for Public Display, Scientific Research, Enhancement, or Rescue/Rehabilitation/Release Activities or Renewal/Amendment of Existing Permit (MMPA and/or ESA) Requesting Renewal/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. Telephone number	3.a. Alternate telephone number	4. 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) (If Broker or Taxidermist is applying on behalf of a foreign national, provide Broker or Taxidermist’s name and address in this block; U.S. hunters must provide their U.S. address)
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 listed on page 3, nonrefundable processing fee. 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.		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 applicant/Principal Officer for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)

Please continue to next page

5. Take/Import/Export of Marine Mammals for Public Display, Scientific Research, Enhancement, or Rescue/Rehabilitation/Release Activities or Renewal/Amendment of Existing Permit (MMPA and/or ESA)

Allow at least 90 days for the application to be processed. Applications for marine mammal permits must be published in the Federal Register for a 30-day public comment period.

Use this application for the take¹, import, export, or re-export of marine mammal species (or their parts) under the jurisdiction of the U.S. Fish & Wildlife Service (sea otters, marine otter, polar bears, walrus, manatees, and dugong; see http://www.fws.gov/international/pdf/factsheet-marine-mammal-policy-2013.pdf) for purposes of public display of live animals, scientific research, or enhancement under the U.S. Marine Mammal Protection Act (MMPA) and/or U.S. Endangered Species Act (ESA). This application may also be used to apply for a letter of authorization (LOA) under MMPA Sections 109(h)/112(c) and/or an ESA permit for enhancement of propagation or survival of the species, which would provide authorization to work as a “cooperator” for the purpose(s) of rescue, rehabilitation, and/or release of stranded marine mammals. Finally, this application may be used for the renewal and/or amendment of an existing permit for these activities.

Note: Renewal and amendment requests require responses to all questions pertaining to your requested activity.

This form should NOT be used for:

• If you are seeking a permit for activities involving marine mammals under jurisdiction of the National Marine Fisheries Service (NMFS) (i.e., whales, dolphins, porpoises, seals, and sea lions), please contact NMFS at http://www.nmfs.noaa.gov/pr/permits.

• For activities involving photography in the wild for educational or commercial purposes, use Form 3-200-86.

• For transport/transfer of live captive-held animals within the United States, use Form 3-200-87.

• For transfer within the United States of dead marine mammal specimens for the purpose of public display or scientific research, use Form 3-200-87.

If you already have MMPA/ESA authorization and need a CITES permit:

• For CITES export/re-export of captive-held LIVE animals, use Form 3-200-53.

• For, export, or re-export of parts or biological samples, use Form 3-200-29; for import of parts of Appendix-I animals, use Form 3-200-37; and for introduction from the sea, use Form 3-200-31.

• Provide a copy of your FWS or NOAA Fisheries permit or authorization with your CITES permit application.

All international shipment(s) must be through a designated port. 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 the Office of Law Enforcement for a Designated Port Exemption Permit (form 3-200-2).

Permit Types and Processing Fees

Please review the complete application carefully before beginning. Provide complete answers to all the questions in the sections relevant to the activity for which you are requesting authorization. If a question is not applicable, answer with “N/A.” You will need to use additional sheets of paper. On all attachments or separate sheets you submit, indicate the application question number you are addressing. If you are applying for multiple species and/or activities, be sure to indicate which species/activity(ies) you are addressing in each response.

Electronic submission of inventories, photographs, and receipts: Some applications contain extensive inventories and /or a large number of photographs or receipts. You may provide electronic versions of the documents. Such a submission will assist in the processing of your application since it may reduce data entry by the U.S. Fish and Wildlife Service. If you wish to provide information electronically, please either include a disk containing your information or, once you have received an application number via the e-mailed acknowledgement letter, e-mail your information to [email protected]. Be sure to include the application number provided in the acknowledgement e-mail that will be sent to you when we receive your application.

_____ I will be submitting documents electronically.

PURPOSE for which you are applying (check below):

___PUBLIC DISPLAY of live animals (Processing Fee = $300): Complete All of Part I and Part II.

NOTE: A public display permit is not available for marine mammal species listed as depleted under the MMPA or listed under the ESA; a public display permit may be valid for the life of an animal and is not renewable; a public display permit may be available for a facility that would hold multiple animals of a particular species and would be renewable every 5 years.

___SCIENTIFIC RESEARCH (Processing Fee = $150): Complete All of Part I and Part III.

___RESCUE, REHABILITATION, and/or RELEASE of stranded marine mammals (Processing Fee = $150): Complete questions 1-7 of Part I and Part IV.

___MMPA ENHANCEMENT of survival or recovery of the species or stock (Processing Fee = $150): Complete Part I and Part V.

Request is for (check below):

___NEW PERMIT (See processing fee above).

___RENEWAL of Permit # __________ (See processing fee above; Complete all questions for your requested activity, as described above).

___AMENDMENT of Permit # ____________ (For Scientific Research, Rescue/Rehabilitation/Release, or MMPA enhancement, amendment fee = $75, and for Public Display = $150).

b. If requesting renewal or amendment of your current permit, provide an update of any activity that has occurred under the permit since your last report.

_________________________________________________________________________________

Part 1.

1. Name and address where you wish the permit to be mailed, if different from page 1. If you would like expedited shipping, please enclose a self-addressed, pre-paid, computer-generated, courier service airway bill. If unspecified, all documents will be mailed via the U.S. Postal Service.

2. Whom should we contact if we have questions about the application (name, phone number, and e-mail)?

3. Have you or any of the owners of the business (if applying as a business, corporation, or institution), been assessed a civil penalty or convicted of any criminal provision of any statute or regulation relating to the activity for which the application is filed; been convicted, or entered 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; forfeited collateral; OR are currently under charges for any violation of the laws mentioned above?

No Yes

If you answered “Yes” to Question 3, 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. Please be aware that a “Yes” response does not automatically disqualify you from getting a permit.

4. List the scientific name (genus, species, and, if applicable, subspecies), and common name of each species for which you are applying.

5. Provide a copy of any other applicable Federal, local, or state permissions (e.g., National Wildlife Refuge Special Use Permit, NOAA National Marine Sanctuary permit, etc.) required to conduct your proposed work, OR indicate whether you have applied for, secured, or will apply for such permissions (please provide contact information).

6. Is (are) the species or population stock for which you applying listed under the U.S. Endangered Species Act (ESA), a species proposed for listing, or a candidate species?

___NO ___YES; complete a-d, below.

1. Attach a justification for taking an ESA-listed species, and explain why your proposed activities are not appropriate for a similar non-ESA-listed species;

2. Describe both the short- and long-term anticipated effects of each of your activities alone or cumulatively on the behavior and physiology of the target animals and critical habitat or proposed critical habitat for the species.

3. Describe how the animals will react to your actions and the consequences of those reactions.

4. Identify how you would mitigate any potential negative effects.

6. Do you plan to conduct activities with MARINE MAMMALS IN THEIR NATURAL ENVIRONMENT (i.e., in the wild) where “non-target” marine mammal and ESA-listed species occur in the United States? (“Non-target” species are species that are not the subject of your activities.)

___NO ___YES; We will need to assess impacts to marine mammal and ESA-listed species that are not the subject of your activities; therefore, provide responses to a-c, below:

1. A list of all non-target marine mammal (http://www.nmfs.noaa.gov/pr/species/mammals/) and ESA-listed (http://www.fws.gov/endangered/) species that might occur in your project area or might be affected by your activities;

2. The maximum number of animals of each non-target marine mammal and ESA-listed species (# per species) that might be harassed by your activities, the precautions that you will take to minimize the likelihood that harassment will occur, and the actions that you will take should harassment occur; and

3. The maximum number of animals of each non-target marine mammal and ESA-listed species (# per species) that might be taken (e.g., killed, injured, feeding activities disrupted, etc.) by your activities, your precautions to minimize the likelihood that take will occur, and your actions should take occur.

(Note: The following link provides access to resources that might be useful to you in gathering the required information to answer this question, including links to FWS and NMFS offices responsible for managing marine mammals stocks, and Stock Assessment Reports, which provide population status information on marine mammal stocks: https://www.fws.gov/ecological-services/species/marine-mammals.html).

6. Do you plan to conduct your public display, research, or MMPA enhancement activities with MARINE MAMMALS that are CURRENTLY HELD IN A CAPTIVE ENVIRONMENT (including, but not limited to import into the U.S. of captive-held live animals/specimens)

___NO ___YES; specify the number of captive individuals for each species of interest: __________; and for each individual animal of each species of interest, respond to a-i, below.

Note: You may provide the information in tabular form, as in the example below:

a. Species	b. Sex	c. Birth date	d. Description (e.g., ID #, ISIS #, transponder #, tattoo #)	e. Country of origin	f. Source (i.e., wild, captive-born, or captive-bred)	g. Current location of animal
Example: Enhydra lutris kenyoni	Female	Approx. 04/09/2010	House # XXX123 Transponder # 45678	USA	wild	ABC Aquarium, Anchorage Alaska

h. For captive-born or captive-bred animal(s), provide a breeder’s statement, ARKS/ZIMS specimen report, or other information that documents the animal was born in captivity, location of birth, and information on the source of the parental stock (e.g., captive-born, wild).

i. For captive-held animal(s) already taken from the wild, provide:

1. Information (e.g., ARKS/ZIMS specimen report(s)) on the source of the animal, including when the animal was removed from the wild, by whom, and the location.

2. A copy of the MMPA permit or LOA under which the animal is currently being held in captivity or a copy of the MMPA permit or authorization authorizing removal of the animal from the wild.

3. Has the U.S Fish and Wildlife Service deemed the animal(s) non-releasable to the wild?

___YES; provide a copy of the official letter confirming the animal’s non-releasable status.

___NO; if you are requesting to have the animal(s) deemed non-releasable at this time, provide an explanation of the following: a) why release of the animal to the wild will not likely be successful given its physical condition; b) why release of the animal to the wild will not likely be successful given its behavior including adverse interactions with humans or marine mammals; or c) why release of the animal to the wild may jeopardize the wild population of the species.

6. For animal(s) to be taken from the wild and brought into a captive environment for public display, research, or MMPA enhancement activities, provide for each species:

1. Information on the actual or proposed date(s) and location(s) of collection;

2. The numbers of animals of each age class and sex to be taken from the wild (include a definition of each of these age classes by range of # months and/or years).

3. An estimate of the species’ population stock in the wild; Note: stock assessment reports might assist you with this information and are available at the following FWS field offices, depending on the species involved:

Southern sea otter: Ventura Fish and Wildlife Office -  https://www.fws.gov/ventura/endangered/species/info/sso.html

Northern sea otter: Washington Fish and Wildlife Office - https://www.fws.gov/wafwo/sea_otters.html

Northern sea otter, walrus, polar bear: Marine Mammals Management, AK - https://www.fws.gov/alaska/fisheries/mmm/reports.htm

Manatee: North Florida Ecological Service Office - https://www.fws.gov/northflorida/Manatee/manatees.htm

4. A description of the efforts made to acquire captive-held animals, in lieu of taking animals from the wild.

(Note: for holding and maintaining animals you must also provide the information requested in question 14.)

6. Are you requesting to CAPTURE LIVE marine mammals in the wild? (i.e., for research, public display, or MMPA enhancement)

___NO ___YES; specify the number of individuals to be captured for each species of interest: __________; and provide a – i, below:

1. A description of the manner in which the animal will be captured, type of gear used, and deployment method (e.g., from shore or boat approach and net deployment).

2. Methods of restraint and holding, including dimensions/type of holding container, if used;

3. The holding time required prior to transport or release of the animal;

4. Number and roles of personnel participating in the captures;

5. Duration of restraint/holding from capture to release; and

6. The number of non-target individual animals of the target species that will be incidentally harassed during capture activities, and precautions you will take to minimize incidental harassment of non-target animals;

7. If capturing females with calves/pups/cubs, describe:

1. How calves/pup/cubs will be held;

2. Which procedures will be conducted on them;

3. The duration of time the pair will be separated; and

4. Procedures used to reunite the pair, and if they do not reunite, explain the disposition of the calf/pup/cub.

8. A description of the use of drugs during capture, including:

1. Name of each drug/chemical used, its dosage rate (ml/kg), method of administration (IV, IM, SQ, topical and whether remotely-deployed IM), and purpose of the drug;

2. Duration of drug and required holding time;

3. The names of the personnel who would administer the drugs;

4. Provisions to minimize adverse reaction(s), including the use of appropriate drug reversals;

5. Procedures to be used to minimize the chance that drugged animals will escape or enter the water prior to complete immobilization; and

6. Measures to be taken to ensure that the animal is fully recovered prior to release.

9. What emergency procedures would be employed (e.g., drugs, bagging, CPR, etc.) in the event that an animal’s condition starts deteriorating during capture activities?

6. Are you requesting to IMPORT LIVE marine mammals?

___NO ___YES; specify the number of individuals to be imported for each species of interest: __________; and provide a – m, below:

1. The proposed date of import;

2. The name and address of the foreign exporter, including the country of export;

3. For wild-sourced animal(s), a description of the manner in which it was taken from the wild and a copy of the foreign collecting/capture authorization(s);

4. The age (approximate or known) of the animal at the time of removal from wild or from its mother;

5. The age (approximate or known) of the animal at time of weaning; and

6. For females, respond to i & ii, below:

1. At the time of removal from the wild, was the female pregnant? ___NO ___YES

2. At the time of the proposed import, will the female be pregnant? ___NO ___YES

7. A description of the means and duration of the transportation used to move and import the animals;

8. A description of the type, size, and construction of all shipping containers used to transport the animals;

9. A description of the arrangements for watering or otherwise caring for the animals during transport;

10. A description of the qualifications of each person accompanying the animal that demonstrates their ability to address the animal’s needs during transport;

11. A copy of the transport plan;

12. Quarantine plans, including location and time-frame; and

13. Any additional documentation showing compliance with U.S. Department of Agriculture (USDA) regulations for transport and care of live marine mammals (7 U.S.C. 2131-2159; 9 CFR 3, Part E).

NOTE: A separate CITES permit will be required from our office prior to the import of CITES Appendix I species (https://www.speciesplus.net).

6. Are you requesting to IMPORT PARTS/SPECIMENS of/from marine mammals?

___NO ___YES; provide a – m, below:

1. The proposed date of import;

2. The name and address of the foreign exporter, including the country of export;

3. The current location of the specimens;

4. The country of origin of the animals from which the specimens were/will be collected;

5. List the number of animals by species, age class/life stage, and sex from which parts/samples are sought. If you are requesting opportunistic sample import, you may request an unlimited number of samples from a specified number of animals, by taxa (e.g., unlimited samples from up to 100 polar bears annually).

6. The types of specimens to be imported (e.g., blood, skin biopsy, carcasses, etc.) and number of each type from each animal;

7. The source of the specimens to be imported (wild, captive-bred, or captive born);

8. Were the animals/will the animals be alive or dead at the time of sample collection? ___DEAD ___ LIVE

9. Provide a detailed description of the source of the specimens to be imported and the manner in which the sample was/will be taken or collected. For example, this might include the following sources:

1. Animals in captivity (samples taken during routine husbandry procedures or under separate authorization; distinguish between permanently captive in public display or research facility or temporarily captive in rehabilitation facility);

2. Animals in foreign countries stranded alive or dead or that died during rehabilitation;

3. Animals killed during legal subsistence harvests;

4. Animals killed incidental to legal commercial fishing operations;

5. Samples from other authorized researchers or collections;

6. Soft or hard parts that are sloughed, excreted, or discharged naturally.

10. Provide a copy of the foreign collecting/capture authorization(s) (if not required, indicate “not required”);

11. If importing samples from subsistence-hunted marine mammals in foreign countries, describe the subsistence method. Include documentation, if available, that verifies that the taking was/will be conducted in a humane manner (i.e., using the method that involves the least possible degree of pain and suffering);

12. If importing samples from live animals, describe how the samples were/will be collected, including animal handling and sample collection protocols. This should include a description of how the take was humane; and

13. Describe how the specimens will be preserved, shipped, and stored/curated.

NOTE: A separate CITES permit will be required from our office prior to the import of specimens of CITES Appendix I species (https://www.speciesplus.net).

6. Are you requesting to EXPORT or RE-EXPORT PARTS/SPECIMENS of/from marine mammals?

___NO ___YES; provide a – e, below:

1. The types of specimens and quantity of each to be exported/re-exported;

2. The complete name and address of person/facility receiving the specimen(s);

3. A description of the origin of the specimens to be exported/re-exported;

4. The name(s) of the facility/institution that currently holds the specimens; and

5. Whether a portion of the specimen will need to be re-imported following export/re-export.

NOTE: A separate CITES permit will be required from our office prior to the export/re-export (https://www.speciesplus.net).

6. Are you a facility requesting MAINTENANCE of LIVE ANIMALS (i.e., holding and caring for animals) for public display, research or MMPA enhancement activities?

___NO ___YES; specify the number of individuals to be held for each species of interest, ____________________, and provide a – h, below:

1. A complete description, including photographs and/or diagrams (no blueprints), of the area and facilities where the animals will be held (including the dimensions of pools and haul-out areas);

2. The number of animals of the same species (include age and sex) presently maintained at the facilities and information indicating whether there is space for additional animals without exceeding USDA/Animal and Plant Health Inspection Service (APHIS) limits (i.e., provide the maximum # of animals of each species that could be held).

3. A list of all animal caretakers and a description of their specific duties/responsibilities;

4. A description of the animal caretakers’ experience in the care, handling, and maintenance of the marine mammal species that is/are the subject of this application and copies of curriculum vitae (CVs) that demonstrate such experience for each caretaker;

5. A description of specific State requirements regarding who (e.g., attending veterinarians, vet technicians, researchers) may handle and administer certain drugs;

6. A list of all marine mammals under the jurisdiction of FWS maintained at the facility (specify whether they are held in the same exhibit/holding area as the target animals will be held and maintained);

7. A description of all deaths of FWS-jurisdiction marine mammal species at the facility within the past five years and the steps taken to prevent or decrease similar mortalities;

8. A copy of the facility’s USDA/APHIS, Animal Welfare Act (AWA) license and the most recent APHIS inspection report.

6. If you are a facility requesting maintenance of live animals for which the primary purpose is scientific research, or enhancement of survival or recovery of the species, are you seeking approval to publicly display the subject animals?

___NO ___YES; in a-c, below, provide information to show that:

a. The facility is open to the general public without limitations or restrictions (other than by the charging of an admission fee);

b. The facility offers a program for education or conservation purposes that is based on professionally recognized standards of the public display community; and

3. Such display will not interfere with attainment of the objectives of the permitted/authorized activity.

Part II.

For Public Display

6. For U.S. facilities, provide information to show that the facility:

   1. Is open to the general public without limitations or restrictions (other than by the charging of an admission fee);

   2. Offers a program for education or conservation purposes that is based on professionally recognized standards of the public display community (include copies of outreach/educational materials and photos of signage); and

   3. Is registered or holds a license issued by the USDA Animal and Plant Health Inspection Service (APHIS) under the Animal Welfare Act (AWA).

Part III.

For Scientific Research

6. Explain how the proposed research meets the MMPA definition of “bona fide research,” i.e., scientific research on marine mammals, the results of which: (A) are likely to be accepted for publication in a refereed scientific journal; (B) are likely to contribute to the basic knowledge of marine mammal biology or ecology; or (C) are likely to identify, evaluate, or resolve conservation problems.

6. Provide a detailed description of the proposed project. You may attach a formal research proposal, provided it includes all the requested information, including:

1. Objectives and hypotheses and associated methodology;

2. Background information discussing relevant published literature on the subject of your proposal, with citations;

3. An explanation of how this study is different from, builds upon, or duplicates past research;

4. An explanation of how you determined your sample size/take numbers (e.g., based on previous encounter rates or abundance estimates for the study area). If appropriate for your study, include a power analysis or other sample size estimation to show whether the sample size is sufficient to provide statistically significant or otherwise robust results appropriate for your study;

5. If proposing novel procedures, include a discussion on results from pilot studies or studies on other species, if available; and

6. Disposition of animals or remaining specimen material once your project is complete.

6. Provide the expected research schedule (clearly specify the proposed start date and end date of your research or field season(s) and overall duration of the project). Include the months of the year and frequency of fieldwork/sampling (e.g., number of times per year). If your research extends beyond five years, or is a continuation of previously authorized research, give information about when the research began and when you expect it to end.

6. Indicate which research procedures/activities you will be conducting that will or might result in TAKE or HARASSMENT of TARGET species, and describe each activity in detail, including the information indicated in a-i, below.

Level A harassment means any act of pursuit, torment, or annoyance, which has the potential to injure a marine mammal or marine mammal stock in the wild.

Level B harassment means any act of pursuit, torment, or annoyance, which has the potential to disturb a marine mammal or marine mammal stock in the wild by causing disruption of behavioral patterns, including, but not limited to, migration, breathing, nursing, breeding, feeding, or sheltering.

Take, as defined by the MMPA means to harass, hunt, capture, or kill, or attempt to harass, hunt, capture, or kill any marine mammal.

___ a. Administration of drugs (including emergency drugs and prophylactic antibiotic use) or other substances (e.g., stable isotopes); include i-vii, below, in your activity description:

1. Name of each drug/chemical used, its dosage rate (ml/kg), method of administration (IV, IM, SQ, topical and whether remotely-deployed IM), and purpose of the drug;

2. Duration of drug and required holding time;

3. The names of the personnel who would administer the drugs;

4. A description of specific State requirements regarding who (e.g., attending veterinarians, vet technicians, researchers) may handle and administer certain drugs;

5. Provisions to minimize adverse reaction(s), including the use of appropriate drug reversals;

6. Procedures to be used to minimize the chance that drugged animals will escape prior to complete immobilization; and

7. Measures to be taken to ensure that the animal is fully recovered prior to release.

___ b. Aerial and vessel surveys (manned); include i-v, below, in your activity description:

1. Type of survey craft and vessel;

2. Type of survey (e.g., line transect, photogrammetry);

3. Number of surveys per year;

4. Minimum and maximum altitude/approach distance; and

5. Duration spent with group or individual per day.

___ c. Aerial surveys using unmanned aircraft systems (UAS); include i-xii, below, in your activity description:

1. Dimensions, mass, and battery life of UAS;

2. Will the UAS ever be beyond the line of sight?

3. Does the device have an auto-return feature should the device fail?

4. Ground control station description (what it is, where it will be located, e.g., on shore or on vessel, number of stations, and how close the station will be to animals);

5. Spotter roles (e.g., one spotter monitoring the UAS, another for monitoring the ground control station);

6. Do you have the appropriate FAA permits/authorizations (including pilot licenses)?

7. Type of survey (e.g., line transect, photogrammetry);

8. Number of surveys per year;

9. Minimum and maximum altitude/approach distance;

10. Duration spent with group or individual per day;

11. The names of the personnel who will pilot the aircraft, and

12. Mitigation measures you will use to minimize disturbance including specific measures you will use to avoid separating female-calf/pup/cub pairs, and measures to ensure the UAS will not collide or crash into any of the animals.

___ d. Capture and restraint; if you will be capturing animals, ensure that you have completed question 10, above.

___ e. Instrumentation, Marking, and Tagging (MTI); include i-x, below, in your activity description:

1. The type of MTI (including dimensions and mass);

2. The maximum number and total mass of MTIs to be attached to/implanted in an animal at a given time;

3. The maximum dart penetration depth if MTI is attached via darts;

4. Methods and location of attachment, including minimum approach distance for remote MTI attachment;

5. If surgeries for implantable tags are being conducted, specify who will be conducting them, where (in the field or in a facility), and if antibiotic prophylactics will be administered;

6. The maximum number of times an animal would be fitted with MTIs in a given year;

7. Will recapture be necessary (if so, how many times will animals be captured annually), would the instrument/tag have a release mechanism, or would the instrument/tag fall off?

8. Have the proposed MTIs been used previously on this species?

9. What are the potential adverse effects and the means of monitoring new MTIs for adverse effects?

10. What actions will be taken in the event that the MTI has a significant adverse impact on the animal(s), and what is the method of animal release from the MTI?

___ f. Intrusive sampling (e.g., blood, blubber, muscle, skin); include i-xiii below, in your activity description:

1. Will sampling be remote or under restraint?

2. Will local anesthetics be administered?

3. Type of tissues sampled;

4. Size or volume of sample (diameter and depth or total volume);

5. Target sampling location on body;

6. Maximum number of samples per animal per day and per year;

7. Sampling intervals (e.g., for serial blood or biopsy samples);

8. Collection method and equipment/materials used (e.g., dart fired from rifle, dart depth, sterilization/disinfection);

9. If remote, what is the minimum approach distance?

10. If restrained, describe treatment of site of sample collection (e.g., cleansing, wound left open or closed);

11. Number of attempts per animal per day (include total number of attempts needed for all work if requesting multiple procedures (e.g., remote tagging and biopsy) on same animal on the same day);

12. The names of the personnel who will conduct the sampling; and

13. Sample preservation and analysis.

___ g. Non-intrusive sampling (e.g., behavioral observations via focal follows and ground surveys, scat collection, passive acoustic monitoring and recording, photo-ID, photogrammetry, remote video monitoring, underwater photography); include i-vi, below, in your activity description:

1. Approach, sampling methods, and platform type;

2. Minimum and maximum approach distance (specify different distances for each deployment method);

3. Are researchers within sight of animals or not (e.g., from a blind)?

4. Frequency of observations/sampling;

5. Duration of observations/sampling per day; and

6. If conducting underwater photography/videography, specify the method (e.g., snorkeling, underwater pole cam, or divers using typical gear or rebreathers) and number of people in the water at a given time, including the safety diver/snorkeler.

___ h. Testing methodologies on captive-held animals; include i-iii, below, in your activity description:

1. A description of the methodologies and equipment to be used;

2. Duration and times of testing and data analyses; and

3. Methods used to decondition the animals that will be released to the wild after testing.

___ i. Other procedures/activities; list each additional procedure/activity and provide a detailed description of each, including all appropriate mitigation measures (note, we might contact you with follow-up clarification of methodologies), novel procedures, and any procedures involving active acoustic or hearing studies)_______________________________________________________________________________.

21. For each procedure/activity, provide the information in a-j, below, including the maximum number of animals of each species expected to be taken by the procedure annually, broken down by sex and age class; the number of takes per animal per year; and an estimate of the number of animals of the study species that might be incidentally harassed (i.e.,# of non-target animals of your study species that might be harassed by your activities). Also, include the time-periods and specific locations of the takes. This information may be provided in table format such as:

a. Species	b. Procedure/ Activity	c. Level A or Level B Harassment* or other Take**	d. Age Class (see question 23, below)	e. Sex	f. Max. # Animals Per Year	g. Max. # Takes Per Animal Per Year	h. Max. # non-target conspecifics incidentally harassed	i. Time-period	j. Location

* Level A harassment means any act of pursuit, torment, or annoyance which has the potential to injure a marine mammal or marine mammal stock in the wild. Level B harassment means any act of pursuit, torment, or annoyance which has the potential to disturb a marine mammal or marine mammal stock in the wild by causing disruption of behavioral patterns, including, but not limited to, migration, breathing, nursing, breeding, feeding, or sheltering.

**Take, as defined by the MMPA means to harass, hunt, capture, or kill, or attempt to harass, hunt, capture, or kill any marine mammal.

21. Will any female-pup/calf/cub pairs be targeted for any of the proposed research activities? If so, describe how you would minimize impacts on pups/calves/cubs and associated females during each of those activities.

21. Define each age class listed in your response to question 21(d), above, for each species (i.e., list the range of months or years (or mass for otters) constituting each age class); provide the minimum age (or mass) that animals will be targeted for take activities; and indicate whether females with calves/pups/cubs less than that minimum age will be targeted for take activities?

21. Describe the precautions that will be taken to minimize the likelihood that harassment of non-target individuals of the study species will occur and the actions that will be taken should harassment occur.

21. Explain how you determined that your methods involve the least possible degree of pain and suffering and why there are no feasible alternative methods to obtain the desired data or results.

21. Provide: a) an estimate of the possible number of unintentional deaths or serious injuries that might result from your research activities; b) the number of unintentional and intentional (via euthanasia for humane purposes if an animal is seriously injured) deaths or serious injuries you seek approval for annually; c) the steps you will take to reduce the likelihood of deaths or injuries; and d) if euthanasia might occur, provide the method of euthanasia (e.g., gunshot, drug, etc.) and who would conduct the euthanasia procedure.

21. In the event of a death, will a necropsy be conducted on the animal?

___NO ___YES

21. If a female animal accompanied by calf/pup/cub(s) dies during research activities, specify the disposition of the associated calf/pup/cub(s).

21. If biological samples are to be collected or received domestically, provide responses to a through m, below, for each individual animal per species. This information, or part of the information, may be provided in table format such as the table below. (Note: if your only proposed activity is to transfer dead marine mammal specimens for purposes of public display or scientific research, complete application # 3-200-87).

a. Species	b. ID #	c. Sex	d. Source (Wild or Captive/ Live or Dead)	e. Birth Date or age class	f. Type of Samples (blood, tissue, DNA)	g. Number of animals sampled annually	h. Number of times each animal will be sampled annually	i. Packaging and Preservation of samples	j. Use/ Disposition of Samples

11. Provide a detailed description of the source of the specimens, including the circumstances under which the animals were/will be taken. For example, this might include the following sources:

    1. Animals stranded alive or dead;

    2. Animals killed during legal subsistence harvests;

    3. Animals killed incidental to legal commercial fishing operations;

    4. Samples from other authorized researchers or collections;

    5. Soft or hard parts that are sloughed, excreted, or discharged naturally;

    6. Samples that will be/were intrusively collected from captive-held animals;

    7. Samples that will /were collected from wild animals.

12. If collecting samples from live animals, describe how the samples were/will be collected, including animal handling and sample collection protocols.

13. For samples received domestically from U.S. permitted researchers, include the researcher’s name, affiliation, and permit number under which samples will be/were collected.

(Note: if samples are to be imported, you must answer question 12, above).

21. Provide a list of all personnel that will be involved in the project, identifying each as either a principal investigator or co-investigator, their project duties/responsibilities, and a brief description or CV that demonstrates their experience and expertise to perform their designated duties, including knowledge of the marine mammal species that is/are the subject of this application.

21. Describe how you will collaborate or coordinate with other researchers in your study area. Who are they? Explain how this will occur and how it will minimize negative impacts on the species. For example, will it involve sharing resources, samples or data; timing surveys to minimize disturbance, etc.?

21. If you intend to conduct research on animals in a captive-holding facility such as a zoo or aquarium, provide documentation showing that the facility(ies) has authorized you to conduct your proposed activities.

21. Animal Welfare Act (AWA) Compliance (for research on live animals only): AWA requirements apply to all research facilities, which include institutions, organizations, or people that use or intend to use LIVE animals in research, tests, or experiments; AND, that receive funds under a grant, award, loan, or contract from a department, agency, or instrumentality of the U.S. for the purpose of carrying out research, tests, or experiments, or acquires or transports the animals in commerce. Provide the following documentation:

1. Registration under the AWA as a research facility:

   1. Attach a copy of your APHIS certificate of registration as a research facility, or for Federal facilities, a letter from your Institutional Officer that you are compliant with applicable requirements for scientific research under the AWA; OR

   2. If your facility does/will not conduct activities requiring registration under the AWA, attach a letter from APHIS confirming that registration is not required.

2. Institutional Animal Care and Use Committee (IACUC) documentation: If your facility is registered as a research facility under the AWA or is a Federal research facility (see a.i), attach the applicable IACUC documentation from the list in i-iii, below. Please note that all activities that involve an invasive procedure, harm, or materially alter the behavior of an animal under study, even if the activities are carried out in the field, are subject to IACUC review and approval. See AWA regulations and standards for definition/explanation of covered research activities. (https://www.aphis.usda.gov/animal_welfare/downloads/Animal%20Care%20Blue%20Book%20-%202013%20-%20FINAL.pdf):

   1. Attach a copy of your final protocols with the IACUC signed approval; OR

   2. Attach a copy of your proposed protocols to be reviewed by your IACUC along with an explanation as to how and when the protocols will be reviewed (Note: A copy of your final signed protocols and certification will be required prior to permit issuance.); OR

   3. Attach the IACUC determination that your research activities are not subject to IACUC review and approval.

3. If your facility is not registered as a research facility under the AWA, please provide an explanation of how your take activities are reviewed and monitored to assure that the proposed takes are humane (i.e., using the method that involves the least possible degree of pain and suffering).

Part IV.

For Rescue, Rehabilitation, and/or release of stranded² Marine Mammals

Marine mammals may be captured from the wild by duly authorized U.S. Fish and Wildlife Service personnel or authorized cooperators for the protection or welfare of the marine mammal or for the protection of public health and welfare and held at cooperating authorized facilities. This section of the application is for those parties interested in applying for a letter of authorization (LOA) under MMPA Sections 109(h)/112(c). Parties interested in rescue, rehabilitation, and release activities involving ESA-listed marine mammals would also use this section of the application to apply for an accompanying ESA permit for enhancement of propagation or survival of the species OR to apply as a “sub-permittee” working under the authority of an ESA permit held by different organization or agency. Authorized “sub-permittees” would be responsible for coordinating their activities with the designated ESA permit-holder (i.e., “Permittee”) and would be required to comply with the conditions of that permit. Each authorized party’s MMPA LOA will document the ESA permit number associated with that LOA, whether the party is a sub-permittee or the Permittee on the ESA permit.

The MMPA LOA or, for ESA-listed species, the combined MMPA LOA and ESA permit would provide authorization for individuals or institutions to work as “cooperators” for the purpose(s) of rescue, rehabilitation, and/or release of stranded marine mammals. Marine mammal rescues are dangerous activities that require trained staff, specialized equipment, and clear communication among stranding partners. The U.S. Fish and Wildlife Service provides opportunities for different levels of involvement for approved cooperators: verifiers, rescuers, transporters, critical care facilities, and rehabilitation/holding facilities. These roles are defined in question 37, below.

21. Are you/your organization currently conducting research activities with marine mammals?

___NO ___YES; provide the permit number under which you are conducting research_____________.

21. What type of authorization are you requesting (check all that apply)?

___ LOA under MMPA Sections 109(h)/112(c)

___ ESA permit for enhancement of propagation or survival of the species

___ Sub-permittee under ESA permit #___________________.

21. What type of stranding event are you requesting to respond as a cooperator for a U.S. Fish and Wildlife Service marine mammal rescue, rehabilitation, and release program?

___ OIL SPILL EVENTS

___ OTHER CONTAMINANT SPILL EVENTS; SPECIFY TYPES__________________________________.

___ OTHER STRANDING EVENTS

21. Indicate at which level(s) of responsibility the cooperator will participate (Check all that apply, and respond to the questions below).

___ VERIFIER: The role of verifiers is limited to answering requests to provide physical verification of the condition of reported live, distressed animals and communicating the location and status of an animal to the appropriate person(s), including the rescue program coordinator and, if so directed, the nearest approved rescue facility. In most cases verifiers are required to stay with the animal until an approved rescue and transport team arrives. No physical interaction with animals is authorized under this designation. Verifiers may handle animals only under the guidance of an onsite designated rescue team(s).

1. Describe your organization’s experience in verifying the condition of reported live, distressed or injured animals of each species requested (e.g., years of experience, number of responses, etc.).

2. Describe the qualifications of each of your staff who would be serving as a verifier in your organization that demonstrates their ability to verify the condition of reported, live, distressed animals of each species requested (including any work and/or volunteer experience that describes where, with what authorized organization, approximate number of hours, approximate number of verifications, and other relevant experience). Resumes, curriculum vitae (CV), and other supporting documents may be used to describe qualifications, including experience with the marine mammal species (or another similar marine mammal species) that is/are the subject of this application.

3. List and describe any specialized training that your staff have completed to perform this duty, including where and when the training occurred, which organization provided the training, types of training, and other relevant information.

4. Describe numbers and types of: a) vehicles (cars, trucks, boats, etc.) that will be used to travel to/from locations of reported, live, distressed animals; b) communications devices that will be used to communicate with rescue responders (phones, radios, etc.); and c) any other related equipment.

5. Provide a statement that you will be available to respond to reports of live, distressed animals of the subject species when needed.

___ RESCUER: Rescuers respond to reports of injured and/or distressed animals and can initiate hands-on rescue and transport efforts as needed. This level of involvement requires substantial expertise and training in species-specific rescue techniques. Rescuers must meet U.S Department of Agriculture (USDA) standards for Humane Handling, Care, Treatment, and Transportation of Marine Mammals when rescuing live animals.

1. Describe your organization’s experience in rescuing distressed or injured animals of each species requested (e.g., years of experience, number of rescues, etc.).

2. Describe the qualifications of each of your staff who would be serving as a rescuer in your organization that demonstrates their ability to rescue distressed animals of the subject species (including any work and/or volunteer experience that describes where, with what authorized organization, approximate number of hours, approximate number of rescues, and other relevant experience). Resumes, CVs, and other supporting documents may be used to describe qualifications, including experience with the marine mammal species (or another similar marine mammal species) that is/are the subject of this application.

3. List and describe any specialized training that your staff have completed to perform this duty, including where and when the training occurred, which organization provided the training, types of training, and other relevant information.

4. Describe how you meet or exceed USDA standards. Include a description of the number and types of: a) vehicles (cars, trucks, boats, etc.) that will be used to support the rescue of distressed animals; b) rescue equipment (nets, stretchers, etc.) that will be used for rescues; c) communications devices that will be used during rescues (phones, radios, etc.); and d) any other related equipment.

5. Describe your methods of capture of the species of interest, including:

1. Methods of restraint and holding, including dimensions/type of holding container, if used;

2. Minimum number of personnel participating in captures at any given time;

3. Precautions you will take to avoid separating female-calf/pup/cub pairs, and protocol in the event they are separated, including disposition of the separated calf/pup/cub; and

4. Precautions you will take to minimize incidental harassment of non-target animals of the target species.

6. Provide a statement that you will be available to respond to reports of live, distressed animals when needed.

___TRANSPORTER: Transporters respond to reports of injured and/or distressed animals and initiate transport efforts as directed. This level of involvement requires substantial expertise and training in the species-specific transport methodology, as well as, the necessary equipment and trained staff to accompany and move the animals to or between approved critical care and/or rehabilitation/holding facilities. Transporters must meet U.S Department of Agriculture (USDA) standards for Humane Handling, Care, Treatment, and Transportation of Marine Mammals when transporting live animals. Transports must also be consistent with Animal Welfare Act requirements for transportation and USFWS transport regulations.

1. Describe your organization’s experience in transporting animals of each species requested (e.g., years of experience, number of transports, etc.).

2. Describe the qualifications of each of your staff in your organization who would be accompanying animals during transport, demonstrating their ability to transport, accompany, and support animals of the subject species (including any work and/or volunteer experience that describes where, with what authorized organization, approximate number of hours, approximate number of transports, and other relevant experience). Resumes, CVs, and other supporting documents may be used to describe qualifications, including experience with the marine mammal species (or another similar marine mammal species) that is/are the subject of this application.

3. List and describe any specialized training that your staff have completed to perform this duty, including where and when the training occurred, which organization provided the training, types of training, and other relevant information.

4. Describe how you meet or exceed USDA standards:

   1. Include a description of the number and types of: a) vehicles (trucks, boats, airplanes, etc.) that you will use to transport animals of the subject species; shipping containers that will be used to transport the animals (including type, construction, dimensions, and weight); other equipment that will be used in the transport of the animals (foam pads, water sprayers, stretchers, etc.); communications devices that will be used during transports (phones, radios, etc.); and any other related equipment.

   2. Describe how the subject animals will be cared for during transport, including the number of attending staff and a description of the arrangements for watering or otherwise caring for the animals during transport.

5. Provide a statement that you will be available to transport animals of the requested species when needed.

___CRITICAL CARE FACILITY: These facilities hold and medically treat sick and/or injured animals whose lives would be jeopardized if care were not provided. These facilities have the species-specific equipment, experience and credentials necessary to rescue, stabilize, rehabilitate and release animals. These facilities may also provide long-term care, as needed, for generally healthy animals awaiting release, or they may provide long-term care for those individuals designated as “non-releasable”. Critical care facilities must meet or exceed USDA standards for Humane Handling, Care, Treatment, and Transportation of Marine Mammals when maintaining, treating, and holding live animals.

1. Describe your organization’s experience in maintaining, holding, and caring for distressed or injured animals of each species requested (e.g., years of experience, number of animals held, etc.).

2. Describe the qualifications of each of the staff in your organization who would be caring for, handling, and maintaining animals of the subject species (including any work and/or volunteer experience that describes where, with what authorized organization, approximate number of hours, approximate number of animals, and other relevant experience). Resumes, CVs, and other supporting documents may be used to describe qualifications, including experience with the marine mammal species (or another similar marine mammal species) that is/are the subject of this application.

3. For authorization as a critical care facility, you must have a qualified, critical care veterinarian. Provide the name of the person assigned this role and describe his/her qualifications, including a CV or resume that demonstrates his/her ability to perform this role.

4. Describe how you meet or exceed USDA standards. Include a description of:

   1. critical care and holding areas, including descriptions of holding tanks and haul-out areas. The description should include photographs, drawings, and/or diagrams illustrating the area(s) and facility (or facilities) where animals of the subject species will be held. When describing holding tanks, include dimensions (tank length, width, depth, water volume); describe pumps and filtration systems in tanks (including type and capacity and other relevant information); describe lifting apparatus; describe water heaters (including degree to which tanks can be heated); describe water source and type (and ability to use freshwater, saltwater and/or both); and any other relevant features.

   2. The maximum number of animals of the subject species that can be housed at your facility.

   3. The current distribution and number of animals of the subject species by holding tank at your facility (include sex, age (if known), time in captivity, age/size class, calves/pups/cubs, etc.).

   4. All deaths of the subject species at your facility within the past five years and the steps taken to prevent them.

5. Describe quarantine plans, including location and time-frame.

5. Provide a copy of i) your USDA Animal and Plant Health Inspection Service (APHIS) Animal Welfare Act (AWA) license; and ii) your most recent APHIS inspection report.

5. Provide a statement that you will be available to maintain, care for, and house animals of the subject species when needed, including round the clock veterinary care.

___REHABILITATION/HOLDING FACILITY: These facilities provide routine husbandry for generally healthy animals that require a minimum of specialized treatments. These facilities may provide long-term care, as needed, for generally healthy animals awaiting release, or they may provide long-term care for those individuals designated as non-releasable. Holding facilities must meet USDA standards for Humane Handling, Care, Treatment, and Transportation of Marine Mammals when holding live animals.

1. Describe your organization’s experience in maintaining and holding animals of each species requested (e.g., years of experience, number of animals held, etc.).

2. Describe the qualifications of each of the staff in your organization who would be caring for, handling, and maintaining animals of the subject species (including any work and/or volunteer experience that describes where, with what authorized organization, approximate number of hours, approximate number of animals, and other relevant experience). Resumes, CVs, and other supporting documents may be used to describe qualifications, including experience with the marine mammal species (or another similar marine mammal species) that is/are the subject of this application.

3. For authorization as a holding facility, you must have a qualified veterinarian. Provide the name of the person assigned this role and describe his/her qualifications, including a CV or resume that demonstrates his/her ability to perform this role.

4. Describe how you meet or exceed USDA standards. Include a description of:

1. holding areas, including descriptions of holding tanks and haul-out areas. The description should include photographs, drawings, and/or diagrams illustrating the area(s) and facility (or facilities) where animals of the subject species will be held. When describing holding tanks, include dimensions (tank length, width, depth, water volume); describe pumps and filtration systems in tanks (including type and capacity and other relevant information); describe lifting apparatus; describe water heaters (including degree to which tanks can be heated); describe water source and type (and ability to use freshwater, saltwater and/or both); and any other relevant features.

2. The maximum number of animals of the subject species that can be housed at your facility.

3. The current distribution and number of animals of the subject species by holding tank at your facility (include sex, age (if known), time in captivity, age/size class, calves/pups/cubs, etc.).

4. All deaths of the subject species at your facility within the past five years and the steps taken to prevent them.

5. Describe your facility’s quarantine plans, including location and time-frame;

5. Provide a copy of i) your USDA Animal and Plant Health Inspection Service (APHIS) Animal Welfare Act (AWA) license; and ii) your most recent APHIS inspection report.

5. Provide a statement that you will be available to maintain and house animals of the subject species when needed.

5. Are you seeking approval to display the animals while holding and maintaining them for rehabilitation purposes?

___NO ___YES; in i-iii, below, provide information to show that:

1. The facility is open to the general public without limitations or restrictions (other than by the charging of an admission fee);

2. The facility offers a program for education or conservation purposes that is based on professionally recognized standards of the public display community; and

3. Such display will not interfere with attainment of the objectives of the permitted/authorized activity.

Part V.

For MMPA Enhancement of survival or recovery of a species or stock

Note: This section of the application should not be completed unless you are specifically requesting MMPA Enhancement activities (e.g., this section is not intended for those parties requesting to conduct rescue, rehabilitation, and release activities for marine mammals).

21. Provide information to show that your proposed activities are likely to contribute significantly to maintaining or increasing the distribution or population numbers necessary to ensure the survival or recovery of the species or stock in the wild.

21. Provide information to show that your proposed activities are consistent with any conservation or recovery plan for the species or stock, or, if no plans are available, that the activity is consistent with the actions required to enhance the survival or recovery of the species or stock and that would be addressed in a conservation or recovery plan.

21. For activities that involve captive maintenance of live animals:

1. Provide an explanation on the benefit of removing animals from the wild into captivity; and

2. Include a description of plans in place for returning animals and any offspring to the wild.

(Note: You must also provide the information requested in question 14, above.)

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. 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, 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, Tribe, 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) 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), a physical U.S. address is required.

• 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. 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.

ALL APPLICANTS COMPLETE SECTION E

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), 50 CFR 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 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 an Take/Import/Transport/Export of Marine Mammals or Renewal/Amendment of Existing Permit application is 2 hours 20 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, 5275 Leesburg Pike, MS: BPHC, Falls Church, VA 22041-3803.

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

1 The term, “take,” as defined by the MMPA means to harass, hunt, capture, or kill, or attempt to harass, hunt, capture, or kill any marine mammal. As defined by the ESA, “take” means to harass, harm, pursue, hunt, shoot, wound, kill, trap, capture, or collect, or to attempt to engage in any such conduct.

2 The term, “stranding,” as defined by the MMPA means an event in the wild in which: (A) a marine mammal is dead and is on a beach or shore of the United States or in the waters under the jurisdiction of the United States (including any navigable waters); OR (B) a marine mammal is alive and is on a beach or shore of the United States and unable to return to the water, on a beach or shore of the United States and, although able to return to the water, is in need of apparent medical attention, or in the waters under the jurisdiction of the United States (including any navigable waters), but is unable to return to its natural habitat under its own power or without assistance.

Form 3-200-43 Rev. 04/2017 Page 20 of 20