Form 3-200-12 Raptor Propagation Permit Application Form

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

OMB Control No. 1018-0022
Expires ##/##/####

Federal Fish and Wildlife Permit Application Form
Click here for addresses.

Type of Activity: Raptor Propagation

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

 New Application
 Requesting Renewal or 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

2. Date of birth (mm/dd/yyyy)

3. Occupation

5.a. Telephone number

5.b. Alternate telephone number

B.

1.c. Middle name or initial

1.d. Suffix

4. Affiliation/ Doing business as (see instructions)
5.c. Fax number

5.d. E-mail address

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.c. Principal officer Middle name/ initial

4.d. Suffix

6. Primary contact name

7.a. Business telephone number

7.b. Alternate telephone number

C.

7.c. Business fax number

7.d. Business e-mail address

All applicants complete address information

1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)

1.b. City

1.c. State

1.d. Zip code/Postal code:

1.e. County/Province

1.f. Country

2.a. Mailing Address (include if different than physical address; include name of contact person if applicable)

2.b. City

2.c. State

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

D.

All applicants MUST complete

1.

Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount of $ 100.00 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))
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 of applicant/Principal Officer (No photocopied or stamped signatures)
Date of signature (mm/dd/yyyy)

Please continue to next page

Form 3-200-12

Rev. 4/2017

Page 1 of 6

OMB Control No. 1018-0022
Expires ##/##/####

SECTION E. RAPTOR PROPAGATION
(Migratory Bird Treaty Act, 50 CFR 21.30)
Note: A Federal Raptor Propagation Permit is required to capture from the wild, possess, transport, import, purchase, barter,
or offer to sell, purchase, or barter any raptor, raptor egg, or raptor semen for propagation purposes. You must be at least 18
years of age to apply. Any raptors that you are authorized to hold, must be maintained in humane and healthful conditions
[per 50 CFR 13.41]. You must also have adequate facilities for the number and species you intend to possess [per 50 CFR
21.30(c)(1-2) and 50 CFR 21.30(w)(3)]. You are responsible for reviewing and understanding these regulations before you
request and accept a permit. These regulations can be found on our website at: https://www.fws.gov/birds/policies-andregulations/permits/permit-policies-and-regulations.php
Please provide the following information on a separate sheet of paper by providing the question number; re-stating the
question; followed by your responses accordingly. You should be as thorough and specific as possible in your responses.
Incomplete applications will be returned. Failure to respond in the time required may delay processing of your application
and may be considered abandoned.
1.

State the purpose for which you seek a raptor propagation permit.

2.

List each raptor you intend to acquire for propagation purposes by species, date of acquisition, source, and band
number.

3.

List each raptor you hold for purposes other than propagation by species, age (if known), sex (if known), date of
acquisition, source, band number if banded, and the permit number it is held under.

4.

You must have at least 2 full years of experience handling raptors and propagating. Provide a detailed description of the
nature and extent of your experience. You must also provide a written recommendation from another person with raptor
handling experience, such as other propagators, falconers, State wildlife personnel, or zoo. The letters must contain
contact information for this person.

5.

Attach photographs (interior and exterior) and a detailed description of your facilities and equipment. Include
dimensions (length, width, and height) of all enclosures intended for housing propagation birds. Also provide a
description of the interior and exterior construction and housing materials, such as flooring, netting, perching, and
watering materials. Also describe your enclosures for transport of the birds, including dimensions (length, width, and
height) and the type and number of species that will be transported in each.

6.

Indicate if you are requesting authorization to take birds (or eggs) from the wild. If you request such authorization,
provide the species, quantity, and location of take, and explain why birds from captive stock are unsuitable.

7.

Sub-permittees: Provide the name(s) of anyone besides yourself who will be conducting activities under your permit. As
the primary permittee, you are legally responsible for ensuring that your subpermittees, staff, and volunteers are properly
trained and adhere to the terms of your permit. Anyone authorized to conduct permitted activities in your absence must
be at least 18 years old. Persons under 18 may assist you in conducting your activities, but you or one of your designated
subpermittees over the age of 18 must be present and maintain direct control of them at all times.

8.

You must retain records legibly written or reproducible in English relating to the activities conducted under your permit for at
least 5 years after the date of expiration of your permit. Is the physical address you provided in Section C on page 1 of this
application the address where your records will be kept? If “no,” provide the physical address.
Yes
No

9.

Any permit issued as a result of this application is not valid unless you also have any required State or tribal permits
or approvals associated with the activity. Have you obtained all required State or Tribal permits or approvals to
conduct this activity?
Yes

Form 3-200-12

If “yes,” attach a copy of the approval(s).

Rev. 4/2017

Have applied (Send copy when issued)

None required

Page 2 of 6

OMB Control No. 1018-0022
Expires ##/##/####

6.

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

No (must check one)

If you answered “Yes” provide: a) the individual’s name, b) date of charge, c) charge(s), d) location of incident, e) court, and f) action
taken for each violation. (list all – use additional pages as necessary)

Form 3-200-12

Rev. 4/2017

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, 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. 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​. ​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.

Rev. 4/2017

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.ecfr.gov​ ​and ​https://www.fws.gov/birds/policies-and-regulations/permits/permit-policies-andregulations.php)

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
2.

3.

Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;
Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50 CFR 17;
Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;
​ .), 50 CFR 18;
Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, e​ t. seq
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.

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.
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 an 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.
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.

c.
d.
e.

f.

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.

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.
i.

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

j.

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 Raptor Propagation permit application is 3 hours for the application and 1 hour 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 b​ urden 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 2.26 – 2.33].

Rev. 4/2017

Page 5 of 6

Migratory Bird Regional Permit
Offices
FWS
REGION

Region 1

Region 2

Region 3

Region 4

Region 5

Region 6

AREA OF
RESPONSIBILITY
Hawaii, Idaho, Oregon,
Washington
Arizona, New
Mexico, Oklahoma,
Texas

Iowa, Illinois, Indiana,
Minnesota, Missouri,
Michigan, Ohio,
Wisconsin

Alabama, Arkansas, Florida,
Georgia, Kentucky, Louisiana,
Mississippi, North Carolina,
South Carolina, Tennessee,
Virgin Islands, Puerto Rico
Connecticut, District of
Columbia, Delaware,
Maine, Maryland,
Massachusetts, New
Hampshire, New Jersey,
New York, Pennsylvania,
Rhode Island, Virginia,
Vermont, West Virginia
Colorado, Kansas, Montana,
North Dakota, Nebraska,
South Dakota, Utah,
Wyoming

Region 7

Alaska

Region 8

California, Nevada

MAILING
ADDRESS

CONTACT
INFORMATION

911 N.E. 11th Avenue
Portland, OR 97232-4181

Tel. (503) 872-2715
Email [email protected]

P.O. Box 709
Albuquerque, NM 87103

Tel. (505) 248-7882
Email [email protected]

5600 American Blvd. West
Suite 990
Bloomington, MN
55437-1458

Tel. (612) 713-5436
Email [email protected]

1875 Century Blvd., NE
Atlanta, GA 30345

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

300 Westgate Center Drive
Hadley, MA 01035-0779

Tel. (413) 253-8643
Email [email protected]

P.O. Box 25486
DFC(60154)
Denver, CO 80225-0486

Tel. (303) 236-8171
Email [email protected]

1011 E. Tudor Road
(MS-201)
Anchorage, AK
99503

Tel. (907) 786-3693
Email [email protected]

2800 Cottage Way
Room W-2606
Sacramento, CA 95825

Tel. (916) 978-6183
[email protected]