APHIS 7003A (propo Application for License (proposed)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579XXXX. The time required to complete this information collection is estimated to average .25 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved
0579-0036
0579-XXXX

OFFICIAL USDA USE ONLY
SEND THE COMPLETED FORM TO:

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

APPLICATION FOR NEW LICENSE
LICENSE/
CUSTOMER NUMBER

(TYPE OR PRINT)

EXPIRATION DATE

AMOUNT

DATE RECEIVED

No license may be issued unless a completed application has been received, the applicable fees have been paid (7 U.S.C. 2132-2143), and the applicant is in compliance with the standards and
regulations of Section 2133.

1. NAME(S) OF APPLICANT(S) AND CONTACT INFORMATION:

2. ALL BUSINESS NAMES AND LOCATION ADDRESSES HOUSING ANIMALS,
INCLUDING INTENDED EXHIBITS (include directions to each location; P.O. boxes not
acceptable):
Use additional sheet, if necessary

TELEPHONE
COUNTY

TELEPHONE
COUNTY

EMAIL

3. IF THE APPLICANT IS A CORPORATION, PARTNERSHIP, OR OTHER BUSINESS

ENTITY, LIST THE ENTITY’S PARTNERS OR OFFICERS AND AGENT FOR SERVICE OF
PROCESS:

NAME

EMAIL

4. (A) PREVIOUS USDA LICENSE NUMBER (If any):

(B) ACTIVE USDA LICENSE NUMBER IN WHICH YOU HAVE AN INTEREST:

TITLE

5. TYPE OF LICENSE:
Class A – Breeder
6. LIST YOUR 12 MONTH BUSINESS YEAR:
DAY

TO
YEAR

MONTH

DAY

Class C – Exhibitor

7. TYPE OF ORGANIZATION:

(Calendar or Fiscal)

FROM
MONTH

Class B – Dealer

Individual

YEAR

Corporation

Partnership

Other (University, State, Municipality, LLC, Trust)
_______________________________________
8. THE ANTICIPATED TYPE AND NUMBER OF ANIMALS TO BE OWNED, HELD, 9. VIOLATIONS AND NOLO CONTENDRE
MAINTAINED, SOLD, OR EXHIBITED DURING THE PERIOD OF LICENSURE
Disclose any pleas of nolo contendere (no contest) or finding of a violation of
(see 9 CFR Sections 2.6 and 2.7)
Federal, State, or local laws or regulations pertaining to animal cruelty or the
transportation, ownership, neglect, or welfare of animals.
Big Cats and
Dogs and Cats

Large Felids

Guinea Pigs and
Hamsters

Wolves

Rabbits

Bears

Group 1-4
Nonhuman Primates

Mega-herbivores

Group 5-6
Nonhman Primates

Other Animals

None

Yes, described below:

Use additional sheet, if necessary
10. EXPERIENCE
If the anticipated type of animals includes wild or exotic animals, the applicant
must submit along with their application form information and records
demonstrating their knowledge of and experience with those animals.
Yes. Information and records are attached.

Marine Mammals

CERTIFICATION
I hereby make application for a license under the Animal Welfare Act 7 U.S.C. 2131 et seq. I certify that the information provided herein is true and correct to the best of my knowledge. I hereby
acknowledge receipt of and agree to comply with all the regulations and standards in 9 CFR, Subpart A, Parts 1, 2, and 3. I certify that the applicant is 18 years of age or older.

11. PRINT NAME AND TITLE:

APHIS FORM 7003A
MAR 2019

12. SIGNATURE:

Previous editions are obsolete.

13. DATE

Privacy Act Notice
Authority: The Animal Welfare Act (AWA), 7 U.S.C. 2131 et seq.
Purpose: This system supports APHIS’ administrative activities and enforcement of the AWA.
Routine Uses:
In addition to those disclosures generally permitted under 5 U.S.C. 552a (b) of the Privacy Act, records
maintained in the system may be disclosed outside USDA as follows:
1) Records maintained under the proviso of this authority form an integral support network
essential for the implementation and enforcement of the Animal Welfare Act, including licensing
and registration of individuals, businesses, and research facilities, compliance with regulations
and standards applicable under the Act, and annual reporting requirements of summary data as
required by law.
2) Referral to the appropriate agency whether Federal, State, local or foreign, charged with the
responsibility of investigating or prosecuting a violation of law, or of enforcing or implementing
the statute, rule, regulation or order issued pursuant thereto, of any record within this system
when information available indicates a violation or potential violation of law, whether civil,
criminal or regulatory in nature, and whether arising by general statute or particular program
statute, or by rule, regulation or order issued pursuant thereto.
3) Disclosure to the Department of Justice for use in litigation when the agency, or any component
thereof, or any employee of the agency in his or her official capacity, or any employee of the
agency in his or her individual capacity where the Department of Justice has agreed to
represent the employee, or the United States, where the agency determines that litigation is
likely to affect the agency or any of its components, is a party to litigation or has an interest in
such litigation, and the use of such records by the Department of Justice is deemed by the
agency to be relevant and necessary to the litigation; provided, however, that in each case, the
agency determines that disclosure of the records to the Department of Justice is a use of the
information contained in the records that is compatible with the purpose for which the records
were collected.
4) Disclosure in a proceeding before a court or adjudicative body before which the agency is
authorized to appear, when the agency, or any component thereof, of any employee of the
agency in his or her official capacity, or any employee of the agency in his or her individual
capacity where the agency has agreed to represent the employee, or the United States, where
the agency determines that litigation is likely to affect agency or any of its components, is a
party to litigation or has an interest in such litigation, and the agency determines that use of
such records is relevant and necessary to the litigation; provided, however, that in each case,
the agency determines that disclosure of the records to the court is a use of the information
contained in the records that is compatible with the purpose for which the records were
collected.
5) Disclosure may be made to a congressional office from the record of an individual in response
to an inquiry from the congressional office made at the request of that individual.
Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may
impede your ability to submit an Animal Care-Application for License (Renewal).

INSTRUCTIONS FOR NEW LICENSE APPLICATION
(APHIS FORM 7003A & TAX IDENTIFICATION SHEET)

• Please read all instructions before completing the application and Tax ID sheet.
• Contact your USDA APHIS Animal Care office before mailing your application.
• Corrections and/or clarifications will delay the processing of your application.
• All blocks must be completed; if one does not apply please put “N/A”.
• Mail in all original documents. We cannot accept applications that are copied,
e-mailed, or faxed.
• Complete the application in blue or black ink.
• Send in only the application, tax ID sheet, and $10 application fee.
• Payments can be made by check, money order, or credit card. Cash is not accepted.
Completing the green Tax ID Sheet:
(a) An Individual; write the individual’s name and Social Security Number.
(b) A Partnership; write either all partner’s names and Social Security Numbers
or the business name and Employee Identification Number.
(c) A Corporation or Other; write the business name and Employee
Identification Number.
Completing the APHIS Form 7003A Application:
Block 1:

Complete this block with the applicant name, business address, county, telephone
number, and email address.
- Applicant means the name the license will be under.
o If applying as an Individual, put the individual’s name only.
o If applying as a Partnership, please either list all partner’s names or the
business name.
o If applying as Corporation or Other, list the business name only.
- Business Address refers to the address all correspondences will be mailed to.
o Cannot be left blank, and can include only one address.
o Include the county that the business address is in along with a
telephone number where the applicant can be reached.

Block 2:

Complete this block the physical address of where the animals currently are, or will be
located for intended exhibits.
- Physical Address means the address of where the animals are located.
o P.O. Boxes cannot be listed in this Block.
o Include the county that the address is located and telephone number.

- If necessary, use an additional sheet if more than one address or if providing
directions.
Block 3:

Complete this block with all officers authorized to conduct business for the license.
- If applying as an Individual;
o This block does not need to be completed.
- If applying as a Partnership;
o Under owners’ names this block does not need to be completed.
o Under the business name list all names authorized to conduct business
for this license.
o Owner cannot be used as a title.
- If applying as a Corporation or Other;
o List all names authorized to conduct business for this license.
o Owner cannot be used as a title.

Block 4:

Complete this block only if you had a previous license number or have a business
interest in another active USDA license.

Block 5:

Check the box that best describes your business.
- Class A (breeder) – sells only animals bred and raised at your facility.
- Class B (broker) – buys and sells animals or is an operator of an auction.
- Class C (exhibitor) – exhibits animals to the public.

Block 6:

Enter a 12-month business year.
- Either as a calendar year (1/1/16 to 12/31/16) or fiscal year (10/1/16 to 9/30/17).

Block 7:

Check the box that best describes your business.
- Individual- Owner name only listed in Block 1.
- Partnership- Either partner’s name or business name listed in Block 1.
- Corporation or Other- Business name listed in Block 1.

Block 8:

Complete this block if applying for Class B or C (dealer or exhibitor) License.
- Enter the number of regulated animals for each category that is owned, held,
or exhibited.

Block 9:

Annotate if you have any animal violations or nolo contendre incidents. If yes,
describe the incident(s). Attach an additional sheet, if necessary.

Block 10:

If the type of animals include wild or exotic animals, annotate “yes” and include
supporting documentation showing knowledge and experience with these animals.

Block 11-13:

Complete these blocks with an authorized person’s name (either listed in Block 1 or
Block 3) and include the printed name, signature, and date.