Form 3-200-3a Import/Export License-U.S. Entities

OMB Control No. 1018-0092
Expires ##/##/####

FWS Form 3-200-3a (Rev. 07/2019)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM

Return to:

U.S. Fish and Wildlife Service
Office of Law Enforcement
Send to the appropriate Issuing Office listed
on Page 4 for the State you listed in Block B.

Type of Activity: Import/Export License – U.S. Entities*
˜ New - $100.00
˜ Renewal of I/E License #LE-________________________ $100.00
˜ Amendment to I/E License #LE-_______________________ $50.00
˜ Name/Address Change ONLY of Permit #LE-___________(no fee)

Complete all sections of this application.
See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A.

All applicants MUST complete

Name of Business (must match Company’s invoice and other permits/shipping documents)
Complete Federal Tax Identification No. or last 4 of SSN

Owner or Principal Officer
Date of Birth (mm/dd/yyyy)

Description of Business

Owner or Principal Officer Last Name Sole Owner? Yes ˜

Owner or Principal Officer First Name

Principal Officer Email Address

URL/Web Address

Principal Officer Title
Principal Officer Telephone Number

Owner or Principal Officer Middle Name

Primary Contact Name
Alternate Telephone Number

Primary Contact Telephone Number

Primary Contact Email Address

B.
All applicants MUST complete
Address (No P.O. Boxes, Retail Postal, or Mail Service Center) (as shown on Company’s invoice and other permits/shipping documents) Where you will
receive all official notices sent from the Service.
City

State

C.

Zip code

County

All applicants MUST complete

1.

Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount listed above. Application fees are nonrefundable.

2.

Do you currently have or have you ever had any Federal Fish and Wildlife license (or other permit)?
Yes ˜ If yes, list the number of the most recent license/permit you have held: ________________________

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.

No ˜

__________________________________________________________________________________________________________________
Signature of Principal Officer (No photocopied or stamped signatures)
Date of Signature (mm/dd/yyyy)
* This application is for U.S. businesses that commercially import (receive into the U.S. from another country) or export (send out from the U.S. to
another country) fish or wildlife (including parts and products). Businesses must be located in the United States to use this form.
Businesses located outside the United States (no U.S. presence at all) that carry their wildlife items into or out of the United States for commercial
purposes should complete 3-200-3b.
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OMB Control No. 1018-0092
Expires ##/##/####

FWS Form 3-200-3a (Rev. 07/2019)
U.S. Department of the Interior

IMPORT/EXPORT LICENSE (U.S. Entities)
APPLICATION CONTINUATION SHEET
SECTION D: ALL APPLICANTS MUST COMPLETE

NOTE: An Import/Export License is required ONLY if you commercially import (receive into the U.S. from
another country) or export (send out from the U.S. to another country). No Import/Export License is required if
your business ships exclusively within the U.S. or its Territories.
1.

Are you the sole owner? Yes ˜

No ˜

(must check one)

2.

Additional Partner(s) or Additional Principal Officer(s) Information (list all – use additional pages as necessary)
Name: _____________________________________________________________________________________
Complete Federal Tax Identification Number or last 4 of SSN:_________________________________________
Date of Birth: _______________________________________________________________________________
Address/City/State/Zip (No P.O. Box, Retail Postal or Mail Service Center):______________________________
___________________________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email address: _______________________________________________________________________________

3.

Are you keeping your business records concerning imports and/or exports of wildlife under this license at
the same location as Block B on page 1 of this application? Yes ˜ No ˜ (must check one)
50 CFR 13.46 and 14.93 describes the required records that are to be maintained for five (5) years from date of expiration of
the I/E License.

If no, provide location of business records (list all – use additional pages as necessary):
Name: _____________________________________________________________________________________
Primary Contact Name: _______________________________________________________________________
Address/City/State/Zip (No P.O. Box, Retail Postal or Mail Service Center):______________________________
___________________________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email address: _______________________________________________________________________________
4.

Are you keeping your wildlife inventories concerning imports and/or exports of wildlife under this license
at the same location as Block B on page 1 of this application? Yes ˜ No ˜ (must check one)
50 CFR 14.93 describes the requirements regarding wildlife inventory.
If no, provide location of wildlife inventories (list all – use additional pages as necessary):
Name: _____________________________________________________________________________________
Primary Contact Name: _______________________________________________________________________
Address/City/State/Zip (No P.O. Box, Retail Postal or Mail Service Center):______________________________
___________________________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email address: _______________________________________________________________________________

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FWS Form 3-200-3a (Rev. 07/2019)
U.S. Department of the Interior

OMB Control No. 1018-0092
Expires ##/##/####

IMPORT/EXPORT LICENSE (U.S. Entities)
APPLICATION CONTINUATION SHEET
5.

General description of the wildlife or wildlife products you wish to import/export. (Choose all that apply)

˜ Perishable
˜ Live (50 CFR 13.41 requires that wildlife possessed under a license must be maintained under humane and
healthful conditions)

˜ Venomous
˜ Dead
˜ Products (Describe: food, sport hunted trophies, jewelry, footwear, carvings, etc.)_______________
___________________________________________________________________________________
˜ Other (Describe)___________________________________________________________________

6.

7.

Type of animal to be used as described in #5 above. (Choose all that apply)

˜ Fish
˜ Coral
˜ Reptiles
˜ Mammals
˜ Birds
˜ Insects/Arachnids
˜ Other______________________________

˜ Amphibians
˜ Molluscs (Shells)

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).

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OMB Control No. 1018-0092
Expires ##/##/####

FWS Form 3-200-3a (Rev. 07/2019)
U.S. Department of the Interior

Office of Law Enforcement Permit Offices
https://www.fws.gov/le/regional-permit-offices.html
Please send your application to the appropriate office.
If you are located in the following states, send your application to the address below:
Alabama, Arkansas, Connecticut, District of Columbia, Delaware, Florida, Georgia, Illinois, Indiana, Iowa,
Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New
Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Puerto Rico, Rhode Island, South
Carolina, Tennessee, U.S. Virgin Islands, Vermont, Virginia, West Virginia, Wisconsin
U.S. Fish & Wildlife Service
Office of Law Enforcement
1875 Century Boulevard, Suite 380
Atlanta, GA 30345-3324
Phone: (404) 679-7195
Fax: (404) 679-7065
Email: [email protected]
If you are located in the following states, send your application to the address below:
Alaska, Arizona, California, Colorado, Guam, Hawaii, Idaho, Kansas, Montana, Nebraska, Nevada, New
Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, the Pacific
Trust Territories
U.S. Fish & Wildlife Service
Office of Law Enforcement
2800 Cottage Way, W-2928
Sacramento, CA 95825-1846
Phone: (916) 414-6660
Fax: (916) 414-6715
Email: [email protected]

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OMB Control No. 1018-0092
Expires ##/##/####

FWS Form 3-200-3a (Rev. 07/2019)
U.S. Department of the Interior

PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to the Form 3-200-3a that must be completed as an application for a U.S. Fish and Wildlife Service
Import/Export License (U.S. Entities). Reminder: It is a violation to import or export fish and wildlife commercially prior to
obtaining an Import/Export License.
GENERAL INSTRUCTIONS:
 Complete all blocks/lines/questions in Sections A through D.
 An incomplete application may cause delays in processing or may be returned to the applicant.
 Be sure you are completing the appropriate application form for the proposed activity.
o 3-200-3a for U.S. Entities; 3-200-3b for Foreign Entities (U.S. Agent required)
 Print clearly or type in the information. Illegible applications may cause delays.
 Sign the application. Scans, faxes or copies of the original signature will not be accepted.
 No Import/Export License will be issued if any information is missing from the application.
 Mail the original application to the appropriate address on the attached address list.
 Keep a copy of your completed application.
 Allow at least 60 days for your application to be processed. (50 CFR 13.11)
 Applications are processed in the order they are received.
COMPLETE SECTION A:
 Enter the complete name of the business who will be the Licensee if an Import/Export License is issued. If no company name
exists, then use the name (Last, First, Middle) of the owner of the business. Enter personal information that identifies the
applicant.
 We no longer will accept applications signed by anyone other than the sole owner or principal officer.
50 CFR 13.12 clearly states that the applicant must certify they read and are familiar with applicable parts of subchapter B of
Chapter I of title 50, Code of Federal Regulations. No broker, freight forwarder, etc., can certify in the applicant’s place.
This section of the regulations also calls for the signature of the applicant.
 Give a brief description of the type of business in which the applicant is engaged (e.g. Taxidermy, Jewelry, Apparel, etc.).
 Doing business as (dba): dbas are not accepted. The name on the Import/Export License must match the invoice and other
shipping documents that accompany the shipment to or from the United States.
 Principal Officer is the person in charge of the listed business. The principal officer is the person responsible for the
application and any permitted activities. Often the principal officer is a Director or President. Sole Owner should enter
“Owner” under Principal Officer Title. Primary Contact is the person at the business who will answer questions about the
application or business activities and can be the preparer of the application.
COMPLETE SECTION B:
 This is the address where you will receive all official notices sent from the Service, which must match the invoice and other
shipping documents that accompany the shipment to or from the United States.
COMPLETE SECTION C:
Application processing fee:
 An application processing fee is required at the time of application. The fee does not guarantee the issuance of an I/E
license. Fees will not be refunded for applications that are approved, abandoned, or denied. We may return fees for
withdrawn applications if no significant processing has occurred.
Federal Fish and Wildlife license/permits:
 List the number of your most recent Import/Export License even if it is no longer valid.
CERTIFICATION:
 The individual identified in Section A as sole owner or principal officer 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 the application.
COMPLETE SECTION D:
 All questions must be answered. Provide additional pages as necessary. You must provide (in writing) a revised list of
additional partner(s) or principal officer(s) within 10 days of any changes.
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FWS Form 3-200-3a (Rev. 07/2019)
U.S. Department of the Interior

OMB Control No. 1018-0092
Expires ##/##/####

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the following: the Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22; the
Endangered Species Act (16 U.S.C. 1531-1544), 50 CFR 17; the Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21; the Marine Mammal
Protection Act (16 U.S.C. 1361, et seq.), 50 CFR 18; the Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15; the 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), 50 CFR 23;
General Provisions, 50 CFR 10; General Permit Procedures, 50 CFR 13; and Wildlife Provisions (Import/export/transport), 50 CFR 14.
Purpose: The collection of contact information is to process applications and to verify the individual has an eligible permit to conduct activities
that affect protected species. This helps FWS monitor and report on protected species and assess the impact of permitted activities on the
conservation and management of species and their habitats.
Routine Uses: The collected information may be used to verify an applicant’s eligibility for a permit to conduct activities with protected wildlife;
to provide the public and the permittees with permit related information; to monitor activities under a permit; to analyze data and produce reports to
monitor the use of protected wildlife; to assess the impact of permitted activities on the conservation and management of protected species and their
habitats; and to evaluate the effectiveness of the permit programs. More information about routine uses can be found in the System of Records
Notice, Permits System, FWS-21.
Disclosure: The information requested in this form is voluntary. However, submission of the requested information is required to process
applications for permits authorized under the listed authorities. Failure to provide the requested information may be sufficient cause for the U.S.
Fish & Wildlife Service to deny the request.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to consider a
permit application, under the applicable laws governing the requested activity, for which a permit is requested, and to respond to requests made
under the Freedom of Information Act and the Privacy Act of 1974. 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. 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 currently valid OMB
control number. OMB has approved this collection of information and assigned Control No. 1018-0092.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 1.25 hours, including time for reviewing instructions, gathering and
maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the
Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: JAO – PERMA-PRB,
Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.
FREEDOM OF INFORMATION ACT
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)].

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