Form 3-200-13 Federal Fish and Wildlife Permit Application Form - Migr

FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM

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

Migratory Bird Depredation
(Migratory Bird Treaty Act, 50 CFR 21.41)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

TYPE OF REQUEST

BEFORE FILLING OUT THIS FORM, please access the
Return Addresses (to obtain the email/postal mail
addresses where this form can be returned), and read the
Frequently Asked Questions and Instructions. Please
retain the "NOTICES" page for your records.

New Application
Renewal
Amendment
If requesting a renewal or amendment, provide 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
instruction page(s) for information on how to make your application complete and help avoid unnecessary delays.

Complete if applying as an individual

A.

1.a. Last name

1.b. First name

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

B.

3.b. Alternate telephone number

3.a. Telephone number

1.c. Middle name or initial

1.d. Suffix

3.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

D.

2.c. State

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

All applicants MUST complete

1. A nonrefundable processing fee is required to process this permit, please attach check or money order payable to the U.S. FISH AND WILDLIFE
SERVICE. Federal, Tribal, State, and local government agencies, and those acting on behalf of such agencies, are exempt from the processing fee –
Please see link for processing fee cost and fee exempt status as outlined in 50 CFR 13.11(d). Click here for Processing Fees
2. Do you currently have or have you ever had any Federal Fish and Wildlife permits?
If yes, list the number of the most current permit you have held or that you are applying to renew/re-issue:
No
Yes
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 stamped signatures. Electronic signatures accepted.)

Date of signature (mm/dd/yyyy)

Please continue to next page

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM

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

Migratory Bird Depredation
(Migratory Bird Treaty Act, 50 CFR 21.41)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

Note: A Federal Migratory Bird Depredation Permit is required to take (capture or kill) migratory birds to reduce depredation or to
protect other interests such as human health and safety or personal property. You should apply for a depredation permit only after
deterrents such as hazing and habitat modification prove unsuccessful. If a permit is issued, you will be expected to continue
nonlethal measures in conjunction with any killing or trapping authorized. Please read the “Frequently Asked Questions” and the
pertinent regulations before you sign and submit your application. You should review Title 50 Parts 10, 13, and 21.41 of the Code of
Federal Regulations (CFR). 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-and-regulations/permits/permit-policiesand-regulations.php. You must be at least 18 years old to apply for this permit.
Please provide the information requested below. If additional information needs to be provided that does not fit in the designated
spaces, add additional sheets to your application submission. You may use as many additional sheets as needed. Please number
pages accordingly using the page number box provided at the bottom of the sheet, and the corresponding question number.
We may request additional information as appropriate to the activities you are requesting (50 CFR 13.21(d)). You should be as
thorough and specific as possible in your responses. Incomplete applications will be returned. If you are requesting renewal, you only
need to provide information that has changed since your prior application. You must answer all of the questions even if the same
information is included elsewhere in the application.
If you are requesting renewal, all required reporting must be up to date or the renewal will not be processed. The report form can be
found at https://www.fws.gov/forms/3-202-9.pdf. If you are requesting renewal, you still need to complete the entire application and
provide all the requested information.
As the permittee, you are legally responsible for ensuring that your subpermittees, staff, and volunteers adhere to the terms of your
permit.
Resident Canada goose nests and eggs: If you are only destroying or addling resident Canada goose eggs and your state is one that
accepts Federal registration, you may register for free online at https://epermits.fws.gov/eRCGR in lieu of obtaining a depredation
permit. The States that accept Federal registration are listed in the “State Agency Contacts and Information” link on the registration
website.
Protected Species:The species listed in the Code of Federal Regulations at 50 CFR 10.13 are protected under the Migratory Bird
Treaty Act (MBTA). A list of species in the U.S. and their status under the MBTA is available at the following website:
https://www.fws.gov/birds/management/managed-species/migratory-bird-treaty-act-protected-species.php

SECTION E.
Questions
1) Attachments - In addition to this form, you should also attach the following to complete your application:
a) Your application for a depredation permit must include a recommendation from the U.S. Department of Agriculture,
Animal and Plant Health Inspection Service, Wildlife Services, for addressing your depredation problem. Contact Wildlife
Services at (866) 487-3297. If Wildlife Services recommends that a permit be issued to capture or kill birds, they will
complete a Wildlife Services Permit Review Form (Form 37). Attach a copy of the completed Form 37. Your application
will be considered incomplete if you fail to include a current Form 37 with your application. The information contained on
the Form 37 is similar to the information that is requested below. You must also complete each section below that is
applicable to your situation;
b) Copies of any receipts, invoices, contracts, or other available records documenting any deterrent measures can be
helpful in processing your application;
c) Take Request Table listing the species you wish to take (you will find this table at the end of this application). Please be
sure to include the location(s) where take will occur in the fields provided at the top of the table. Be as specific as
possible. Please include photographs of the species causing the damage if you are uncertain of the species;
d) Any other supporting documentation (example photographs of damages);
e) The report form for this application can be found at:

022-05-01/105))

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

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

2) 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, Have Attached
None Required
Have Applied, Will Provide Upon Request
3) Provide the information requested below for each species. Include photographs or other documentation to assist us in
reviewing your request.
(a) What are the specific details for the depredation or injuries you are experiencing? Include details such as types of
crops/livestock destroyed or property damaged. Include number livestock injured or killed, if applicable. Include risks to
human health and safety hazards. What is the extent of the damage and estimate the economic loss suffered as a
result, such as percentage of acres of crop and dollar loss, cost to replace damaged property, or cost of injuries? Attach
copies of any receipts, invoices, contracts, or other available documentation to support your estimates.

(b) How long has this depredation been occurring (provide number of days, months, or years)?.

(c) When during the year does this depredation or human safety hazard occur?

(d) What is the size of the area affected (e.g. 1-acre pond, 50-acre vineyard, 500-acre airfield)?

(e) How long are you requesting the permit for and how often will you be conducting depredation activities?

4) What is location of the property or properties where the take activity would be conducted? Include state, county, physical address, and
latitude/longitude in decimal degrees (e.g. 36.87998 N/ 88.3435 W). For assistance determining the
latitude/longitude for a specific location in decimal degrees, please visit https://earthexplorer.usgs.gov/

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

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

5) Describe the following with your justifications:
(a) your requested method(s) of take, including type(s) of trap(s);

(b) your proposed trapping methods;

(c) who will be conducting any trapping and describe their previous experience;

(d) if you are requesting authorization for trap and relocation, identify the areas to be used for relocation. (Always ask for
landowner and state permission to release relocated birds.)

6) Describe the deterrents that you have used previously to address this depredation situation, specifically addressing the
following nonlethal measures. Photographs or other documentation of the situation can assist us in reviewing your application.
(a) What hazing or harassment techniques (e.g., horns, pyrotechnics, propane cannons) have you used to manage or
eliminate the problem? Of these tools, how often and how long did you use these deterrents (e.g., number of
weeks, months, year(s))?

(b) What habitat management measures (e.g., vegetative barriers, longer grass management, fencing
and netting) have you used to discourage depredation by birds?

(c) What cultural practices (e.g., crop selection, crop placement, animal and pet management, feeding schedules,
and no-bird-feeding policies) have you established to discourage depredation in the areas you have identified?

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

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

7) A depredation permit is not considered a long-term solution for most situations. What long-term measures do you plan to
take to eliminate or significantly reduce the continued need for killing or removal of birds, or destroying eggs/nests? Discussing
how you will continue to use the non-lethal deterrents described in question 5 above can help with answering this question.
(Recall that no permit is needed to remove nests without eggs, except for eagles and endangered birds.)

8) If you are applying on behalf of an airport for a permit to control birds in flight zones, indicate whether you are operating under a
Federal Aviation Administration-approved Wildlife Hazard Management Plan. If you are operating under an FAA-approved
WHMP, please provide an electronic copy of the most recent plan.

I am not applying on behalf of an airport
I am applying on behalf of an airport
An approved WHMP is attached
We do not have a WHMP

9) 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?
Yes
No
If “no,”provide the
physical address:
10) Anyone who will be assisting you with the permitted activities or acting as your agent must either have their own Federal
migratory bird permit for the activity or be identified by you, in writing, as a subpermittee under your permit. They may also require
a State permit. Subpermittees must be at least 18 years old. As the primary permittee, you will be responsible for ensuring that
your subpermittees are properly trained and adhere to the terms of your permit. Provide the name of any subpermittees who will
be conducting activities under your permit. Include any commercial company that may be contracted to conduct the work.

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

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

11) Disqualification factor. Have you, the permittee, or your client (if a broker on behalf of your client):
(a) Been assessed a civil penalty or convicted of any criminal provision of any statue or regulation relating to the activity for which
the application is filed (50 CFR 13.21(b) (1)?
(b) 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. (50 CFR 13.21 (c)(1))?
(c) Had a permit revoked within the last five years for willfully violating any Federal or State statute or regulation, or any Indian tribal
law or regulation, or any law or regulation of any foreign country, which involves a violation of the conditions of the permit or of the
laws or regulations governing the permitted activity (50 CFR 13.28 (a)(1)) or failing to correct deficiencies that were the cause of a
permit suspension within 60 days (50 CFR 13.28 (a)(2))?
Answer "yes" if ANY of the events listed immediately above (11-14) have occurred. Answer "no" if none of the events
listed immediately above have occurred.
Yes
NO
If you answered “Yes”, provide: a) the individual’s name; b) date of conviction, civil penalty assessment or revocation; c)
charge(s), or reason(s) for revocation; d) location of the incident; e) court (if applicable, ticket, federal/state/tribal court etc.); and
f) legal action taken for each violation (i.e. fine, incarceration, probation, or other). Please be aware that a “Yes” response does
not automatically disqualify you from getting a permit.

15) Are you eligible for Fee Exempt Status? Fee exempt status applies to government agencies (Federal, State, Tribal, and
municipal governments). Applicants acting on behalf of such agencies must submit either 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, or the agencies tax exempt form.
Yes = Government Agency
Yes = Acting on behalf of Government Agency
Documentation Included
No = not eligible for Fee Exempt Status

16) I acknowledge that I have read the form Instructions and FAQ, have accessed the page with the Return Addresses to
obtain the address where I should return this form, and have filled out all fields and questions. I have also obtained a
completed Form 37 from Wildlife Services and will include it with my application. Check this box to acknowledge:

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022
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 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 verify the individual has an eligible permit to conduct activities that affect
protected species. The information the individual provides helps the 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 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
monitor take and disposition of migratory birds, 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. 1018-0022.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 1 hour 45 minutes (individuals) and 3 hours 30 minutes (private sector)
Amended submission - paper-based: 1 hour 30 minutes (individuals) and 3 hours (private sector)
Original submission - electronic: 1 hour 15 minutes (individuals) and 2 hours 45 minutes (private sector)
Amended submission - electronic: 1 hour (individuals) and 1 hours 30 minutes (private sector)
These estimates include 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: PRB/PERMA (JAO), 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 nonconfidential summary and remaining documents may be made available to the public under FOIA [43 CFR 2.26 – 2.33].

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022

Take Request Table

Expires ##/##/####

Instructions: Complete the following table for each species of migratory bird(s) you request to take under a Depredation Permit. If you propose to conduct take activities at multiple locations, please

fill out a separate table for each location. If you propose multiple methods of take for one species, use a separate line for each method; in such a case, the “estimated total number of birds involved
in the damage or safety concern” for each line should be the same, as in the example below.

County/State (required):

Activity Location (required):

Provide the exact location of the property or properties where the activity would be conducted including state, county, and physical address, and latitude/longitude in decimal degrees (e.g. 36.87998/
-88.3435). For assistance determining the latitude/longitude for a specific location in decimal degrees, please visit https://earthexplorer.usgs.gov/

Species
(Common
name)
EXAMPLE: Canada goose
Canada goose

3-200-13 Rev. 7/2019

Estimated
total
number of
birds
causing
damage or
safety
concern
50
50

PROPOSED METHOD OF TAKE
Number of birds you propose to:
Kill
10
0

Trap &
Relocate
0
0

Other (specify quantity
& method)
0
0

Number of nests (not
individual eggs) you
propose to:
Addle
(oil/shake)
0
25

Destroy
0
0

Proposed disposition
(bury, incinerate, release, food
bank,falconer (specify name/State/
permit number), other permit (give
permittee name and permit
number), institution, other (give
name))
Bury
Other – leave

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FWS Form 3-200-13 (Rev. 01/2020)
U.S. Department of the Interior

MIGRATORY BIRD DEPREDATION PERMIT APPLICATION - TAKE REQUEST TABLE

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

Supplemental Page Number:

Activity Location (required):
Provide the exact location of the property or properties where the activity would be conducted including state, county, and physical address, and latitude/longitude in decimal degrees (e.g.
36.87998/ -88.3435). For assistance determining the latitude/longitude for a specific location in decimal degrees, please visit https://earthexplorer.usgs.gov/

PROPOSED METHOD OF TAKE

Estimated

Species
(Common
name)

3-200-13 Rev. 7/2019

total
number of
birds
causing
damage or
safety
concern

Number of birds you propose to:

Kill

Trap &
Relocate

Other (specify quantity
& method)

Number of
nests (not
individual eggs)
you propose to:
Addle

(oil/shake)

Destroy

Proposed disposition
(bury, incinerate, release, food
bank,falconer (specify name/State/
permit number), other permit (give
permittee name and permit
number), institution, other (give
name))

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