Form 3-200-25 Application - Export of Raptors (MBTA and/or CITES)

FWS Form 3-200-25 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

EXPORT OF RAPTORS UNDER CITES AND/OR THE MIGRATORY BIRD TREATY ACT
☐New

☐Reissue/Renew ☐Amendment

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C.**
A. Complete if applying as an individual
1.a. Last name
2 Date of birth
(mm/dd/yyyy)

5.a. Telephone number

1.b. First name
5.b. Alternate telephone
number

1.c. Middle name or initial

1.d. Suffix

6. 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.a. Description of business, agency, Tribe, or institution

4.a. Principal officer (P.O.) last name 4.b. P.O. first name

4.c. P.O. middle initial

5. Primary contact name

6. Primary e-mail address

7.a. Business telephone number

7.b. Alternate phone no.

3.b. Website URL (if applicable)
4.b. P.O. Title

8.a. Primary contact telephone no.

C. 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. Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, a nonrefundable processing fee (see the fee
schedule). 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.
3.

If you are requesting a reissue/renew/amendment, what is your permit/file number?
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.

The individual/principal officer of the business must print and sign the application. (No photocopied or stamped signatures)

Date (mm/dd/yyyy)

** Click here for additional instructions on completing the above form (link to instruction page). See the last page for information on the Privacy Act,
Paperwork Reduction Act, Estimated Burden, and Freedom of Information Act aspects of this application form.
Mail your application(s) to Division of Management Authority, Branch of Permits, MS:IA 5275 Leesburg Pike, Falls Church, VA 22041-3803.
Page 1 of 6

FWS Form 3-200-25 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

E. EXPORT OF RAPTORS UNDER THE CONVENTION ON INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD
FAUNA AND FLORA AND/OR THE MIGRATORY BIRD TREATY ACT
Provide the following information. Complete all questions on the application. Mark questions that are not applicable with
"N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you submit, indicate the
application question number you are addressing. If applying for more than one bird, be sure to indicate which bird is
being addressed in each response.
NOTE: The U.S. FWS may not be able to issue documents for the commercial export of Appendix-I species, unless the
specimens were produced at a CITES-registered Appendix-I commercial breeding operation. For more information on
registering an Appendix-I commercial breeding operation, contact the Division of Management Authority at
[email protected].
Electronic submission of inventories, photographs, and receipts: If you wish to provide information electronically, please
include a flash drive containing this information with your physical application.

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 regular mail through the U.S. Postal Service.

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

3. Have you or your client (if a broker applying on behalf of your client), 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.

Page 2 of 6

FWS Form 3-200-25 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

4. For EACH bird to be exported (see table below):
a.
b.
c.
d.
e.

Scientific name (Genus, species, and, if applicable, subspecies) and common name:
Hatch date and/or age class:
Gender (if known):
Source (indicate if the raptor was taken from the wild or captive bred):
Band number:
b. Hatch Date

a. Scientific Name

c. Gender

d. Source

e. Band #

5. Current location of specimen:

6. What is the purpose of the export?
____ Commercial

____ Exhibition

____ Scientific

____ Breeding

____ Other (specify: _________________________)

7. Provide the name and address of the recipient of the shipment (if self, provide address abroad).
Name:
Address:
City:
Country and Postal code:
8. If the bird was wild-collected:
a.

Provide information on the exact location of capture;

b.

Date of capture;

c.

Individual(s) capturing the bird; and

d.

History of transactions (e.g., U.S.FWS form 3-186A)

e.

In addition, provide copies of all Federal, State, and local permits that allowed the capture of the bird.
Page 3 of 6

FWS Form 3-200-25 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

9. If the bird was captive born:
•

•

If you are the breeder, provide a statement that the bird was bred and hatched at your facility. This statement
must include:
a.

Name and address of your facility where the bird was bred and hatched;

b.

Hatch date, band/tag number, and sex of each specimen;

c.

Your federal raptor propagation permit number;

d.

State raptor propagation permit number; and

e.

Your signature and date.

If you are NOT the breeder of the specimen
a.

Provide copies of documentation, such as U.S. FWS form 3-186A, showing that you acquired the bird
from the breeder;

b.

Documentation demonstrating the history of transactions (chain of custody of each bird);

c.

A signed statement from the breeder or breeder's record that includes:
i.

Complete name and address of the breeding facility;

ii.

That the bird was bred and hatched at his/her facility;

iii.

Hatch date,

iv.

Band/tag number, and

v.

Sex of each specimen he/she bred;

vi.

Breeder's Federal Raptor propagation permit number;

vii.

Breeder's State Raptor propagation permit number; and

viii.

Breeder's signature and date.

10. Provide a written certification from the Appropriate Government Agency of the importing country that the
recipient is an experienced falconer or raptor propagator who is required to maintain any raptors in his/her
possession under the conditions that are comparable to the conditions under which a permittee must maintain
raptors under 50 CFR 21.29 or 21.30. Certification is not required for shipments to the United Kingdom as
long as the recipient has a license from the appropriate authority in the U.K. because the U.K. has a program
for falcons comparable to the Service's program.

Page 4 of 6

FWS Form 3-200-25 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

11. The transport conditions must comply with the CITES Guidelines for Transport of Live Animals or, in the case
of air transport, with the International Air Transport Association (IATA) live animal regulations (contact airline
for information). As such, describe:
a.

The type, size, and construction of any shipping container; and

b.

The arrangements for watering or otherwise caring for the wildlife during transport.

12. For the non-commercial export of CITES Appendix-I species, provide a copy of the CITES import permit or
evidence one will be issued by the Management Authority of the country to which you plan to export the
specimen(s). In accordance with Article III of the CITES treaty, it is required that import permits are issued
before the corresponding export permit.
13. If the bird was bred at a CITES-registered Commercial Breeding Operation for Appendix I wildlife, no CITES
import permit is required. Provide the name ____________________ and registration number ________ of
the breeding operation.
14. Attach copies of your Federal and/or State permits or licenses, which authorize your possession, acquisition,
transfer, or disposition of raptors or their eggs, as required by the MBTA.
15. If the specimen is part of an approved Wild Bird Conservation Act Cooperative Breeding Program, identify the
breeding operation and provide an explanation of how the specimen is surplus to the operation.
All international shipment(s) must be exported through a designated port. A list of designated ports
(where an inspector is posted) is available. 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).

Page 5 of 6

FWS Form 3-200-25 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
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 verify the individual has an eligible permit to conduct activities which
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 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
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) in order provide the U.S. Fish
and Wildlife Service the information necessary, under the applicable laws governing the requested activity, for which a
permit is requested. 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 applicable 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. 1018-0093.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages 45 minutes (electronically) to 1 hour (paperbased), 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: PRB/PERMA (JAO), Falls
Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.

Page 6 of 6