Form 3-200-30 Application - Export/Re-export/Re-import of Circuses and

Federal Fish and Wildlife Permit Applications and Reports--Management Authority; 50 CFR 13, 15, 16, 17, 18, 22, 23

3-200-30 App - CITES ESA Ex-Reex-Reim-Reiss Traveling Exhibitions 03092020

ePermits Application - Export/Re-export/Re-import of Circuses and Traveling Animal Exhibitions (and Reissuance) (CITES/ESA) (Form 3-200-30) - Private Sector

OMB: 1018-0093

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1018-0093 can be found here:

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FWS Form 3-200-30 (Rev. 01/2020)
U.S. Department of the Interior

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

EXPORT/RE-EXPORT/REIMPORT OF CIRCUSES, TRAVELING ANIMAL EXHIBITIONS, OR
MUSEUM EXHIBITIONS (and Reissuance) (CITES/ESA)
☐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

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.
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FWS Form 3-200-30 (Rev. 01/2020)
U.S. Department of the Interior

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E. EXPORT/RE-EXPORT/REIMPORT OF CIRCUSES, TRAVELING ANIMAL EXHIBITIONS, OR MUSEUM
EXHIBITIONS (AND REISSUANCE) (CITES/ESA)

PURPOSE
This application covers a wide range of CITES and/or ESA-listed animals, whether live or dead. To determine
whether the species is regulated under CITES, when the species was listed, and whether exemptions apply to
your requested activity and would then not require a CITES permit. To determine whether the species is
regulated under the ESA, when the species was listed, and whether exemptions apply to your requested
activity and would not need ESA authorization, see. A Traveling Exhibition Certificate (Resolution Conf.
12.3(Rev. CoP13)) applies only to an animal or non-living specimens that qualify as pre-Convention 1 or Bred
in Captivity 2 as defined in Resolution Conf. 10.16 (Rev.). A CITES certificate may be issued up to 3 years for
a single animal or a group of (non-living) specimens. For animals or non-living specimens that do not qualify
for a Traveling Exhibition Certificate, a Master File can be established that is valid for up to three years for one
or more animals or specimens. A Master File would authorize a number of (re-)exports and/or imports over a
three-year period, but you would still be required to obtained CITES re-export documents for the re-exporting
country before returning to the United States. Once a Master File is approved, you must obtain single-use
permits, valid for 6 months or until the expiration of the Master File, whichever is sooner, for each export/reexport or import (50 CFR 13.11).
Use this application form for exports/re-exports and re-import for:
Temporary travel (export and re-import) to exhibit animals, museum exhibitions, or other traveling exhibitions
where specimens do not change ownership (e.g., not being bought or sold while outside the United States).
This form should NOT be used for:
•

Transferring ownership or offer specimens for sale outside the United States, submit form 3-200-23 (preConvention specimens) or 3-200-37 (ESA/CITES specimens)

•

Traveling with musical instruments, submit form 3-200-88 (Musical Instrument Certificate)

•

Activities involving live marine mammals, use form 3-200-53 (Export /Re-Export of Live Captive Held
Marine Mammals (CITES))

All forms are located on our website.
If you are applying on behalf of a client, provide documentation such as a Power of Attorney
authorizing you to act on behalf of the client.

PERMIT TYPES AND PROCESSING FEES
Please review the complete application before beginning.
☐ Single-use Permit: A single-use permit is valid for six months from the date of issuance. For re-issuance or
amendment of a single-use permit, the original permit must be returned with this completed application form. You
may apply for a single-use permit for multiple animals or non-living specimens that is valid for a single export or
re-export. If you are making a single import, please use form 3-200-37.
☐ Export: A one-time export of CITES-listed animals or non-living specimens.

1 Specimen

was acquired (removed from the wild or held in captivity or a controlled environment) before the date CITES applied to
it (CFR 23.45 b1).
2 Specimen was born/hatched from parents mated in captivity in the United States with reliable documentation to that effect. See
Appendix I.
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☐ Re-export: A one-time export of animals or non-living specimens that were previously imported under a
CITES permit.
☐ Pre-Convention specimens: A one-time export of animals or non-living specimens that were obtained
before the species was listed under CITES. NOTE: No CITES import permit is required for an Appendix-I
specimen that qualifies as pre-Convention.
☐ Master File: This application form allows you set up a Master File, valid for up to 3 years and is renewable, for
exports or re-exports of one or more animals or non-living specimens. Once the Master File is approved, it
authorizes a number of exports, re-exports and/or imports over a three-year period, but you would still be required
to obtain CITES re-export documents for the re-exporting country before returning to the United States. You must
also obtain partially completed permits, valid for 6 months, for each export/re-export or import (50 CFR 13.11).
☐ To amend an established Master File: Allows you to amend a currently valid Master File. You must
complete the relevant sections within the application (3-200-52 may not be used to amend or renew this
Master File), providing information on any changes to the quantity, your facility, operations, or species for the
animals or non-living specimens that you wish to export.
☐ To reissue, or amend and reissue an established Master File: Allows you to renew your Master File that
has or will soon expire. You must complete relevant sections within the application (3-200-52 may not be
used to amend or reissue this Master File), including providing information on any changes to the quantity,
your facility, operations, or species for the animals or non-living specimens that you wish to export.
A fee is required for partially completed permits to accompany each shipment under a Master File: Once
the Master File is approved, you must also obtain partially-completed permits to accompany each export (50 CFR
13.11). The partially-completed permits will be valid for six months and can be requested using this form when
establishing or renewing a Master File. For future shipments, additional permits may be requested using FWS
Form 3-200-74.

GENERAL INFORMATION
Review this application carefully and provide complete answers to all of the questions in the sections relevant to
the activity for which you are requesting authorization. If you are applying for multiple species, be sure to indicate
which species you are addressing in each response. If a question is not applicable, answer with "N/A". If more space is
needed, attach a separate sheet with your responses numbered according to the questions.
To accommodate the different purposes of this application, please complete the sections that are applicable to your
request as laid out below:
Part I.

All applicants must complete (pg. 4).

Part II.

Live Animals (pgs. 5-7).

Part III.

Non-living Specimens (pgs.8-10).

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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.

PART I.
ALL APPLICANTS MUST COMPLETE
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 any of the owners of the business (if applying as a business, corporation, or institution), 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.
4. If requesting a single-use permit, provide the name and address of foreign recipient (if shipping to yourself, include
your foreign address):
Name:
Business Name:
Address:
City:
State/Province:
Country, Postal Code:
5. If requesting renewal, amendment, or establishment of a Master File, please be aware that partially completed
permits must be issued off of the Master File in order to ship the requested specimen(s). Considering that partially
completed permits are only valid for a 6-month period, please specify the number you are requesting at this time:
______ (Provide the additional fee per requested permit).

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PART II
LIVE ANIMALS
6. For EACH animal, provide the following. If your application covers more than one animal, be sure to answer
questions 8 through 16 for each animal being addressed in the application.
Live animals
Scientific name
(genus, species, and
if applicable,
subspecies) and
Common name

Gender,
if
known

Date of Birth
(MM/DD/YYYY
)

Source
(Wild or
Born in
captivity)

Country of last
re-export

Description (e.g., I.D. #, band #,
tattoo #, tag #, size, microchip #,
house name). If microchip #,
provide manufacturer and
location of microchip 3. (Border
officials must be able to verify
that the permit and the animal
correspond.)

BORN IN CAPTIVITY
7. If you are the breeder, provide a statement that the animal was bred and born/hatched at your facility. This statement
must include:
a.

Birth/hatch date, and if applicable band/tag number, and sex of each specimen;

Name and address of your facility where the animal was bred and born;

Location of parental stock; and

Your signature and date.

8. If you are NOT the breeder, provide copies of documentation showing that you acquired the animal from the breeder
or documentation demonstrating the history of transactions (chain of ownership of each animal) and a signed
statement from the breeder or breeder's record that includes:
a.

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

Birth/hatch date, and, if applicable, band/tag number, or other identifiers;

Sex of each specimen;

Location (Name, Street address, City, State) of Parental Stock;

Complete name and address of the breeder's facility.

COLLECTED FROM THE WILD
9. If the animal was collected from the wild, provide the following:

3The

exporter may be asked to have a microchip reader on hand to read the microchip at the time of export.
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Location of where, when, and by whom (name/address) the specimen was removed from the wild;

Purpose of removal;

Copy of any permits or other documents from the State or local wildlife authorities approving the activities;

Documentation showing that the specimens were legally acquired by the applicant; and

Copies of any applicable State permits or licenses that are required to house, maintain, and breed these
specimens (contact your State for information).

10. If this animal qualifies as pre-Convention, provide documents, signed statements or other evidence that the wildlife
was born or removed from the wild prior to the date CITES applied to it (e.g., bill of sale, ISIS record, breeder's
record).
11. For animals protected by the U.S. Endangered Species Act (ESA):
Is the animal pre-Act (acquired or held in a controlled environment on or before (a) December 28, 1973 or the date
when the species was listed, and (b) has not entered into commerce (e.g., been bought, sold, or offered for sale by
you or anyone else) since December 28, 1973, or the date when listed)?
a.

If yes, provide evidence that meets the above criteria.

If no, you must be able to show that your proposed activity would meet the issuance criteria under ESA. For
endangered species, permits can be issued for activities that enhance the survival or propagation of the
species or scientific research. For threatened species, permits can be issued for the above reasons, as well
as education, zoological display, or other purposes that would meet the purpose of the Endangered Species
Act.
Provide a statement, and documentation to support the statement, on how the activities will enhance or
benefit the wild population (in-situ and ex-situ projects). While permits cannot be issued solely for
educational or display purposes for endangered species, if your activities include conservation education,
provide copies of educational materials (e.g., handouts, text of signage or public presentations). If you are
submitting more than one application at this time for a group of animals, you can complete this section on
one application and refer any subsequent application to this statement. If you need more explanation on this
question, please contact the Division of Management Authority.

12. If your activity includes public presentations, please provide the following:
a.

In what type of presentation are you proposing to use the specimen (e.g., live performance, movie, TV)?

Provide a copy of the actual script or material that will be presented to the audience at each performance,
show, or viewing of the specimen(s). This material must be original in nature (e.g., photocopies from a
reference book are not appropriate) and must be the actual material that will be presented each time the
animal is viewed by the target audience.

Will fact sheets, brochures, or posters be used? Is the written material available free-of-charge?

When will the material be presented? If the material will be presented orally, when will this presentation be
given? What activities will be occurring at the same time the presentation of the message is being provided
and could the activity diminish the effectiveness of the presentation? If the material will be presented in a
written form, will an oral announcement be made regarding the availability of this material? If the material is
in poster form, will the posters be placed so that the material will be accessible by the public?

When exhibiting in countries where English is not the primary language, explain how the conservation
education information will be presented to the non-English speaking audience.

13. If the animal a non-human primate, provide a copy of your current Centers for Disease Control (CDC) registration.
14. For live exhibitions, provide the following on your facilities:
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Provide address of the permanent facility where the animal(s) is/are maintained.
i.

Name of Facility

ii.

Address

iii.

City, State, Zip code

A detailed description, including size, construction materials, protection from the elements, and photographs
or detailed diagrams clearly depicting the permanent facilities;

Provide the same as above for transportation units used while traveling within the United States and abroad.
The transport conditions must comply with 50 CFR Part 13, the CITES Guidelines for Transport of Live
Animals, as well as the Animal Welfare Act and, in the case of air transport, with the International Air
Transport Association (IATA) (www.iata.org/cargo/live.htm) live animal regulations. Your description must
include:
i.

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

ii.

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

iii.

Description of the qualifications of the individuals to train and care for the animal, including the
number of years’ experience with this species or similar species, and names of current caretakers.

15. For live exhibitions, provide a list all mortalities of ESA listed species which occurred at your facility during the past
five years, and explain the cause of the mortalities and measures taken to prevent future mortalities if appropriate.

16. Provide copies of any applicable permits, licenses and registrations (State Fish and Game, U.S. Department of
Agriculture Animal Welfare Act (AWA), Center for Disease Control and Prevention).
All international shipment(s) must be 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).

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PART III NON-LIVING SPECIMENS
17. For EACH non-living specimen, provide the following. If your application covers more than one specimen, be sure to
answer questions 19 through 28 for each specimen being addressed in the application.
Scientific
name (genus,
species, and if
applicable,
subspecies)
and Common
name

Date of
Manufactu
re

Description of
item
(published
description
from a catalog
or art book)

Size (in
metrics)

Date of acquisition (e.g.
bill of sale, US
Customs import
declaration, transfer
document)

BORN IN CAPTIVITY
18. If you are the breeder of the animal from which the specimen was obtained, provide a statement that the animal was
bred and born/hatched at your facility. This statement must include:
a.

Birth/hatch date, and if applicable band/tag number, and sex of each specimen;

Name and address of your facility where the animal was bred and born;

Location of parental stock; and

Your signature and date.

19. If you are NOT the breeder of the animal from which the specimen was obtained, provide copies of documentation
showing that you acquired the animal from the breeder or documentation demonstrating the history of transactions
(chain of ownership of each animal) and a signed statement from the breeder or breeder's record that includes:
a.

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

Birth/hatch date, and, if applicable, band/tag number, or other identifiers;

Sex of each specimen;

Location (Name, Street address, City, State) of Parental Stock;

Complete name and address of the breeder's facility.

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COLLECTED FROM THE WILD
20. If the specimen was collected from the wild, provide the following:
a.

Location of where, when, and by whom (name/address) the specimen was removed from the wild;

Purpose of removal;

Copy of any permits or other documents from the State or local wildlife authorities approving the activities;

Documentation showing that the specimens were legally acquired by the applicant; and

Copies of any applicable State permits or licenses that are required to house, maintain, and breed these
specimens (contact your State for information).

21. If this specimen qualifies as pre-Convention, provide documents, signed statements or other evidence that the
wildlife was born or removed from the wild prior to the date CITES applied to it (e.g., bill of sale, ISIS record, breeder's
record).
22. For specimens protected by the U.S. Endangered Species Act (ESA):
Is the specimen is pre-Act (acquired or held in a controlled environment on or before (a) December 28, 1973 or the
date when the species was listed, and (b) has not entered into commerce (e.g., been bought, sold, or offered for sale
by you or anyone else) since December 28, 1973, or the date when listed)?
a.

___ If yes, provide evidence that meets the above criteria.

___ If no, you must be able to show that your proposed activity would meet the issuance criteria under ESA.
For endangered species, permits can be issued for activities that enhance the survival or propagation of the
species or scientific research. For threatened species, permits can be issued for the above reasons, as well
as education, zoological display, or other purposes that would meet the purpose of the Endangered Species
Act.
Provide a statement, and documentation to support the statement, on how the activities will enhance or
benefit the wild population (in-situ and ex-situ projects). While permits cannot be issued solely for
educational or display purposes for endangered species, if your activities include conservation education,
provide copies of educational materials (e.g., handouts, text of signage or public presentations). If you are
submitting more than one application at this time for a group of animals, you can complete this section on
one application and refer any subsequent application to this statement. If you need more explanation on this
question, please contact the Division of Management Authority.

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23. If your activity includes public presentations, please provide the following:
a.

In what type of presentation are you proposing to use the specimen (e.g., live performance, movie, TV)?

Will fact sheets, brochures, or posters be used? Is the written material available free-of-charge?

When exhibiting in countries where English is not the primary language, explain how the conservation
education information will be presented to the non-English speaking audience.

24. Current location of specimen(s):

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APPENDIX I
FOR THE PURPOSE OF EXPORT FROM THE UNITED STATES
SPECIES THAT QUALIFY AS CAPTIVE-BRED
IN ACCORDANCE WITH CONF. 10.16

MAMMALS
Order Primates
Callithrix jacchus - Common marmoset [App. II]
Cercocebus agilis – Agile mangabey [App. II]
Lophocebus spp. – Mangabeys [App. II]
Erythrocebus patas - Patas monkey [App. II]
Macaca fascicularis - Crab-eating macaque [App. II]
Macaca mulatta - Rhesus monkey [App. II]
Order Carnivora
Canis lupus (Alaskan population) - Gray wolf [App. II]
Caracal (=Felis) caracal - Caracal [excluding Asian population]
Leptailurus (=Felis) serval - Serval [App. II]
Panthera leo - Lion [excluding Asian population]
Order Artiodactyla
Antilope cervicarpa - Blackbuck [App. III]
Hexaprotodon liberiensis- Pygmy hippopotamus [App. II]
Hippopotamus amphibius - Hippopotamus [App. II]
Lama guanicoe - Guanaco [App. II]
BIRDS
Order Anseriformes
Cygnus melanocoryphus - Black-necked swan [App. II]
Order Falconiformes
Buteo buteo - European buzzard [App. II]
Order Galliformes
Argusianus argus - Great argus pheasant [App. II]
Gallus sonneratii - Sonnerat'sjunglefowl, Gray junglefowl [App. II)
Polyplectron bicalcaratum - Gray peacock pheasant [App. II]
Polyplectron germaini - Germain's peacock pheasant [App. II]
Polyplectron malacense - Malaysian peacock pheasant [App. II]
Order Psittacifornies
Aratinga jandaya - Jendaya parakeet [App. II]
Barnardius zonarius barnardi - Malice ringneck parrot [App. II]
Bolborhynchus lineola - Lineolated parakeet [App. II]
Cyanoramphus auriceps - Yellow-fronted parakeet [App. II] (excluding C. a. forbesi)
Forpus coelestis - Pacific parrolet [App. II]
Neophema chrysostoma - Blue-winged parrot [App. II]
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Neophema elegans - Elegant parrot [App. II]
Platycercus adscitus - Pale-headed rosella [App. II]
Platycercus elegans - Crimson rosella [App. II]
Platycercus eximius - Eastern rosella [App. II]
Platycercus icterotis - Western (Stanley) rosella [App. II]
Platycercus venustus - Northern rosella [App. II]
Polytelis alexandrae - Princess parrot [App. II]
Polytelis anthopeplus - Regent parrot [App. II]
Polytelis swainsonii - Superb parrot [App. II]
Psephotus haematonotus - Red-rumped parakeet [App. II]
Psephotus varius - Mulga parakeet [App. II]
Psittacula eupatria - Alexandrine parakeet [App. II]
Purpureicephalus spurius - Red-capped parrot [App. II]
Trichoglossus chlorolepidotus - Scaly-breasted lorikeet [App. II]
Order Passeriformes
Poephila cincta cincta - Parson finch [App. II]
REPTILES
Order Squamata
Antaresia childreni - Children's python [App. II]
Antaresia maculosa - Spotted python [App. II]
Antaresia perthensis - Pygmy python [App. II]
Boa constrictor - Boa constrictor [App. II] (includes B. c. contrictor, B. c. imperator, B. c. melanogaster, B.
c. mexicana, and B. c. ortonii)
Eryx johnii - Blunt-tailed sand boa [App. II]
Eunectes murinus - Green anaconda [App. II]
Morelia spilota variegata - Carpet python [App. II]
Python curtus - Sumatran short-tailed python [App. II]
Python reticulatus - Reticulated python [App. II]
Python molurus bivittatus - Burmese python [App. II]
Python regius - Ball or royal python [App. II]
Python sebae - African rock python [App. II]
Python natalensis - Southern African rock python [App. II]
AMPHIBIANS
Order Caudata
Ambystoma mexicanum - Axolotl [App. II]

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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 (original submission - electronic) and 1
hour (original submission - paper-based) and 20 minutes (amended submission - electronic) and 30 minutes (amended
submission - paper-based), 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 13 of 13

File Type	application/pdf
File Title	NPS Form 10-29
Author	dhaas
File Modified	2020-03-09
File Created	2020-01-24