Form 3-200-37c Application -Take (Cull, Lethal Harvest) of a Live Anima

FWS Form 3-200-37c (Rev. 01/2020)
U.S. Department of the Interior

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

TAKE (CULL, LETHAL HARVEST) OF A LIVE ANIMAL UNDER A VALID CBW (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

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.
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FWS Form 3-200-37c (Rev. 01/2020)
U.S. Department of the Interior

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

E. Take (cull, lethal harvest) of LIVE Exotic Animals under a valid Captive Bred Wildlife (CBW) Registration
(ESA)
This application is for the take (culling) of excess exotic endangered or threatened species by an agent of a CBW
holder permit holder. The applicant must either possess or must concurrently apply for a CBW (3-200-41) for the
same species for which take will occur. Additionally, the applicant needs to document the trophy fees to be charged
to an agent and clearly identify what portion of those trophy fees are to be donated towards in situ projects for each
species for which authorization is being sought. Please allow at least 90 days for the application to be processed.
ESA
To determine whether an exotic animal species is protected under the ESA, please review the list of ESA-listed
species in the Code of Federal Regulations.
Please be aware that any permit request involving an ESA endangered species must be published in the Federal
Register for a required 30-day public comment period.
Questions
If you have any questions regarding an action you are requesting authorization for please contact the Division of
Management Authority at [email protected].
Please note: for renewal or amendment of a cull/take permit being requested within the 5 year Federal Register
public notice period, use application 3-200-52
This form should NOT be used to apply for a Captive Bred Wildlife Registration (use application 3-200-41).

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.

All applicants must complete
Electronic Information Submission
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. Point of contact if we have questions about the application (name, phone number, and email).
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?
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FWS Form 3-200-37c (Rev. 01/2020)
U.S. Department of the Interior

____ No

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

____ 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. What is the valid CBW # __________ that you are conducting take under? Provide a copy. If you do not possess a
valid CBW, indicate whether you have applied for one.
5. List all locations where animals will be maintained:
Name:
Address:
City:
State/Province:
Postal Code:
DESCRIPTION AND JUSTIFICATION FOR REQUESTED ACTIVITY
6. For each species provide the following:
a.
b.
c.
d.
e.
f.
g.
h.
i.

Scientific name (genus, species, and if applicable, subspecies),
Common name,
Current inventory (males.females.unknown sex.,10.2.3),
Number of years the species has been maintained at the facility,
Number of births per year over the past 5 years,
Number of mortalities per year over the past 5 years and steps taken to avoid or decrease mortalities
including natural predation,
Approximate carrying capacity for the species at your facility,
List of fees per species charged for a hunt,
Number of animals per species you anticipate culling per year.

7. Please provide a detailed description on how the proposed activities will enhance or benefit the wild population
within its native range (e.g., direct or indirect conservation efforts) and provide documentation (e.g., signed
memorandums of understanding) demonstrating your commitment to supporting specific programs and how these
programs contribute directly to the species identified in your application.

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FWS Form 3-200-37c (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:
Original submission - paper-based: 1 hour
Amended submission - paper-based: 45 minutes
Original submission - electronic: 45 minutes
Amended submission - electronic: 30 minutes
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.

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