Form 3-200-37e Application - Import/Export/Re-Export of Biological Spec

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

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

IMPORT/EXPORT/RE-EXPORT OF BIOLOGICAL SPECIMENS (CITES/ESA)
FOR SCIENTIFIC RESEARCH
☐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 3-200-37e (Rev. 01/2020)
U.S. Department of the Interior

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

E. Import/Export/Re-export of Biological Specimens (CITES/ESA) for Scientific Research

General Information
This application covers activities involving CITES and ESA-listed animal specimens used for scientific research,
including any readily recognizable parts, products, or derivatives unless otherwise noted in the Appendices.
Review this application carefully and provide complete answers to all of the questions. If you are applying for
multiple species, be sure to indicate which species you are addressing in each response. If more space is
needed, attach a separate sheet with your responses numbered according to the questions.
Please allow at least 90 days for the application to be processed.

How do I determine whether the species is protected under CITES and/or the ESA?
To determine whether an animal species is
protected under CITES, when the species was
listed, or whether exemptions apply to your
requested activity, visit the CITES listed species

To determine whether an animal species is
protected under the ESA, please review the list of
ESA-listed species in the Code of Federal
Regulations electroniccodeoffederalregulations.gov
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.

●
●

If applying as an individual or institution please note that you will have to pay the appropriate permit fee.
If applying as an institution that is (or is acting) on behalf of a Federal, Tribal, State, and/or local
government agency, no permit fee is required. Provide fee exempt documentation with your application
materials.
○ The individual signing the permit must have legal authority to do so if applying on behalf of the
institution.

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 multi-use permit being requested within the 5 year Federal Register
public notice period, use application 3-200-52
This form should NOT be used for:
●
●

Captive Bred Wildlife Registration (use application 3-200-41)
ESA Plants (use application 3-200-36)

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.

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

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

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?
____ 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.
PROPOSED ACTIVITY

☐ Import

☐ Export
☐ Re-export (e.g. export of a specimen that was previously imported into the United States)
4. The current location of the samples (if different from the physical address provided on pg. 1):
Name:
Address:
City:
State/Province:
Postal Code:
Country:

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

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

5. Recipient/Sender:

●

If export or re-export, provide name and physical address of the recipient in the foreign country.

●

If import, provide name and physical address of the exporter/re-exporter in the foreign country.

Name:
Address:
City:
State/Province:
Postal Code:
Country:
6. Information on the type of biological samples involved in the import/export/re-export, provide for each species (you
may use the table located below):
a.

Scientific name (genus, species, and, if applicable, subspecies);

b.

Common name;

c.

Number and type of sample(s) (e.g. 10 blood samples, ear clips, etc.)

d.

Source (wild or captive-born)

e.

Approximate date of collection (MM/YYYY)

f.

Description of packaging (vials, slides, envelopes, etc.)

g.

Total # of all samples in shipment.

a. Scientific name
(genus, species, and, if
applicable, subspecies)

EXAMPLE:
Pan troglodytes

b. Common
Name

c. Number & type of

d. Wild or
Captive born

e. Appx date of
collection
(mm/yyyy)

f. Description of packaging
(vials, slides, envelopes,
etc)

Chimpanzee

10 blood samples; 4
hair samples

W

08/2015

Vial
Envelope

sample/part

g. TOTAL # of
all samples in
the shipment:

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

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

SOURCE OF SPECIMEN
7. For each biological sample taken from a captive-born/captive hatched animal(s), provide a signed and dated
statement from the breeder or appropriate documentation (e.g. Species 360 report) that includes the following:
a.

Scientific name (genus, species, and if applicable, subspecies),

b.

Common name,

c.

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

d.

Birth/hatch date (mm/dd/yyyy),

e.

Identification information (studbook #, microchip, leg band, etc.),

f.

Name and address of facility where the parental stock is located; and

g.

A statement from the breeder that the animal was bred and born at the breeder’s facility (including the
facility’s name and address), and

h.

If not the breeder, documentation demonstrating the history of transactions (e.g., chain of custody or
ownership of the sample(s), if applicable).

8. For each biological sample taken from an animal in the wild, provide:
a.

Scientific name (genus, species, and if applicable, subspecies),

b.

Common name,

c.

Specific location (e.g., county, state, province, country) where the samples were taken from the wild,

d.

The name of the individual(s) who collected the animal/samples and their authorization to do so including (but
not limited to) copies of foreign and domestic (Federal, State, and/or Tribal) government collecting permits,
licenses, contracts and/or agreements.

e.

Method of collection: sampling protocol, approximate length of time held in captivity, any injury and/or
mortality experienced during collection, transport, or holding;

f.

Information related to any remuneration, either financial or in-kind, provided for acquiring the sample(s);

g.

Efforts to use captive specimens (e.g., captive-born, captive-held), in lieu of taking samples from wild animals.

9. For each biological sample being re-exported (e.g., exporting a specimen that was previously imported into the
United States), provide:

a.

A copy of the canceled CITES export or re-export document issued by the appropriate CITES office in the
country from which the wildlife was imported;

b.

A copy of your Declaration for Importation or Exportation of Fish or Wildlife (Form 3-177), cleared by USFWS
Office of Law Enforcement.

c.

A copy of the ESA permit that authorized the original import.

d.

If you did not make the original import, please provide documentation outlining chain-of-ownership since
import, including:

i.

A copy of the importer's CITES, ESA, and declaration documents (a, b, & c above) and,

ii.

Subsequent invoices (or other documentation) showing the history of transactions leading to your
ownership of the sample(s) after import (provenance).

DESCRIPTION AND JUSTIFICATION FOR REQUESTED ACTIVITY
10. Describe the purpose of the scientific research and include:
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FWS Form 3-200-37e (Rev. 01/2020)
U.S. Department of the Interior

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

a. A copy of the research proposal (outlining the purpose, objectives, methods),
b. How long the research has been (or will be) conducted,
c. Detailed information on sampling methods including:
i.
who will be taking the samples
ii.
equipment and methods used
iii.
measures taken to prevent injuries and mortalities during collection
d. A copy of the study’s Institutional Animal Care and Use Committee (IACUC) form (if applicable),
e. Peer-reviewed scientific papers published from this research (if applicable),
f. An explanation of whether similar research has already been conducted or is currently being conducted.
11. 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 the program and how the program
contributes directly to the species identified in your application.

TECHNICAL EXPERTISE & AUTHORIZATIONS
12. CV or resume outlining the technical experience of the researchers and field technicians collecting the samples, as it
relates to the proposed activities, including experience with other similar species.

SHIPMENT INFORMATION
13. Please indicate if this is a one-time shipment or if you anticipate needing to import/export/re-export samples
multiple times within one year or over multiple years.
14. How will the samples be imported or exported (e.g., personally carried or shipped)?
15. If personally carried, please specify the individual(s) who will be transporting the samples.
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).

CITES APPENDIX I & MARINE MAMMAL SPECIES
●

For export of a CITES Appendix I-listed 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.

●

For import of CITES Appendix-I listed species, provide information to show the import is not for primarily
commercial purposes as outlined in Resolution Conf. 5.10 (Rev CoP15).

●

For import of CITES Appendix-I marine mammal samples, please provide a copy of your FWS or NMFS
Marine Mammal Protection Act (MMPA) permit or authorization.

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FWS Form 3-200-37e (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: 2 hours
Amended submission - paper-based: 1 hour 45 minutes
Original submission - electronic: 1 hour 45 minutes
Amended submission - electronic: 1 hour 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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