Form 3-200-41 Application - Captive-Bred Wildlife Registration (U.S. E

FWS Form 3-200-41 (Rev. 07/2020) OMB Control No. 1018-0093

U.S. Department of Interior Expires ##/##/####

CAPTIVE-BRED WILDLIFE REGISTRATION (U.S. Endangered Species 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.^**

Complete if applying as an individual
1.a. Last name			1.b. First name		1.c. Middle name or initial	1.d. Suffix
2 Date of birth (mm/dd/yyyy)	5.a. Telephone number	5.b. Alternate telephone number		6. 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.a. Description of business, agency, Tribe, or institution				3.b. Website URL (if applicable)
4.a. Principal officer (P.O.) last name	4.b. P.O. first name		4.c. P.O. middle initial		4.b. P.O. Title
5. Primary contact name			6. Primary e-mail address
7.a. Business telephone number		7.b. Alternate phone no.		8.a. Primary contact telephone no.

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

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

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.

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.

E. CAPTIVE-BRED WILDLIFE REGISTRATION (U.S. Endangered Species Act)

Please use the following application for all CBW requests. The CBW registration was designed to facilitate export, reimport, interstate and foreign commerce of exotic species that are captive born in the U.S. Obtaining a registration under the permitting regulations found at 50 CFR 17.21(g) means that otherwise prohibited activities are allowed for the purpose of enhancing the propagation or survival of the species (conservation breeding). Therefore you application must show how your activities will either enhance organized breeding programs or in situ projects to enhance the survival of the species in the wild. Loans and donations are not prohibited by the Act.

All applicants must complete Part 1 of the application. A CBW Registration remains valid for five years and may be renewed once for a total validity of ten years, after which the CBW Registration number will be retired and you must apply for a new CBW Registration. If a renewal application is submitted thirty days or more prior to the CBW Registration expiring, the applicant may continue to conduct previously authorized activities during the renewal process. However, if the application is submitted fewer than thirty days prior to expiration, activities must cease at the time the registration expires until the renewal process is completed.

• For New applications and amendments, complete Part 2 of the application. You may renew your CBW once after 5 years, but after a CBW registration has been valid for 10 years, you must submit a complete new application responding to all questions.

*** Please note: If you have a change of mailing address, you must notify the Service within 10 days. If your facilities move, you will need to apply for an amendment.

• To renew your CBW (it has been less than 10 years since you submitted a completely new application), complete Part 3 of this application.

• If you maintain exotic wildlife in a natural setting, such as a ranch, complete Part 1 and Part 4 only of the application.

Electronic submission of inventories, photographs, and receipts/invoices: If you wish to provide information electronically, please include a flash drive containing this information with your physical application.

Part 1: 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 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.

4. Provide copies of any license or registration under the Animal Welfare Act regulations of the U.S. Department of Agriculture (9 CFR 2) (if required) and/or any State license or registration required to maintain or breed the species requested in Part 2 or Part 3 below. If available, provide a copy of your last two (2) USDA AWA inspection reports.

5. The exact location(s), including address(es), where the wildlife requested in this application will be maintained. If more than one location exists, list all that apply. NOTE: You must report any change in address or location of facilities to the Division of Management Authority within 10 days of such a change taking place.

4. Provide a current inventory, including those out on loan, for each of the exotic ESA-listed species you are requesting to include or have already been approved to hold (if currently holding a valid CBW registration) on your CBW registration.

4. Attach a brief resume for all senior animal care staff or personnel that will be working with or maintaining each species, including the number of years’ experience with this species or similar species.

Part 2: New Application, Amendment, or Renewal of CBW which are older than 10 years:

FOR EACH SPECIES BEING REQUESTED for inclusion in a registration, whether a new application or amendment, complete each of the following questions. Signify that you have read each question by writing “N/A” if non-applicable. If submitting hard copy pages, please indicate the species and the application question number you are addressing.

4. The scientific name (genus, species and, if applicable, subspecies) and common name of each species for which you wish to be registered.

4. The name, address, and CBW registration number of the person(s) or institution(s) from whom you plan to acquire the wildlife, including the sale or loan agreements for the specimens. If currently unknown, describe your efforts, including documentation, to acquire appropriate specimens for your breeding efforts.

4. Indicate if there is an organized breeding program that you are currently involved with or if you have communicated with other breeding organizations regarding your potential participation in those programs. Provide documents to show you are currently involved with a breeding program or include any communication you have had with breeding organizations that you wish to be involved.

4. Provide a description of how your proposed activities are going to facilitate captive breeding for conservation purposes of this species, including your long-term goals for your breeding program and intended disposition of any progeny. Be specific.

4. Provide a detailed description and documentation showing how your captive population is being managed to maintain its genetic vitality. If you do not currently maintain a sufficient number of specimens for each species being requested to successfully maintain the genetic viability of the species, you must participate in an organized breeding program. Please identify this program and provide documentation describing the objectives and goals of the program, and confirmation that you are a participant in this program.

4. If your activities include the holding of surplus animals (i.e., not currently needed in and not being bred) for an organized breeding program, document how your acquisition of such wildlife will relieve crowding at the locations from which the wildlife will be obtained, and thereby assist the breeding program for the species involved. Provide documentation that you are a participant in an organized breeding program where the holding of surplus wildlife has been identified as a necessary objective of the breeding program. Provide a description of how you will restrict/control breeding at your facility.

4. For each requested species, provide a description of your experience in maintaining and propagating the requested species or similar species, including:

1. The number of years you or the facility has/have maintained the requested species or similar species.

2. During the past five years, how many (by species, by year) successful births/hatchings of each requested species or similar species have occurred at your facility? How many survived beyond 30 days?

3. How many mortalities of requested species or similar species have occurred at your facility during the past five years? What were the causes? What measures have you taken to prevent future mortalities?

4. Provide a detailed description, including size, construction materials, and protection from the elements, as well as photographs and detailed diagrams (no blueprints) clearly depicting your existing facilities, including space for future progeny, where the wildlife will be maintained.

Part 3: Applications to Renew CBW registrations that are 5 years old or less:

All CBW registrants are required to submit an annual report on activities conducted at the facility over the previous year, as well as a current inventory of all species covered under the registration. If you have already responded to the following questions in your annual report, please note that in your answer to the question.

4. Have there been any changes to your operation such as reconstruction or new construction, new facilities, or other physical changes? If yes, please describe them.

4. Have there been any changes to senior staff or personnel changes that would affect how your operation handles the species included in the registration? If yes, please describe these changes.

4. Have there been any changes to your inventory that have not been reflected in your annual reports or the current inventory list provided to the Service? If yes, please describe these changes.

4. Is there any additional information that you believe the Service should be aware of in regards to your operation, facilities, inventory, or business model?

Part 4: Applications for wildlife that is maintained in a natural setting:

20. Provide a specific description of how your proposed activities are going to facilitate captive breeding for conservation purposes of this species, including your long-term goals for your breeding program and intended disposition of any progeny. Be specific.

20. How often do you conduct surveys of your wildlife?

20. How do you determine and identify which specimens are surplus to your operation?

20. What is the approximate maximum number of specimens of each species your facility can support?

20. What are you doing to prevent predation of stock?

20. Provide a detailed description as well as photographs clearly depicting your existing facilities, including space for future progeny, where the wildlife will be maintained.

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) to 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 to average 2 hours, 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 (JAO/3W), 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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