Form 3-200-48 Application - Import of Bird(s) Under an Approved Cooper

FWS Form 3-200-48 (Rev. 01/2020)
U.S. Department of the Interior

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

IMPORT OF BIRD(S) UNDER AN APPROVED COOPERATIVE BREEDING PROGRAM
(WBCA)
☐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 3-200-48 (Rev. 01/2020)
U.S. Department of the Interior

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

E. IMPORT OF BIRD(S) UNDER AN APPROVED COOPERATIVE BREEDING PROGRAM (WBCA)
This application is used after you have an approved Cooperative Breeding Program (CBP). To apply for a
CBP, submit form 3-200-49 prior to submitting this application.
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 number of the
application question you are addressing. If applying to import multiple birds, be sure to indicate which bird is
being addressed in each response.
Electronic submission of inventories, photographs, and receipts/invoices: If you wish to provide information electronically,
please include a flash drive containing your 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 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. Provide the name and number of the approved CBP:______________________________________________.

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FWS Form 3-200-48 (Rev. 01/2020)
U.S. Department of the Interior

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

5. For each specimen to be imported, provide the following:
Scientific name (genus, species, and, if
applicable, subspecies)

Common
Name

Hatch date
Quantity Sex
(mm/dd/yyyy)
(m/f)

Removed from the wild or
captive-bred?

6. What is the current location of the bird(s)?
Name:
Address:
City/Province:
State, Country, Postal Code:
7.

Will each of the bird(s) identified in question 5 remain at your facility? If not, please identify the other CBP members
that will house the specimens.

8. If the bird(s) is/are still in the wild or was taken from the wild, provide:
a. The country and location where the removal will occur or occurred;
b. Date specimen(s) was/were removed from the wild or will be removed;
c.

The name and qualifications of the agency/individuals who will be taking/has taken the bird(s) from the
wild (brief resume or curricula vitae are acceptable);

d.

A copy of all foreign collecting permits or authorizing letters from the appropriate government authority
allowing the collection of the bird(s).

9. If the bird(s) was/were captive-bred, include:
a. Specimen report OR
b. A signed statement from the breeder containing the scientific and common name certifying that the bird(s)
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FWS Form 3-200-48 (Rev. 01/2020)
U.S. Department of the Interior

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

was/were hatched and bred by the breeder, including the name and address of the breeder, hatch date,
and when known, the identity of the parental bird(s);
c.

Documentation showing how the bird(s) was/were acquired including the history of transactions (e.g.,
chain of ownership), if applicable;

d. Provide documentation on the parental stock of the requested birds including from where the parental
stock was originally sourced and any other documentation detailing their acquisition. In some instances,
we may request documentation going back more than two generations.
10. Who is the foreign exporter?
Name:
Address:
City/Province:
State, County, Postal Code:
11. Provide a signed and dated letter of endorsement from the lead cooperator of the approved CBP. This letter must
include at a minimum an indication that the lead cooperator is aware of and agrees to the requested import. The letter
must also include a statement confirming that the requested bird(s) will be used in accordance with the guidelines
established for the CBP.
12. Provide a copy of the CITES export permit from the country of export.
13. Have there been any changes within the cooperative breeding program since it was last approved?
If so, please provide a brief discussion of these changes.

14. Certification Statement:
I certify that the bird(s) described in this application is being imported as part of a Service-approved WBCA
cooperative breeding program and will be used solely for purposes of that breeding program. I further certify that
the imported bird(s) and any progeny will be disposed of in accordance with the management plan approved as
part of the cooperative breeding program, and the Wild Bird Conservation Act and its regulations.
Signature __________________________________________ Date _______________
All international shipment(s) must be through a designated port. A list of designated ports (where an inspector is
posted) is available from the list of designated ports. 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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FWS Form 3-200-48 (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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