Form 3-200-75 Application - Registration of a Production Facility for

FWS Form 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

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

REGISTRATION OF A PRODUCTION FACILITY FOR EXPORT OF NATIVE CITES SPECIES
☐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 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

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

E. REGISTRATION OF A PRODUCTION FACILITY FOR EXPORT OF NATIVE CITES SPECIES
This application is to be used by qualified production facilities to establish an annual registration, or master file, to
export certain native species (if requesting authorization for sturgeon or paddlefish, please use form 3-200-76 or 3-20080. The master file will allow the registrant to obtain a number of single-use CITES export documents (at a cost of $5
each) for approved species. Please contact the Division of Management Authority or see our webpage at for a list of
qualified species and conditions that must be met to qualify for registration, or to answer any questions you may have.
The U.S. FWS may not be able to issue CITES documents for the commercial export of Appendix-I specimens,
unless the specimens were obtained from animals produced at a CITES-registered Appendix-I commercial
breeding operation. For more information on registering an Appendix-I commercial breeding operation, contact
the Division of Management Authority at [email protected].
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.
This application can be used to:
___ ESTABLISH A NEW REGISTRATION
This application allows you set up a Registration, valid for one year and renewable, for exports of certain native
species under CITES. Once the Registration is approved, you will need to obtain single-use permits, valid for 6
months, for each export (50 CFR 13.11.)
____ RENEW AND/OR AMEND AN EXISTING REGISTRATION, FILE # _____________
For either the establishment of a new registration or renewal/amendment of an existing registration, please
indicate the number of single-use permits you anticipate using in the next 6 months _____________
(Provide $5 for each 6-month permit.) Additional permits may be requested by submitting 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 (questions 1-8)

Part II

Captive-bred Appendix II species and captive-bred
Appendix III species other than Graptemys sp. or
Macrochelys temminckii (questions 9-15)
Wild collected Appendix II species and wild collected
Appendix III species other than Graptemys sp. or
Macrochelys temminckii (questions 16-19)

Part III

NOTE: For those applying to register a facility solely for Appendix III Graptemys sp. (map turtles) and/or
Macrochelys temminckii (alligator snapping turtles), complete Part I only.

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FWS Form 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

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

PART I
ALL APPLICANTS MUST COMPLETE
Please respond to each of the following questions and provide all information requested. Mark questions that
are not applicable with “N/A”. If needed, use separate sheets of paper. Please indicate the question number
you are addressing on all attachments or separate sheets you submit. If you are applying for multiple species,
be sure to indicate which species you are addressing in each response.
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. Scientific (genus, species, and if applicable, subspecies) and common name of species to be registered.

5. Description of all products and/or specimens to be exported (e.g., live, whole carcasses, meat). If live, what are
the typical sizes being exported (e.g., hatchlings, sub-adults, adults)?

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FWS Form 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

6. Location of farm or production facility (physical address, including county):
Name:
Street Address:
City/County:
State:
Zip Code:
7. Copies of any licenses or permits required for your farm or production facility under Federal, Tribal, State, or local
laws or regulations.

8. The transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals or,
in the case of air transport, with the International Air Transport Association (IATA) live animal regulations (contact
airline for information). As such, describe:
a.

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

b.

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

PART II
FOR ALL CAPTIVE-BRED APPENDIX II SPECIES AND OTHER CAPTIVE-BRED APPENDIX III SPECIES:
Provide the information requested in 9 through 15 if the registration is for a species listed in Appendix II or Appendix
III species other than Graptemys sp, and Macrochelys temminckii.
9. Description of your production system (e.g., how your specimens are produced; number of male and female
breeding stock maintained at your facility; whether you supplement your stock with individuals collected in the
wild; if supplemented from other sources, provide those sources and how often you supplement).
10. If the specimens for export are captive-bred, provide:
a.

Evidence the animals were captive-bred (e.g., breeder’s records, signed breeder’s statement, ISIS
documents)
Please note: If you are not the breeder of the wildlife, you must submit breeder’s records and copies of
invoices or other documents showing that you acquired the wildlife from the breeder. If there have been
several owners, show the history of transactions including invoices for each change of ownership from the
time the specimen was harvested until the time you purchased it.

b.

Evidence that your founder stock was legally taken (e.g., State license and tag number)

c.

Purpose founder stock was removed from the wild

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FWS Form 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

d.

Where founder stock specimens were taken (exact location)

e.

Date they were taken

f.

Gear used to capture founder stock specimens

OMB Control No. 1018-0093
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11. Estimate of your production and export of specimens for the coming year. If dealing with more than one type of
specimen, please provide estimates for each of them.

12. Normal mortality rates at your facility. If you have experienced unexpected or higher than normal mortality rates,
disease breakouts, or contaminant events at your facility during the past five years please provide a brief
discussion.

13. As the Breeder, sign (in ink) the following statement:
I hereby certify that the animal(s) submitted on this application to be exported was bred and born/hatched
from parental stock at my facility listed below. (Additional information on the parental stock may be
requested upon receipt of your application).
Name and address of your facility where the animals were bred and born/hatched:
Name:
Street Address:
City/Providence:
State, Zip Code:
Current location of parental stock:
Name:
Street Address:
City/Providence:
State Zip Code:
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FWS Form 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
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Signature ___________________________________________________Date __________________
14. If you are NOT the breeder of the specimen(s), provide copies of documentation showing that you acquired the
Animal(s) 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;

b.

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

c.

sex of each specimen he/she bred;

d.

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

e.

complete name and address of the breeder's facility.

15. Provide labeled photographs depicting the facilities for the specimens described in your application.
PART III
FOR WILD-COLLECTED APPENDIX II SPECIES AND OTHER WILD-COLLECTED APPENDIX III SPECIES:
Provide the information requested in 16 through 19 if the registration is for a species listed in Appendix II or
Appendix III species other than Graptemys sp, and Macrochelys temminckii.
16. For specimens taken from the wild, provide:
a.

Evidence that the specimens will be legally taken (e.g., State license, collection permits)

b.

Purpose for removal from the wild

c.

State and county/parish (if known) where specimens will be taken

d.

Dates specimen are typically taken

e.

Gear used to capture specimens, if applicable

17. Provide a description of your production facility (e.g., do you remove specimens for the wild for immediate export;
do you maintain specimens until they are a large size; do you sell live animals, skins, or meat).

18. Provide labeled photographs depicting the facilities for the specimens described in your application.

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FWS Form 3-200-75 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
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19. The export of some CITES species require that skins be tagged before being exported. If that is the case with
your specimens, we will either request a list of tags while we are processing your application or, if approved, have
you incorporate the list on the face of the permit that we issue.

All exports and re-exports 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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FWS Form 3-200-75 (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: 30 minutes
Amended submission - paper-based: 20 minutes
Original submission - electronic: 20 minutes
Amended submission - electronic: 15 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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