Form 3-200-60 Federal Fish and Wildlife Permit Application Form - Nati

FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM
U.S. FISH AND WILDLIFE SERVICE
Return to: U.S. Fish and Wildlife Service (USFWS)

Type of Activity: Native Endangered and Threatened Species
Interstate Commerce

click here for return addresses

Complete Sections A or B, and C, D, and E of this application. A U.S. address may be required in Section C, see instructions for details.
Refer to the Application Form Instructions for information on how to make your application complete and help avoid unnecessary delays.
A. Complete if applying as an individual
1.a. Last name

1.b. First name

1.c. Middle name or initial

2. Date of birth (mm/dd/yyyy)

3. Occupation

4.a. Affiliation/Doing business as (see instructions)

5.a. Telephone number

5.b. Alternate telephone number

6. E-mail address

1.d. Suffix

4.b. Website URL (if applicable)

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

3.b. Website URL (if applicable)

4.a. Principal officer (P.O.) last name

4.b. P.O. first name

4.d. P.O. e-mail address

5. P.O. title
7.a. P.O. telephone number

4.c. P.O. middle initial
6. Primary contact name

7.b. Alternate phone no.

8.a. Primary contact telephone no.

8.b. Primary contact e-mail address

C. All applicants MUST complete
1.a. Physical address (U.S. 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.e. County/Province

2.f. Country

2.a. Mailing address (if different than physical address) and name of contact person (if applicable)
2.b. City

2.c. State

2.d. Zip code/Postal code

D.

All applicants MUST complete

1.

Attach the nonrefundable application processing (check or money order), payable to the U.S. FISH AND WILDLIFE SERVICE in the amount
indicated on page 3. 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 Application Form Instructions (50 CFR 13.11(d)).

2.

Do you currently have or have you ever had any Federal Fish and Wildlife permits?
☐ Yes. List the number of the most recent permit you have held, or that you are applying to renew or amend: __________________________
☐ No.

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.

_____________________________________________________________________________________
Original or electronic signature of individual applicant/Principal Officer (no photocopied or stamped signatures)

____________________________
Date (mm/dd/yyyy)

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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

E. ALL APPLICANTS MUST COMPLETE.
Provide the information described in Section E. Be as complete and descriptive as possible. Please do not send pages that are over 8.5” x 11”,
videotapes, or DVDs. See page 8 for information on the Paperwork Reduction Act, Privacy Act, and Freedom of Information Act aspects of your
application.

OTHER FEDERAL, TRIBAL, STATE, OR LOCAL APPROVALS OR AUTHORIZATIONS REQUIRED TO CONDUCT YOUR REQUESTED ACTIVITY
Please be aware that there may be other requirements necessary to conduct proposed activities such as obtaining permission to work on Federal or
Tribal lands, a Federal bird banding permit, a Tribal, State, county or municipal permit, etc.
Have you obtained all required Federal, Tribal, State, county, municipal or foreign government approval to conduct the activity you propose?
☐ Yes. Provide a copy of the approval(s). List the Federal agency, Tribe, State, county, and/or municipality involved and type of
document required. Include a copy of these documents with the application.

☐ I have applied. List the Federal agency, Tribe, State, county, and/or municipality involved, date of application(s), and type
of permit(s). Provide the reasons why the authorizations/permits have not been issued.

☐ Not required. The proposed activity does not require issuance of other approvals and/or authorizations.

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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

APPLICATION TYPE AND PROCESSING FEES
Annual reports and any other required reports under your valid permit(s) must be on file before a permit will be considered for renewal or
amendment. Check the appropriate box below for the activity that you are requesting.
☐ Administrative change: You may update your name, address, telephone number, fax number, or e-mail address in your

current application package on file at any time. These changes are considered administrative changes, and an application
processing fee is not required. If you wish to make an administrative change, please complete pages 1-2 and indicate the
information you are updating (e.g., address, telephone number, etc.). Submit completed pages 1-2 to the appropriate
Regional Office (see https://www.fws.gov/endangered/permits/recovery-permits-contacts.html).

Requests other than an administrative change require an application processing fee, as described below. Mark the appropriate box and enclose a
check or money order payable to the U.S. Fish and Wildlife Service in the amount indicated. If you are fee exempt, attach evidence or a justification
and mark this box  (see section D.1.).
☐ New. $100 permit application processing fee
Note: Interstate commerce permits may not be renewed or amended, other than for administrative changes noted above.

DISQUALIFICATION FACTOR
A conviction, or entry of a plea of guilty or nolo contendere, for a felony violation of the Endangered Species Act, Lacey Act, Migratory Bird Treaty
Act, or the Bald and Golden Eagle Protection Act disqualifies any such person from receiving or exercising the privileges of a permit, unless such
disqualification has been expressly waived by the USFWS Director in response to a written petition (50 CFR 13.21(c)).
Have you or, if applying as a business, any of the owners of the business, been convicted, or entered a plea of guilty or nolo contendere, forfeited
collateral, or are currently under charges for any violations of the Endangered Species Act, Lacey Act, Migratory Bird Treaty Act, or the Bald and
Golden Eagle Protection Act?
☐ No.
☐ Yes. Provide the following (use a separate page(s) if needed to complete your response:
a)

The individual’s name:

b)

Date of charge:

c)

Location of incident:

d)

Court:

e)

Action taken for each violation:

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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

SPECIFIC RELEVANT ACTIVITY REQUIRED INFORMATION: INTERSTATE COMMERCE
Specific Relevant Activity Required Information
General permit regulations for the USFWS can be found at 50 CFR 13. Application requirements for Interstate Commerce permits under the ESA can
be found at 50 CFR 17.22(a)(1) for endangered wildlife species, 50 CFR 17.32(a)(1) for threatened wildlife species, 50 CFR 17.62(a) for endangered
plant species, and 50 CFR 17.72(a) for threatened plant species.
Interstate Commerce permits authorize the sale of native endangered and threatened species across State lines, but only for activities that will
contribute to the species’ recovery by enhancing their propagation or survival or for scientific purposes that promote conservation of the species.
PLEASE NOTE:

Interstate commerce activities for wildlife require the buyer to obtain a permit prior to the sale (50 CFR 17.21(f) and 17.31(a)).
In addition, regulations at 50 CFR 17.62(a) for endangered plant species and 17.72(a) for threatened plant species require that:
o Interstate commerce activities for plants taken from the wild require the buyer to obtain a permit prior to the sale.
o Interstate commerce activities for plants taken from cultivated stock require the seller to obtain a permit prior to the
sale.

•
•

Interstate Commerce permits are issued by the USFWS Region having the lead responsibility for the affected species. To determine the lead Region
for a species, follow the instructions at the top of our Endangered Species permit web page at https://www.fws.gov/endangered/permits/how-toapply.html.
Applications for an Interstate Commerce permit must provide the following specific information (relevant to the activity) in addition to the general
information on pages 1-4 of this application. Please attach separate pages. In order to assist us in processing your request, please provide the item
number (e.g., A.1., etc.) of the required information before each of your responses.
A.

For Wildlife
1.

Provide the common and scientific names of the species being requested for coverage in the permit and their Federal listing status
(endangered (E) or threatened (T)).

2.

Describe the purpose of your proposed activity. For example, if the purpose is scientific research, attach a copy of your research proposal
outlining the purpose, objectives, methods (i.e., specific information on survey/collection methods, sampling regime, equipment to be
used, etc.), and whether similar work has already been done or is currently being done. If the purpose is conservation education, provide
a complete description of your educational program, including copies of educational materials (i.e., handouts, text of signage or public
presentations, etc.). If the purpose is for propagation for conservation purposes, provide a description of how the species will be
propagated, planned disposition of progeny, and any captive propagation and reintroduction plans that you have in place, if applicable.

3.

Provide the sex, birth date, birth place, age, number of specimens, and identifying features (e.g., band number, collar number, scars,
tattoo number, etc.).

4.

Provide the name, address, and telephone number of the seller. If the seller is not the breeder of the wildlife in question, provide
documentation demonstrating the history of transactions (i.e., chain of ownership of the animal).

5.

State whether the wildlife has been captively bred or removed from the wild.

6.

Provide the expected timeframe needed to complete the transaction(s).

7.

Provide a complete description with photographs and/or diagrams of the area and facilities where wildlife will be held in captivity, and a
description of arrangements for care during transportation and maintenance.

8.

If your purpose for obtaining the wildlife in question is captive breeding, provide a complete description of your experience breeding
these or similar species, including the number of years each species has been maintained at your facility, the number of births by year for
each species for the last 5 years, and mortalities at the facility with these or similar species in the last 5 years, causes of such mortalities,
and steps taken to avoid or decrease such mortalities.

9.

Indicate your willingness to participate in a cooperative breeding or propagation program or to contribute data to a database or studbook.

10. Provide a certified (signed and dated) statement from the wildlife breeder that the wildlife was bred at their home/facility. This statement
must include the name and address of the breeder, date of birth or hatch, band number or any other identifying marks or characteristics.
11. Provide detailed information on how you propose to manage your breeding stock to uniquely identify all progeny, and to ensure that the
genetic diversity and integrity of your breeding stock are maintained to the maximum extent possible.
B.

For Plants
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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

1.

Provide the common and scientific names of the species being requested for coverage in the permit and their Federal listing status
[endangered (E) or threatened (T)].

2.

Identify the activity sought to be authorized for each species.

3.

Provide the location where plants will be cultivated for sale.

4.

Provide the full names of person(s) who will care for live specimens, including any experience in raising, caring for, and propagating similar
plants.

5.

State whether the breeding stock is of cultivated or wild origin.

6.

If you are applying for a permit to buy plants taken from the wild, provide the name, address and telephone number of the seller and
documentation that the plants were lawfully removed from the wild for this purpose. If you are applying for a permit to sell plants taken
from cultivated stock, provide the name, address, and telephone number of the buyer.

7.

Indicate your willingness to participate in a cooperative breeding or propagation program or to contribute data to a database.

END OF APPLICATION REQUIREMENTS

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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

APPLICATION FORM INSTRUCTIONS
The following instructions pertain to U.S. Fish and Wildlife Service (USFWS) permit applications. The General Permit Procedures in 50 CFR 13
address the permitting process. For simplicity, all licenses, permits, registrations, and certificates are referred to as a permit.

GENERAL INSTRUCTIONS:
•
•
•
•
•
•
•
•

Complete all relevant questions in Sections A or B, C, D, and E.
An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are completing
in the appropriate application form for the proposed activity.
Print clearly or type the required response. Illegible applications may cause delays.
Original or electronic signature of the application is required. Faxes or copies of the original signature will not be accepted.
Mail the original application to the address at the top of page one of the applications or, if applicable, on the attached address
list.
Keep a copy of your completed application.
Please plan ahead. Allow at least 60 days for your application to be processed; however, some applications may take longer
than 90 days to process (50 CFR 13.11).
Applications are processed in the order in which they are received.

SECTION A OR SECTION B:
Section A. Complete if applying as an individual:
• Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal
information that identifies the applicant.
• If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing power
of attorney must be included with the application.
• Affiliation or Doing business as (dba): business, agency, organizational, Tribe, or institutional affiliation directly related to the
activity requested in the application (e.g., a taxidermist is an individual whose business can directly relate to the requested
activity).
Section B. Complete if applying as a business, corporation, public agency, Tribe, or institution:
• Enter the complete name of the business, agency, Tribe, or institution that will be the permittee if a permit is issued. Give a
brief description of the type of business the applicant is engaged in. Provide contact phone number(s) of the business. If you
are applying on behalf of a client, a document evidencing power of attorney must be included with the application.
o Principal Officer is the person in charge of the listed business, corporation, public agency, Tribe, or institution and
who is responsible for the application and any permitted activities. Often the Principal Officer is a Director or
President.
o Primary Contact is the person at the business, corporation, public agency, Tribe, or institution who will be available to
answer questions about the application or permitted activities. Often, it is the preparer of the application.
ALL APPLICANTS COMPLETE SECTION C:
•
•

A physical U.S. address is required.
Mailing address is the address to which communications from USFWS should be mailed if different from the applicant’s
physical address.

ALL APPLICANTS COMPLETE SECTION D:
Section D.1. Application processing fee:
• An application processing fee is required at the time of application, unless exempted under 50 CFR 13. The application
processing fee is assessed to partially cover the cost of processing a request. The fee does not guarantee the issuance of a
permit, nor will fees be refunded for applications for which processing has begun.
• Documentation of fee exempt status is not required for applications submitted by Federal, Tribal, State, or local
government agencies, but must be supplied by those applicants acting on behalf of such agencies. Such applications must
include a letter on agency letterhead and signed by the head of the unit of government for which the applicant is acting on
behalf, confirming that the applicant will be carrying out the permitted activity for the agency.
Section D.2. Federal Fish and Wildlife permits:
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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

•

OMB Control No. 1018-0094
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List the permit number of your most recently issued USFWS permit.

Section D.3. CERTIFICATION:

•

The individual identified in Section A, the principal officer named in Section B, or a person with a valid power of attorney
(documentation must be included in the application) must sign and date the application using original or electronic
signature. This signature legally binds the applicant to the statement of certification. You are certifying that you have read
and understand the regulations that apply to the permit. You are also certifying that all information included in the application
is true to the best of your knowledge, as described under 50 CFR 13. Be sure to read the statement and re-read the
application and your answers before signing.

CONTINUE TO NEXT PAGE

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FWS Form 3-200-60 (Rev. 05/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

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 of 1973 (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 USFWS monitor and report on protected species and assesses 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 species; 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 species; 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: Response to 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 needed to decide whether or not to allow the requested use and to respond to requests made under the Freedom of Information Act
and the Privacy Act of 1974. The information that you provide is voluntary; however, submission of the requested information is required to
evaluate the qualifications, determine eligibility, and document permit applicants. Failure to provide all required information is sufficient cause for
the U.S. Fish and Wildlife Service to deny a permit. We may not conduct or sponsor, and you are 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 OMB Control
No. 1018-0094.
ESTIMATED BURDEN STATEMENT
Public reporting for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
the Service Information Clearance Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or
via email at [email protected]. Please do not mail your completed form to this address.
FREEDOM OF INFORMATION ACT NOTICE (FOIA)
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request that you identify
any information that should be considered privileged and confidential business information to allow the USFWS to meet its responsibilities under
FOIA. Confidential business information must be clearly marked "Business Confidential" at the top of the letter or page and each succeeding page
and must be accompanied by a non-confidential summary of the confidential information. The non-confidential summary and remaining documents
may be made available to the public under FOIA [43 CFR 2.23 and 43 CFR 2.24].

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