Form 3-200-35 Application - Import of Wild Collected Appendix 1 Plants

FWS Form 3-200-35 (Rev. 01/2020)
U.S. Department of the Interior

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

IMPORT OF WILD-COLLECTED APPENDIX-I PLANTS (CITES)
☐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 3-200-35 (Rev. 01/2020)
U.S. Department of the Interior

E.

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

IMPORT OF WILD-COLLECTED APPENDIX-I PLANTS (CITES)

Complete all questions on the application on separate sheets of paper or electronic document. Mark questions that
are not applicable with "N/A". On all attachments or separate sheets you submit, indicate the application question
number that you are addressing. If applying for more than one species, answer questions 1-7 for each species
requested for import in this application. For species that are protected by the U.S. Endangered Species Act, please
use form 3-200-36 instead of this form since additional questions related to the Endangered Species Act must be
addressed.
NOTE: Import of wild-collected specimens of Appendix-I plants cannot be for primarily commercial purposes, as
outlined in Resolution Conf. 5.10 (Rev. CoP15) on Definition of ‘primarily commercial purposes’.
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.
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.

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FWS Form 3-200-35 (Rev. 01/2020)
U.S. Department of the Interior

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

4. For EACH plant species requested for import provide the following information and attach photographs of the
specimens to be imported:
a.

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

b.

Quantity of specimens requested for import;

c.

General description of specimens (e.g., seed, whole plant, parts); AND

d.

If whole plants or cuttings, indicate size of specimen (e.g., leaf span, height, length) OR

e.

If plant parts or products (e.g., rhizomes, biological samples, pharmaceutical products, lumber),
indicate: type of sample; packaging/container; and the total number of units, the unit weight or
volume, and the total number of plants or plant parts used to produce each unit.

5. Current location of the specimens (provide address and country) and whether the plants have already been
collected/harvested:

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FWS Form 3-200-35 (Rev. 01/2020)
U.S. Department of the Interior

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

6. For each species provide:
a.

number of specimens collected/harvested (since the number of specimens harvested may differ than
the number actually imported, this number may be different than the quantity identified in question 4b
above);

b.

specific harvest location(s)(including land ownership);

c.

who will/did collect/harvest the specimens (name, address, phone number, and applicable e-mail);

d.

approximate density, such as number of plants per acre/hectare, and distribution of the species at the
harvest location(s);

e.

harvest methodology (e.g., whether specimens will be removed from one or several locations; and

f.

ratio of the number of specimens collected to the number of plants remaining at the collection site.

7. Provide copies of any required foreign permits, licenses or other documents from the foreign country to export
the requested specimens (e.g., collection permits, landowner permission, harvesting license).
8. Provide details on the intended use of the specimens (e.g., scientific research, cooperative propagation
program) and documentation to support that use.

9. Describe your experience maintaining and/or cultivating this species and attach photographs and a complete
description of the facilities where plants/specimens will be held within the United States.

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FWS Form 3-200-35 (Rev. 01/2020)
U.S. Department of the Interior

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

10. If the purpose is for propagation for conservation purposes, describe how the species will be propagated,
disposition of progeny, and cooperative agreements that are or will be established for re-introduction.

11. Provide a statement on the final disposition of the imported specimens. Note that wild specimens of Appendix
I species cannot be imported for purposes that are primarily commercial.

12. Attach a description of the type, size and construction of shipping containers and the arrangements for care of
any live specimens during transportation to the United States.

13. Provide copies of your current U.S. State nursery license, if applicable, United States Department of
Agriculture Protected Plant Permit, and State permits related to this import of plants or plant products and
subsequent propagation (if applicable).

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FWS Form 3-200-35 (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 45 minutes (electronically) to 1 hour (paperbased), 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/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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