Form 3-200-70 Application - Export/Re-Import/Transport of Bald and Gol

FWS Form 3-200-70 (Rev. 01/2020)
U.S. Department of the Interior

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

EXPORT/RE-IMPORT/TRANSPORT OF BALD AND GOLDEN EAGLE FOR INDIAN
RELIGIOUS PURPOSES (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.
Page 1 of 5

FWS Form 3-200-70 (Rev. 01/2020)
U.S. Department of the Interior

E.

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

EXPORT/RE-IMPORT/TRANSPORT of BALD and GOLDEN EAGLE FOR INDIAN RELIGIOUS
PURPOSES (CITES)

This application is for a permit under the Convention on International Trade in Endangered Species of Wild Fauna
and Flora (CITES) and the Bald and Golden Eagle Protection Act (BGEPA) for transport of bald eagle (Haliaeetus
leucocephalus) or golden eagle (Aquila chrysaetos) parts from or to the United States for Indian religious purposes.
BGEPA regulations provide that bald and golden eagle items may be temporarily transported out of the United
States; the same items, unchanged, must be re-imported. A permit, if issued, allows for one-time travel to a specific
location noted in the permit.
If you will be transporting any other species listed under CITES (e.g., river otter), or other species listed under the
Migratory Bird Treaty Act (e.g., songbird, hawk), in addition to bald or golden eagle parts, you may include them in
this application.
Complete all questions on the application. Mark questions that are not applicable with "N/A". If needed, use
separate sheets of paper. On all attachments or separate sheets you submit, indicate the application question
number you are addressing.
NOTE: A CITES permit is only required if the feathers are leaving and re-entering the United States from a
foreign nation that is not Mexico or Canada.
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.

Page 2 of 5

FWS Form 3-200-70 (Rev. 01/2020)
U.S. Department of the Interior

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

4. Provide the following (use a separate sheet if necessary):
a.

Scientific and common names of species that are found on the items in this application:

b.

Full description of each item (e.g., feather, fan, head dress), including age, country of origin, and
NUMBER of feathers on item(s):

c.

Documentation or other evidence that the specimen/item was lawfully acquired and any available
information on the origin of the specimen/item (e.g., a permit or a receipt from the National Eagle
Repository). If the item was a gift, provide the name and address of gifter and any available
information on the origin of the item.

d.

5. If you have a Federal Eagle Permit for Indian Religious Purposes for eagle feathers received from the
National Eagle Repository, please attach a copy of your permit. If you do not have such a permit, please
attach a completed Certificate of Enrollment (copy attached) certifying that you are an enrolled member of
a federally recognized Tribe, band, nation, or other organized group or community eligible to receive
services from the Bureau of Indian Affairs.
6. How long will the items be out of (or in) the United States?

7. Anticipated date of departure/arrival: _________________________
8. Anticipated date of return: _________________________________
9. Where will you be staying while outside of the United States (e.g., hotel, house)?
a. Name:
b. Address:
c. City:
d. State/Province:
e. Country, Postal Code:
10. Please explain in detail your purpose for traveling abroad with your regalia:

11. Re-export – Provide a copy of the validated foreign CITES export or re-export document [cancelled by
Office of Law Enforcement (OLE)] issued by the appropriate CITES office in the country from which the
wildlife was imported, and a copy of the *Wildlife Declaration (Form 3-177), stamped cleared by OLE.

Page 3 of 5

FWS Form 3-200-70 (Rev. 01/2020)
U.S. Department of the Interior

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

12. For export/re-export of CITES Appendix-I species, provide a copy of the CITES import permit issued by
the Management Authority of the country where you plan to transport the wildlife. (Not required if specimen
qualifies as pre-Convention).
CERTIFICATION STATEMENT:
13. I certify that, to the best of my knowledge, I lawfully acquired and hold the bald and golden eagle parts and
other wildlife described above. I certify that I am transporting these items for bona fide Native American
Indian religious purposes, and that I intent to return these items to the United States.
Signature __________________________________________ Date ______________
*Permits cannot be issued without the documents being stamped cancelled and cleared by OLE.
All exports, re-exports, and imports 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).

Page 4 of 5

FWS Form 3-200-70 (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 20 minutes (electronically) to 30 minutes (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.

Page 5 of 5