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

FWS Form 3-200-60 (Rev. 09/2022) OMB Control No. 1018-0094

U.S. Department of the Interior Expires ##/##/20##

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM

Native Endangered and Threatened Species -

Interstate Commerce

Return to: U.S. Fish and Wildlife Service (USFWS)

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.

See attached instruction pages 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

1.d. Suffix

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

3. Occupation

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

4.b. Website URL (if applicable)

5.a. Telephone number

5.b. Alternate telephone number

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

3.b. Website URL (if applicable)

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

4.b. P.O. first name

4.c. P.O. middle initial

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

5. P.O. title

6. Primary contact name

7.a. P.O. telephone number

7.b. Alternate phone no.

8.a. Primary contact telephone no.

8.b. Primary contact e-mail address

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

2.c. State

2.d. Zip code/Postal code

2.e. County/Province

2.f. Country

D. All applicants MUST complete

1. Pay via ePermits (preferred) or attach the nonrefundable application processing (check or money order), payable to the U.S. FISH AND WILDLIFE SERVICE in the amount indicated on page 2. 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)).

Do you currently have or have you ever had any Federal Fish and Wildlife permits? Yes If yes, list the number of the most current 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. Signature (in blue ink) of applicant/person responsible for permit (No photocopied or stamped signatures) Date (mm/dd/yyyy)

*See page 14 for additional instructions on completing the above form. See page 16 for information on the Paperwork Reduction Act, Privacy Act, and Freedom of Information Act aspects of this application form.

INTERSTATE COMMERCE

ALL APPLICANTS MUST COMPLETE SECTION E.

• Provide the information outlined in Section E. on the following pages.

• Be as complete and descriptive as possible.

• Please do not send pages that are over 8.5” x 11”, videotapes, or DVDs.

OTHER FEDERAL, TRIBAL, STATE, OR LOCAL APPROVALS OR AUTHORIZATIONS REQUIRED TO CONDUCT YOUR REQUESTED ACTIVITY

Be aware that there may be other permits, requirements, or authorizations necessary to conduct proposed activities such as obtaining permission to work on Federal or Tribal lands, possession of a valid federal bird banding and marking permit, or other Tribal, State, county or municipal permits, etc.

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 pay via ePermits (preferred) or 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.). Note: Interstate commerce permits for wildlife may not be renewed or amended, other than for administrative changes. Interstate commerce permits for plants may be renewed and amended.

• New. $100 permit application processing fee.

• Renew (without changes). $100 permit application processing fee: Renew my existing valid permit (without changes) using my current application on file. Permit no. ________ .

If you are applying to renew a valid permit, your complete application package must be received at least 30 days prior to the expiration of the valid permit (50 CFR 13.22) to avoid a lapse in permit coverage. Use Option 1 below to provide the required information.

• Amendment. $50 permit application processing fee: An amendment to a valid permit is requested at a time other than renewal. Permit no. .

When the information in your current application package on file has changed, then you must apply for an amendment to your valid permit. For example, such changes may include the additions of species to the permit and/or changes in location or activities. Please contact the Regional Recovery Permit Contact within the U.S. Fish and Wildlife Service Region of your proposed activity for technical assistance in making this determination (https://www.fws.gov/endangered/permits/recovery-permits-contacts.html).

Please indicate the amendment(s) you are requesting:

• Add species (specify)

• Add new activity (specify)

• Add a geographic area

• Change in personnel

• Other (specify)

DISQUALIFICATION FACTOR

A conviction, or entry of a plea of guilty or nolo contendere, for a felony violation of the Endangered Species Act (ESA), 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 ESA, 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:

1. The individual’s name:

2. Date of charge:

3. Location of incident:

4. Court:

5. Action taken for each violation:

SPECIFIC RELEVANT ACTIVITY REQUIRED INFORMATION: OPTION 1

Option 1. Renew an existing valid recovery permit without changes.

If you are applying to renew an existing valid plant interstate commerce permit without changes, sign the following statement. The individual signing Section D. on page 1 of the application must also sign the following statement. This certification language is required under 50 CFR 13.22(a).

I certify that the statements and information submitted in support of my original application for a U.S. Fish and Wildlife Service Recovery permit no. _____________________ are still current and correct and hereby request renewal of that permit without changes. I also certify that all annual reports and any additional reporting requirements have been submitted to the USFWS.

Original or electronic signature of individual applicant/Principal Officer

Please legibly write or type the Signatory’s name _Date

Signing the above statement completes your renewal application. Please submit completed pages 1-4 of this application to the lead Regional Office for the affected species. To determine which region is the lead region for the species of interest, search our endangered species database at https://ecos.fws.gov/ecp/ and enter the species' scientific name in the search box. Lead region will be listed under the Current Listing Status Summary heading or by contacting your closest Regional Endangered Species office. Requests for permit renewal must be complete and received by the USFWS no later than 30 days prior to the permit expiration to ensure that your current permit remains in effect while we process your request.

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:

  • Interstate commerce activities for plants taken from the wild require the buyer to obtain a permit prior to the sale.

  • 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 which region is the lead region for the species of interest, search our endangered species database at https://ecos.fws.gov/ecp/ and enter the species' scientific name in the search box. Lead region will be listed under the Current Listing Status Summary heading or by contacting your closest Regional Endangered Species office.

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.

1. 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, the physical address of the facilities, and a description of arrangements for care during transportation and maintenance. Also, provide the full names of person(s) who will care for live specimens, including any experience in raising, caring for, and propagating similar wildlife.

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.

2. For plants:

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

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. To apply online use the U.S. Fish and Wildlife Service ePermits website.

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 filling in the appropriate application form for the proposed activity.

• Print clearly or type in the information. Illegible applications may cause delays.

• Original or electronic signature of the application is required. Sign the application in blue ink. Faxes or copies of the original signature will not be accepted.

• Mail the original application to the address at the top of page 1 of the application 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/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.

• 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.

• 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:

• 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.

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 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 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) 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

We estimate public burden for this collection of information to average:

Original submission (paper-based): 3 hours

Original submission (electronic): 2.75 hours

Amended submission (paper-based): 1.5 hours

Amended submission (electronic): 1.25 hours

These estimates include 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

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 Service to meet its responsibilities under the Freedom of Information Act (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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