Form 3-200-30 Application - Export/Re-export/Re-import of Circuses and

OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

Export/Re-Export/Re-Import of Traveling Animal Exhibitions or Museum Exhibitions (and
Reissuance) (CITES/ESA)
☐New ☐Reissue/Renew ☐Amendment
APPLICATION FORM INSTRUCTIONS
The following instructions pertain to U.S. Fish and Wildlife Service (FWS) 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.
If you are an individual, who would be named on the face of the permit, you need to complete the Individual Applicant section of this
application.
If you are an individual seeking permits issued to yourself for activities not associated with your business or institution, you need to
complete the Individual Applicant section as an individual permittee.
If you are an individual associated with a business or institution, and the business or institution’s name would appear on the face of the
permit, you need to complete the Business Applicant section of this application.
If you are a business applying on behalf of an individual, you need to complete the Business Applicant section of this application and
include a limited power of attorney from the person for whom you represent.
A person/entity is qualified to obtain a U.S. Fish and Wildlife Service permit or license when they are "subject to the jurisdiction of the
United States", per 16 USC 1532(13). A foreign person/entity with no permanent physical presence in the United States only qualifies
for an import/export license when they physically enter or exit the U.S. with the wildlife items. The foreign entity is required to designate
a U.S. agent for purposes of record keeping.
GENERAL INSTRUCTIONS:
•

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. Items marked with an asterisk (*) are required fields.

•

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

•

Sign the application. Faxes or copies of the original signature will not be accepted.

•

If you choose to mail your submission, mail the original application to the address listed below or, if applicable, on the attached
address list. We encourage electronic filing in the ePermits system.

•

Keep a copy of your completed application.

•

Please plan ahead. Unless otherwise indicated, 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). Longer processing times will be noted on those applications.

•

Applications are processed in the order they are received.

Individual or Business Applicants:
Individual Applicant. Complete if applying as an individual [do not complete this application if applying for Import/Export License (3200-3) or a Designated Port Exception Permit (3-200-2)]:
•

Enter the information requested. Required fields must be completed. This is used to create your profile and consumer information
in the ePermits system. If you do not have an email address, enter not applicable.

•

Doing business as (dba) / Affiliation: The Division of Management Authority (DMA) and the Office of Law Enforcement (OLE) do
not accept doing business as affiliations for individuals seeking permits on behalf of themselves. “Doing business as” affiliations
apply to individuals seeking permits for a business, agency, Tribe, organizational, or institutional affiliation directly related to the
activity requested in the application. For example, a taxidermist is an individual whose business can directly relate to the requested
activity of exporting taxidermy (dba relevant permit); however, said taxidermist should not apply as a business for permits to nonbusiness related travel with their pet exotic parrot (dba is not relevant to the permit; complete the Business Applicant section).

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Business Applicant. Complete if applying as a business, corporation, public agency, Tribe, or institution:
•

Enter the information requested. Required fields must be completed. This is used to create your contact and account information in
the ePermits system. If you do not have an email address, enter not applicable.

•

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. The principal
officer is the person responsible for the application and any permitted activities. Often the principal officer is a Director or President.

•

The Contact is the person at the business, corporation, public agency, or institution who will be available to answer questions
about the application or permitted activities. Often this is the preparer of the application. Each person that is associated with the
business that would need to access the business account needs to create their own contact in the ePermits system.

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. Checks or money orders must be for the exact
amount for each application submitted. If you are making more than one request, you must submit a separate payment
for each request, otherwise your application will be returned.

•

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.

CERTIFICATION:
•

The individual identified in the Individual Applicant Section, the principal officer named in the Business Applicant Section, or person
with a valid power of attorney (documentation must be included in the application) must sign and date the application. 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. Be sure to read the statement and re-read the application and your answers before signing.

ALL APPLICANTS COMPLETE THE QUESTIONS ASSOCIATED WITH YOUR APPLICATION
Please continue to next page. DO NOT RETURN THIS PAGE WITH THE APPLICATION
Mail applications to: U.S. Fish and Wildlife Service; Division of Management Authority; Branch of Permits, MS:IA; 5275 Leesburg
Pike; Falls Church, Virginia 22041-3803 or as directed by specific applications.
If you would like expedited mailing, please enclose a self-addressed, pre-paid, computer-generated, courier service airway bill. If
unspecified, all documents will be mailed via the U.S. Postal Service.
Please refer to the fee schedule for the appropriate fees for the activity you are requesting.

If you are making more than one request, you must submit a separate
payment for each request, otherwise your application will be returned.

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OMB Control No. 1018-0093
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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

INDIVIDUAL APPLICANTS
*First Name

Middle Name

*Last Name

*Email Address

Telephone Number

*Street Address

*City

*State/Province

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, please enclose a self-addressed, pre-paid, computer-generated, courier service
airway bill. If unspecified, all documents will be mailed via the U.S. Postal Service.

Have you or your client (if a broker applying on behalf of your client), 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”, 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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OMB Control No. 1018-0093
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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

Certification Statement

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 and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
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))
*Required fields. Applications without this information are subject to delays or returns.

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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BUSINESS APPLICANTS
*Business Name

doing business as (dba)

*Indicate your business type:
__ Business or other for profit
__ Farm

__ Small business

__ Government (Federal/State/Local/Tribal)

__ Not-for-profit institution

Name that will appear on the permit if you are applying on behalf of an individual/business

*Primary Contact Name

*Primary Contact Email Address

*Business Email Address

*Preferred Contact Method (e.g. phone, email)

*Principal Officer Name

*Principal Officer Title

*Principal Officer Email

Tax ID Number

*Business Phone

Alternate Phone

*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, please enclose a self-addressed, pre-paid, computer-generated, courier service
airway bill. If unspecified, all documents will be mailed via the U.S. Postal Service.

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OMB Control No. 1018-0093
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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

Have you or your client (if a broker applying on behalf of your client), 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”, 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.

Certification Statement

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 and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
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))
*Required fields. Applications without this information are subject to delays or returns.

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

EXPORT/RE-EXPORT/REIMPORT OF TRAVELING ANIMAL EXHIBITIONS OR MUSEUM EXHIBITIONS (And
Reissuance) (CITES/ESA)
This application covers a wide range of CITES and/or ESA-listed animals, whether live or dead. Please check to
determine whether the species is regulated under CITES, when the species was listed, and if any exemptions apply to
your requested activity (no CITES permit required). Additionally, determine whether the species is regulated under the
ESA when the species was listed, and if any exemptions apply to your requested activity (no ESA authorization required).
A Traveling Exhibition Certificate (Resolution Conf. 12.3 (Rev. CoP13)) applies only to an animal or non-living
specimens that qualifies as pre-Convention 1 or Bred in Captivity 2 as defined in Resolution Conf. 10.16 (Rev.). A CITES
certificate may be issued up to 3 years for a single animal or a group of (non-living) specimens.
Use this form for exports/re-exports and re-import for:
•

Temporary travel (export and re-import) to exhibit animals, museum exhibitions, or other traveling exhibitions where
specimens do not change ownership (e.g., not being bought or sold while outside the United States).

This form should NOT be used for:
•

Transferring ownership or offering specimens for sale outside the United States: submit Form 3-200-23 (preConvention specimens) or Form 3-200-37d (ESA/CITES specimens).

•

Individuals or Orchestras traveling with musical instruments; submit Form 3-200-88 (Musical Instrument Certificate).

•

Activities involving live marine mammals; use form 3-200-53 (Export /Re-Export of Live Captive Held
Marine Mammals (CITES))

NOTE: One-time shipments for specimens that do not qualify for a traveling exhibition certificate as described
above.
If you are applying on behalf of a client, provide Power of Attorney documentation authorizing you to act on
behalf of the client.

This application can be used to request:

☐ New Allows multiple cross-border movements with your non-commercial exhibition containing CITES or ESA-listed
species throughout the validity of the certificate. Specimens must qualify as bred-in-captivity under Resolution Conf.
10.16 (Rev), artificially propagated under Resolution Conf. 11.15 (Rev. CoP 18) or pre-Convention to apply for a
traveling exhibition certificate. Items must return to the United States at the end of the valid date and when renewing.
☐ Amend Allows you to amend a currently valid traveling exhibition certificate. You must complete the relevant

sections within the application (3-200-52 may not be used to amend or renew this certificate), providing information
on any changes to the quantity, your facility, operations, or species for the animals or non-living specimens that you
wish to export.

☐ Re-issue or amend and re-issue Allows you to renew your traveling exhibition certificate that has or will soon

expire. You must complete relevant sections within the application (3-200-52 may not be used to amend or reissue
this certificate), including providing information on any changes to the quantity, your facility, operations, or species for
the animals or non-living specimens that you wish to export.

1

Specimen was acquired (removed from the wild or held in captivity or a controlled environment) before the date CITES applied to it (50
CFR 23.45).
2 Specimen was born/hatched from parents mated in captivity in the U.S. with reliable documentation to that effect. See Annex 1.
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OMB Control No. 1018-0093
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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

GENERAL INFORMATION
Review this application carefully and provide complete answers to all 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 – Species Information (page 9).
Part II – Live Animals (pgs. 10 - 12).
Part III – Non-living Specimens (pgs.12 - 13).

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FWS Form 3-200-30 (Rev. 02/2023)
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Part I − Species Information
For EACH live animal, provide the following. If your application covers more than one animal, be sure to answer questions 2
through 11 for each animal being addressed in the application
Scientific name
(genus, species,
and if applicable,
subspecies) and
Common name

Gender, if
known

Date of Birth
(MM/DD/YYYY)

Source
(Wild or
Born in
captivity)

Country of last reexport

Description (e.g., I.D.
#, band #, tattoo #, tag
#, size, microchip #,
house name). If
microchip #, provide
manufacturer and
location of
microchip 3. (Border
officials must be able
to verify that the
permit and the animal
correspond.)

For EACH non-living specimen, provide the following. If your application covers more than one specimen, be sure to answer
questions 12 through 20 for each specimen being addressed in the application.
Scientific name
(genus, species,
and if
applicable,
subspecies) and
Common name

Date of
Manufacture

Description
of item
(published
description
from a
catalog or art
book)

Size (in metrics)

Date of
acquisition (e.g.
bill of sale, US
Customs import
declaration,
transfer
document)

1. Description of proposed activity: Generally describe your exhibition, including known locations of your exhibition
and estimated return date to the United States.

3

The exporter may be asked to have a microchip reader on hand to read the microchip at the time of export.
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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

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Part II − Live Animals
BORN IN CAPTIVITY
2. If you are the breeder, provide a statement that the animal was bred and born/hatched at your facility. This statement
must include:
a. Birth/hatch date, and if applicable band/tag number, and sex of each specimen;
b. Name and address of your facility where the animal was bred and born;
c.

Location of parental stock; and

d. Your signature and date.
3.

If you are NOT the breeder, provide copies of documentation showing that you acquired the animal 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 species;

d.

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

e.

Complete name and address of the breeder's facility.
COLLECTED FROM THE WILD

4.

If the animal was collected from the wild, provide the following:
a. Location of where, when, and by whom (name/address) the specimen was removed from the wild;
b. Purpose of removal;
c.

Copy of any permits or other documents from the State or local wildlife authorities approving the activities;

d. Documentation showing that the specimens were legally acquired by the applicant; and
e. Copies of any applicable State permits or licenses that are required to house, maintain, and breed these species
(contact your State for information).
5. If this animal qualifies as pre-Convention, provide documents, signed statements or other evidence that the wildlife
was born or removed from the wild prior to the date CITES applied to it (e.g., bill of sale, ISIS record, breeder's
record).
a.

If the species was previously imported after the CITES listing date provide:
i. A copy of the canceled CITES export or re-export document issued by the appropriate CITES office in the
country from which the wildlife was imported; and,
ii. For animals only, cleared Wildlife Declaration for Import Form 3-177.

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

6.

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For animals protected by the U.S. Endangered Species Act (ESA):
Is the animal pre-Act (acquired or held in a controlled environment on or before (a) December 28, 1973 or the date
when the species was listed, and (b) has not entered into commerce (e.g., been bought, sold, or offered for sale by
you or anyone else) since December 28, 1973, or the date when listed)?

☐ Yes, provide evidence that meets the above criteria.

☐ No, you must be able to show that your proposed activity would meet the issuance criteria under ESA. For

endangered species, permits can be issued for activities that enhance the survival or propagation of the species
or scientific research. For threatened species, permits can be issued for the above reasons, as well as
education, zoological display, or other purposes that would meet the purpose of the Endangered Species Act.
Provide a statement, and documentation to support the statement, on how the activities will enhance or benefit the
wild population (in-situ and ex-situ projects). While permits cannot be issued solely for educational or display
purposes for endangered species, if your activities include conservation education, provide copies of educational
materials (e.g., handouts, text of signage or public presentations). If you are submitting more than one application at
this time for a group of animals, you can complete this section on one application and refer any subsequent
application to this statement. If you need more explanation on this question, please contact the Division of
Management Authority.
7.

If your activity includes public presentations, please provide the following:
a. Type of presentation in which the specimen is proposed to be a part of (e.g., live performance, movie, TV)?
b. Provide a copy of the actual script or material that will be presented to the audience at each performance,
show, or viewing of the specimen(s). This material must be original in nature (e.g., photocopies from a
reference book are not appropriate) and must be the actual material that will be presented each time the
animal is viewed by the target audience.
c.

Will fact sheets, brochures, or posters be used? Is the written material available free-of-charge?

d. When will the material be presented? If the material will be presented orally, when will this presentation be
given? What activities will be occurring at the same time the message is being provided? Could the activity
diminish the effectiveness of the presentation? If the material will be presented in a written form, will an oral
announcement be made regarding the availability of this material? If the material is in poster form, will the
posters be placed so that the material will be accessible by the public?
e. When exhibiting in countries where English is not the primary language, explain how the conservation
education information will be presented to the non-English speaking audience.
8.

If the animal a non-human primate, provide a copy of your current Centers for Disease Control (CDC) registration.

9.

For live exhibitions, provide the following on your facilities:
a. Name and address of the permanent facility where the animal(s) is/are maintained.
i. Name of Facility
ii. Address
iii. City, State, Zip code
b. A detailed description of permanent facilities, including size, construction materials, protection from the elements,
and photographs or detailed diagrams;

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

c.

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Provide the same as above for transportation units used while traveling within the United States and abroad. The
transport conditions must comply with 50 CFR Part 14, Subpart J, the CITES Guidelines for Transport of Live
Animals, as well as the Animal Welfare Act and, in the case of air transport, with the International Air Transport
Association (IATA) live animal regulations. Your description must include:
i.

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

ii.

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

iii. Description of the qualifications of the individuals to train and care for the animal, including the
number of years’ experience with this species or similar species, and names of current caretakers.
10. For live exhibitions, provide a list all mortalities of ESA listed species which occurred at your facility during
the past five years, and explain the cause of the mortalities and measures taken to prevent future mortalities
if appropriate.
11. Provide copies of any applicable permits, licenses, and registrations (State Fish and Game, U.S.
Department of Agriculture Animal Welfare Act (AWA), Center for Disease Control and Prevention).
All international shipment(s) must be through a designated port. A list of designated ports (where a wildlife
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).
Part III – Non-living Specimens
BORN IN CAPTIVITY
12. If you are the breeder of the animal from which the specimen was obtained, provide a statement that the animal was
bred and born/hatched at your facility. This statement must include:
a. Birth/hatch date, and if applicable band/tag number, and sex of each specimen;
b. Name and address of your facility where the animal was bred and born;
c.

Location of parental stock; and

d. Your signature and date.
13. If you are NOT the breeder of the animal from which the specimen was obtained, provide copies of documentation
showing that you acquired the animal 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;

d. Location (Name, Street address, City, State) of Parental Stock;
e. Complete name and address of the breeder's facility.
COLLECTED FROM THE WILD
14. If the specimen was collected from the wild, provide the following:
a. Location of where, when, and by whom (name/address) the specimen was removed from the wild;
b. Purpose of removal;
c.

Copy of any permits or other documents from the State or local wildlife authorities approving the activities;

d. Documentation showing that the specimens were legally acquired by the applicant; and
e. Copies of any applicable State permits or licenses that are required to house, maintain, and breed these
specimens (contact your State for information).
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15. If this specimen qualifies as pre-Convention, provide documents, signed statements or other evidence that the wildlife
was born or removed from the wild prior to the date CITES applied to it (e.g., bill of sale, ISIS record, breeder's
record).
16. If this animal qualifies as pre-Convention, provide documents, signed statements or other evidence that the wildlife
was born or removed from the wild prior to the date CITES applied to it (e.g., bill of sale, ISIS record, breeder's
record).
17. If the species was previously imported after the CITES listing date provide:
a. A copy of the canceled CITES export or re-export document issued by the appropriate CITES office in the country
from which the wildlife was imported; and
b. For animals only, cleared Wildlife Declaration for Import Form 3-177.
18. For specimens protected by the U.S. Endangered Species Act (ESA):
Is the specimen pre-Act (acquired or held in a controlled environment on or before (a) December 28, 1973 or the date
when the species was listed, and (b) has not entered into commerce (e.g., been bought, sold, or offered for sale by
you or anyone else) since December 28, 1973, or the date when listed)?

☐ Yes, provide evidence that meets the above criteria.

☐ No, you must be able to show that your proposed activity would meet the issuance criteria under ESA. For

endangered species, permits can be issued for activities that enhance the survival or propagation of the species
or scientific research. For threatened species, permits can be issued for the above reasons, as well as
education, zoological display, or other purposes that would meet the purpose of the Endangered Species Act.

Provide a statement, and documentation to support the statement, on how the activities will enhance or benefit the
wild population (in-situ and ex-situ projects). While permits cannot be issued solely for educational or display
purposes for endangered species, if your activities include conservation education, provide copies of educational
materials (e.g., handouts, text of signage or public presentations). If you are submitting more than one application at
this time for a group of animals, you can complete this section on one application and refer any subsequent
application to this statement. If you need more explanation on this question, please contact the Division of
Management Authority.
19. If your activity includes public presentations, please provide the following:
a. In what type of presentation are you proposing to use the specimen (e.g., live performance, movie, TV)?
b. Provide a copy of the actual script or material that will be presented to the audience at each performance,
show, or viewing of the specimen(s). This material must be original in nature (e.g., photocopies from a
reference book are not appropriate) and must be the actual material that will be presented each time the
animal is viewed by the target audience.
c.

Will fact sheets, brochures, or posters be used? Is the written material available free-of-charge?

d. When will the material be presented? If the material will be presented orally, when will this presentation be
given? What activities will be occurring at the same time the message is being provided? Could the activity
diminish the effectiveness of the presentation? If the material will be presented in a written form, will an oral
announcement be made regarding the availability of this material? If the material is in poster form, will the
posters be placed so that the material will be accessible by the public?
e. When exhibiting in countries where English is not the primary language, explain how the conservation
education information will be presented to the non-English speaking audience.
20. Current location of specimen(s):

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Annex I

FOR THE PURPOSE OF EXPORT FROM THE UNITED STATES SPECIES THAT QUALIFY AS
CAPTIVE-BRED IN ACCORDANCE WITH CONF. 10.16
MAMMALS
Order Primates
Callithrix jacchus - Common marmoset [App. I]
Cercocebus spp. other than galeritus (i.e., agilis, albigena, aterrimus, and torquatus)
- Mangabeys [App. II] *
Cercopithecus diana- Diana monkey [App. I]
Erythrocebus patas - Patas monkey [App. II]
Lemur catta - Ring-tailed lemur [App. I] *
Lemur macaco macaco - Black lemur [App. I] *
Lemur variegatus variegatus (=Varecia variegata variegata) - Ruffed lemur [App. I] *
Leontopithecus rosalia - Golden lion tamarin [App. I] *
Macaca fascicularis - Crab-eating macaque [App. II]
Macaca mulatta - Rhesus monkey [App. II]
Macaca silenus - Lion-tailed macaque [App. I] *
Microcebus murinus - Lesser mouse lemur [App. I]
Pan troglodytes - Chimpanzee [App. I] *
Papio (=Mandrillus) sphinx - Mandrill [App. I]
Pongo pygmaeus abelii - Sumatran orangutan [App. I] *
Pongo pygmaeus pygmaeus - Bornean orangutan [App. I] *
Saguinus oedipus (including S. o. geoffroyi) - Cotton-top tamarin [App. I] *
Order Carnivora
Ailurus fulgens - Lesser panda [App. I] *
Canis lupus - Gray wolf [ App. II]
Caracal (=Felis) caracal - Caracal [App. I - Asian population]
Leopardus (=Felis) pardalis - Ocelot [App. I]
Leopardus (=Felis) wiedii - Margay [App. I]
Leptailurus (=Felis) serval - Serval [App. II]
Panthera leo - Lion [App. I and ll] *
Panthera onca - Jaguar [App. I] *
Panthera pardus - Leopard [App. I]
Panthera tigris - Tiger [App. l] *
(asterisk applies only to P. t. altaica [Siberian] and P. t. sumatrae [Sumatran] subspecies)
Speothos venaticus - Bush dog [App. I]
Tremarctos ornatus - Spectacled bear [App. I] *
Uncia (=Panthera) uncia - Snow leopard [App. I] *
Order Perissodactyla
Equus grevyi - Grevy's zebra [App. I] *
Equus hemjonus - Asiatic wild ass [App. I & II]
Equus przewalskii - Przewalski's or Asian wild horse [App. I] *
Equus zebra hartmannae - Hartmann's mountain zebra [App. II] *
ORDER ARTIODACTYLA
Addax nasomaculatus - Addax [App.I] * 4
Antilope cervicarpa - Blackbuck [App. III]
Bos gaurus - Gaur [App. I] *
Capra falconeri - Markhor [App. I]
4

For these species there is no need to obtain comments from the Chairman of the AZA Permits Evaluation Committee regarding the export of
sport-hunted trophies taken from game ranches in the United States; see OSA General Advice of April 9, 1 993.

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Cervus duvauceli - Swamp deer (Barasingha) [App. I] *
Cervus eldi thamin - Burmese brow-antlered deer [App. I]
(subspecies of Eld's brow-antlered deer)
Gazella dama - Dama gazelle [App. I]
Hexaprotodon (=Choeropsis) liberiensis - Pygmy hippopotamus [App. II] *
Hippopotamus amphibius - Hippopotamus [App. II]
Lama guanicoe - Guanaco [App. II]
Oryx dammah - Scimitar-horned oryx [App. I] *
Oryx leucoryx - Arabian oryx [App. I] *
Tragelaphus spekei - Sitatunga [App. III]
BIRDS
Order Anseriformes
Anas laysanensis - Laysan teal [App. I]
Branta sandvicensis - Hawaiian goose, Nene [App. I]
Cygnus melanocoryphus - Black-necked swan [App. II]
ORDER FALCONIFORMES
Buteo buteo - European buzzard (App. II]
Vulture gryphus - Andean condor [App. I] *
ORDER GALLIFORMES
Argusianus argus - Great argus pheasant [App. II]
Catreus wellichii - Cheer pheasant [App. I]
Crossoptilon crossoptilon - White eared pheasant [App. I]
Crossoptilon mantchuricum - Brown eared pheasant [App. I]
Gallus sonneratii - Sonnerat's junglefowl. Gray junglefowl [App. II]
Lophophorus· impejanus - Himalayan monal [App. I]
Lophura edwardsi - Edward's pheasant [App. I]
Lophura swinhoii - Swinhoe's pheasant [App. I]
Polyplectron bicalcaratum - Gray peacock pheasant [App. II]
Polyplectron emphanum – Palawan peacock pheasant [App. I]
Polyplectron germaini – Germain’s peacock pheasant [App. II]
Polyplectron malacense – Malaysian peacock pheasant [App. II]
Syrmaticus ellioti - Elliot's pheasant [App. I]
Syrmaticus humiae - Bar-tailed pheasant [App. I]
Syrmaticus mikado - Mikado pheasant [App. I]
Tragopan caboti - Cabot's tragopan [App. I]
Tragopan satyra - Satyr tragopan [App. III]
Order Psittaciformes
Agapornis fischeri - Fisher's lovebird [App, II]
Agapornis roseicollis - Peach-faced lovebird [App. II]
Arantinga jandaya - Jendaya conure [App. II]
Barnardius barnardi - Mallee ringneck parrot [App. II]
Bolborhynchus Iineola - Lineolated parakeet [App. II]
Cyanoramphus auriceps - Yellow-fronted parakeet (App. II]
(C. a. forbesi is Appendix I and is not included on this list)
Cyanoramphus novaezealandiae - Red-fronted parakeet [App. II]
Forpus coelestjs - Pacific parrolet [App. II]
Neophema bourkii - Bourke's parrot [App. II]
Neophema chrysostoma - Blue-winged parrot [App. II]
Neophema elegans - Elegant parrot [ App. II]
Neophema pulchella - Turquoise parrot [App. II]
Neophema splendida - Scarlet-chested parrot [App. II]
Platycercus adelaide - Adelaide rosella [App. II]
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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Platycercus adscitus - Pale-headed rosella [App. II]
Platycercus elegans - Crimson rosella [App. II]
Platycercus eximius - Eastern rosella [App. Il]
Playtycercus icterotis - Western (Stanley) rosella [App. II]
Playtycercus venustus - Northern rosella [App. II]
Polytelis alexandrae - Princess parrot [App. II]
Polytelis anthopeplus - Regent parrot [App. II]
Polytelis swainsonii - Superb parrot [App. II]
Psephotus chrysopterygius - Golden-shouldered parakeet [App. I]
Psephotus haematonotus - Red-rumped parakeet [App. II]
Psephotus varius - Mulga parakeet [App. II]
Psittacula eupatria - Alexandrine parakeet [App. II]
Purpureicephalus spurius - Red-capped parrot [App. II]
Trichoglossus chlorolepidotus - Scaly-breasted lorikeet [App. II]
Order·Passeriformes
Leucopsar rothschildi - Rothschild's starling or myna (=Bali myna) [App. I] *
Poephila cincta cincta - Parson finch [App. II]
REPTILES
ORDER SQUAMATA
Antaresia (-Liasis) childreni - Children's python [App. II]
Antaresia (-Liasis) maculosa - Spotted python [App.II]
Antaresia (=Liasis) perthensis - Pygmy python [App. II]
Boa constrictor constrictor - Boa constrictor [App. II]
Boa constrictor imperator - Central American boa [App. II]
Boa constrictor melanogaster - Black-bellied boa [App. II]
Boa constrictor mexicana - Mexican boa [App. II]
Boa constrictor ortonii - Peruvian boa [App. II]
Eryx johnii johnii - Smooth-scaled sand boa [App. II]
Eryx johnii persicus - Northern smooth-scaled sand boa [App. II]
Eunectes murinus murinus - Green anaconda [App. II]
Eunectes murinus gigas - Northern green anaconda [App. II]
Eunectes murinus noteaus - Yellow anaconda [app. II]
Morelia spilota variegata - Carpet python [App. II]
Python curtus breitensteini - Blood or Borneo short-tailed python [App. II]
Python curtus brongersmai - Blood or short-tailed python [App. II]
Python curtus curtus - Blood or Sumatran short-tailed python [App. II]
Python reticulatus - Reticulated python [App. II]
Python molurus bivittatus - Burmese python [App. II]
Python regius - Ball or royal python [App. II]
Python sebae - African rock python [App. II]
Python sebae natalensis - Sothern African rock python [App. II]
AMPHIBIANS
Order Caudata
Ambystoma mexicanum - Axolotl [App. II]
* SSP species requiring comments from AZA Permits Evaluation Committee Chairman.

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FWS Form 3-200-30 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

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 (PRA; 44 U.S.C. 3501 et seq.) 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 PRA, 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 (original submission - electronic) and 1
hour (original submission - paper-based) and 20 minutes (amended submission - electronic) and 30 minutes (amended
submission - paper-based), 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
(JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to
this address.
Questions regarding permits from Management Authority should be sent to [email protected].

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