Form 3-200-37a Application - Import/Export-Re-Export of Live Animals (C

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

FWS Form 3-200-37a (Rev. 02/2023)
U.S. Department of the Interior

Import/Export/Re-export of Live Animals (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 3-200-37a (Rev. 02/2023)
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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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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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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 3-200-37a (Rev. 02/2023)
U.S. Department of the Interior

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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FWS Form 3-200-37a (Rev. 02/2023)
U.S. Department of the Interior

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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 3-200-37a (Rev. 02/2023)
U.S. Department of the Interior

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IMPORT/EXPORT/RE-EXPORT OF LIVE ANIMALS (CITES/ESA)
General Information
This application covers activities involving LIVE CITES and ESA listed animals.
Review this application carefully and provide complete answers to all questions. If you are applying for multiple
species, be sure to indicate which species you are addressing in each response. If more space is needed, attach a
separate sheet with your responses, numbered according to the questions.
Please allow at least 90 days for the application to be processed.
How do I determine whether the species is protected under CITES and/or the ESA?
CITES

ESA

To determine whether an animal species is protected under To determine whether an animal species is protected under
CITES, when the species was listed, or whether exemptions the ESA, please review the list of ESA-listed species in the
Code of Federal Regulations.
apply to your requested activity, see the list of CITES
species
Please be aware that any permit request involving an ESA
endangered species must be published in the Federal
Register for a required 30-day public comment period.

If you have any questions regarding an action you are requesting authorization, please contact the Division of
Management Authority at [email protected].
Please note: for renewal or amendment of a multi-use permit being requested within the 5-year Federal Register public
notice period, use application 3-200-52.
This form should NOT be used for:
●

Pre-Convention, Pre-Act, or antique (antique exemption criteria) specimens (use application 3-200-23)

●

Captive Bred Wildlife Registration (use application form 3-200-41)

●

ESA Plants (use application form 3-200-36)

●

Import of LIVE African Elephants from Botswana, Namibia, South Africa, and Zimbabwe and Southern White
Rhinoceros from eSwatini and South Africa (use application form 3-200-37f)

1. Type of Activity:

☐ Import

☐ Export

☐ Re-Export (e.g., exporting a specimen previously imported into the United States)

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2. The current location of the animal(s) (if different from the physical address):
Name:
Address:
City:
State/Province:
Postal Code:
Country:
3. Recipient/Sender:
•

If export/re-export, provide name and physical address of the recipient in the foreign country.

•

If import, provide name and physical address of the sender in the foreign country.

Name:
Address:
City:
State/Province:
Postal Code:
Country:
4. For each animal involved in the import/export/re-export, provide (you may use the table on the following page):
a. Scientific name (genus, species, and if applicable, subspecies)
b. Common name
c.

Approximate or actual birth/hatch date (mm/dd/yyyy)

d. Wild or captive-born
e. Quantity
f.

Sex (males.females.unknown sex, (e.g., 10.2.3))

g. Permanent markings and/or identification information (microchip #, leg band #, tattoos, studbook #).

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a. Scientific name
b. Common
(genus, species, and Name
if applicable,
subspecies)

c. Approximate
or Actual
Birth/Hatch
Date
(mm/dd/yyyy)

d. Wild

EXAMPLE:

08/01/2006

C

Chimpanzee

(W) or
Captiveborn (C)

e.
Quantity

f. Sex (male.
female.
unknown sex,
ex: 1.0.0)

g. Permanent markings/ID
information (e.g., microchip #,
leg band #, tattoo, studbook
#, etc.)

1

1.0.0 OR

Studbook# 152;

male

Microchip# 00056321-00

Pan troglodytes

5. For each captive-born/captive-hatched animal(s), provide a signed and dated statement from the breeder or other
appropriate documentation (e.g., Species 360 report or other records) that includes the following:
a.

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

b.

Common name;

c.

Name and address of the facility where the animal was bred and born;

d.

Birth/hatch date (mm/dd/yyyy);

e.

Identification information (studbook, microchip, leg band, etc.);

f.

Name and address of the facility where the parental stock is located;

g.

A statement from the breeder that the animal was bred and born at the breeder’s facility (including the facility’s
name and address); and

h.

If you are not the breeder, provide documentation demonstrating the history of transactions (e.g., chain of
custody or ownership of the animal).

6. For each animal(s) taken from the wild, provide:
a. Scientific name (genus, species, and if applicable, subspecies);
b. Common name;
c.

Specific location (e.g. county, state, province, country) where the animal was removed from the wild;

d. The name of the individual(s) who collected the animal(s) and their authorization to do so, including copies of
foreign and domestic (Federal, State, and/or Tribal) government collecting permits, licenses, contracts and/or
agreements;
e. Method of collection, including capture protocol and any injury and mortality experienced during collection,
transport, and holding;
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f.

Information related to any remuneration, either financial or in-kind, provided for acquiring the animal(s);

g. Efforts to use captive specimens (e.g., captive-born, captive-held) in lieu of taking animals from the wild.
7. For each animal being re-exported (e.g., exporting animal(s) previously imported into the US) provide:
a. A copy of the CITES export or re-export document issued by the appropriate CITES office in the country from
which the wildlife was imported (this document is stamped cancelled by FWS Office of Law Enforcement upon
import inspection); and
b. A copy of your Declaration for Importation or Exportation of Fish or Wildlife (Form 3-177) cleared by FWS Office
of Law Enforcement;
c.

A copy of the ESA permit that authorized the original import;

d. If you did not make the original import, provide documentation outlining chain-of-ownership since import,
including:
i. A copy of the importer's clearance documents (a, b & c above) and,
ii. Subsequent invoices (or other documentation) showing the history of transactions leading to your ownership
of the animals after import (chain of custody).
Description and Justification for Requested Activity
Describe the purpose of your proposed activity.
8. If scientific research, provide:
a. A copy of the research proposal (outlining the purpose, objectives, and methods),
b. Detailed information on capture methods including:
i. Who will be capturing the animals,
ii. Equipment used,
iii. Measures taken to prevent injury and mortality.
c.

An explanation of whether other similar work has already been conducted or is currently being conducted,

d. A copy of the study’s Institutional Animal Care and Use Committee (IACUC) form (if applicable),
e. Peer-reviewed scientific papers published from this research (if applicable).
9. If conservation education and/or zoological display, provide:
a. Objectives of proposed activity in support of an education program,
b. Copies of educational materials (e.g., handouts, text of signage or public presentations), incorporating the
following information:
i. Status in the wild
ii. Current threats
iii. Conservation efforts

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10. If captive propagation for the conservation and survival of the species, provide:
a. A description of how the species will be propagated (e.g. artificial insemination, breeding pairs/groups),
b. Documentation showing your participation in an established breeding program (example: current breeding plan
outlining your role in the program AND letter from the breeding coordinator confirming your participation in this
breeding program.)
c.

A copy of your breeding protocol including information regarding separation of mother and young, use of
cameras, etc.

d. How your breeding stock is managed to maintain genetic vitality, including:
i. Avoidance of inbreeding and considerations of average kinship,
ii. Differences in paternal and maternal average blood relationships/relatedness,
iii. Carrying capacity of your facility,
iv. Disposition of progeny.
e. Plans and agreements for future re-introduction (if applicable).
11. Please provide a detailed description on how the proposed activities will enhance or benefit the wild population
within its native range (e.g., direct or indirect conservation efforts) and provide documentation (e.g., signed
memorandums of understanding) demonstrating your commitment to supporting the program and how the program
contributes directly to the species identified in your application.
Technical Expertise and Facilities
•

For export/re-export, provide information for the receiving institution.

•

For import, provide information for your institution.

•

For import to multiple facilities, provide information for all receiving institutions.

12. Provide copies of or cite any species-specific care/husbandry manuals, protocols, or guidelines that are used at the
facility.
13. Describe the facility’s record keeping.
14. CV or resume outlining the technical experience of each caretaker, veterinarian, and administrator with direct
oversight of the specimens working with, maintaining, and/or propagating each species/specimen, as it relates to the
proposed activities, including experience with similar species.
15. Current inventory of the species or similar species at the facility (males.females.unknown sex, e.g., 10.2.3),
16. Number of years the species or similar species has been maintained at the facility,
17. Number of births by species or similar species per year over the last 5 years,
18. Number of mortalities by species or similar species per year over the last 5 years and steps taken to avoid, decrease,
or mitigate such mortalities,
19. A detailed description, diagrams, and photos clearly depicting the existing facilities where the specimens will be
maintained, including dimensions, type of construction materials, structures for the provision of food and water,
climate conditions, and protective measures from the elements (e.g., direct sun, rain, snow). Do not provide
blueprints.
20. Approximate carrying capacity for the species at the facility.
21. Describe any plans for ongoing staff training with regard to safety, security, record keeping, or animal management.
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22. Describe any plans for ongoing animal training with regard to husbandry behaviors (e.g., crate or chute acclimation) or
veterinary procedures (e.g., health exam or blood collection).
23. Describe how the dietary needs of the species will be met.
24. Describe how the facility addresses the social well-being and behavior of the species such as social grouping,
methods of integration, and appropriate social and behavioral enrichment.
25. Will this import affect the current specimens at the facility? Are there any planned transfers of specimens currently at
the facility? If so, provide detailed information regarding the transfer plans.
26. If accredited by a regional or national animal care organization, please identify the organization and provide proof of
accreditation.
27. Please provide copies of any State or Federal licenses to display, exhibit, or hold the species, as well as a copy of the
most recent USDA APHIS inspection report.
Transport/Shipment of Live Animals
28. Transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals. All air
transport must also comply with our regulations at 50 CFR 14, Subpart J and the International Air Transport
Association (IATA) live animal regulations (contact airline for information). As such, provide:
a. Duration of the trip (including airline flights and ground transport)
b. The type, size, and construction of any shipping container and,
c.

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

d. Will a veterinarian or animal keeper accompany the specimen and be able to provide any necessary care?
e. CV or resume of the individual(s) arranging and/or conducting the transport of the specimen(s).
For additional information, please see the CITES guide for transport of live specimens.
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).
Imports must also comply with U.S. Department of Agriculture, Animal and Plant Health Inspection Service inspection and
quarantine requirements. For additional information, please visit the USDA Import/Export website.
Appropriate and Acceptable Destination
For import of live CITES Appendix-I listed species, a determination that the receiving facility meets the CITES
“appropriate and acceptable destination” annotation must be made.
For additional information, please see: Conf. 11.20 (Rev. CoP18) on Definition of the term ‘appropriate and acceptable
destinations.
29. Identify all persons and/or facilities who will be receiving a specimen, including persons and/or facilities who are likely
to receive a specimen within 1 year after it arrives in the US.
For each person and/or facility identified in question 29, please provide the following information:
30. Description of the facility, including diagrams, photographs, or construction plans,
31. Description of the enclosures and their construction and maintenance, including information on whether or not there is
sufficient space provided to the specimen(s) to allow each animal to make normal postural and social adjustments
with adequate freedom of movement,

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32. Description of the adequacy of the enclosures or holding areas to prevent escape or unplanned exchange of genetic
material with specimens of the same or similar species outside the facility,
33. Description of environmental enrichment elements provided to the specimen(s).
34. If the specimen(s) is/are on public display, provide a description of any off-exhibit area, consisting of indoor and
outdoor accommodations, as appropriate, that can house the specimen(s) on a long-term basis, if necessary.
35. Provision of water and nutritious food of a nature and in a way that are appropriate for the species (if grazing in
natural areas, provide information on the natural vegetation present).
36. Copies of all Standard Operating Procedures (protocols) used at the facility for the care and housing of the animal(s).
Examples include, but are not limited to quarantine, diet, veterinary care, animal and staff training, enrichment, daily
and seasonal routines, emergency measures, record keeping, routine medical examinations, etc.
37. Description and resumes of the recipient staff who will care for the specimen(s), including information on staffs’
training and experience in providing proper daily care and maintenance for the animal(s) being imported, or for a
closely related species,
38. Readily available veterinary care or veterinary staff experienced with the species or a closely related species,
including emergency care (e.g., veterinarian names, clinic/facility names and locations, full-time or part-time vets, staff
or contract vets, 24/7 availability),
39. Security measures to prevent theft or harm of specimens and measures taken to rectify any previous theft, harm or
security problems involving elephants,
40. Survival rate of specimens of the same species or, alternatively, closely related species at the facility, mortalities for
the previous 3 years, significant injuries to wildlife, occurrence of significant disease outbreaks during the previous 3
years, and measures taken to prevent similar mortality, injury, damage, or disease. (Note: significant injury, damage,
or disease outbreaks are those that are permanently debilitating or re-occurring),
41. Sufficient funding on a long-term basis to cover the cost of maintaining the facility and the specimens imported.
CITES Appendix I and Marine Mammal Species
42. For export of a CITES Appendix I-listed species, provide a copy of the CITES import permit, or evidence one will be
issued by the Management Authority of the country to which you plan to export the specimen(s). In accordance with
Article III of the CITES treaty, it is required that import permits are issued before the corresponding export permit.
43. For import of CITES Appendix-I listed species, provide information to show the import is not primarily for
commercial purposes as outlined in Resolution Conf. 5.10 (Rev CoP 15).
44. For import of live CITES Appendix-I marine mammals, provide a copy of your FWS or NMFS Marine Mammal
Protection Act (MMPA) permit or authorization.

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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 to average 1.5 hours (electronically) to 2 hours (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 (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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