Form 3-200-40 Application - Export and Re-import of Museum Specimens (

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

FWS Form 3-200-40 (Rev. 02/2023)
U.S. Department of the Interior

Export/Re-Import of ESA-listed Museum Specimens (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 3-200-40 (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
Expires xx/xx/xxxx

FWS Form 3-200-40 (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
Expires xx/xx/xxxx

FWS Form 3-200-40 (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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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-40 (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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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-40 (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 3-200-40 (Rev. 02/2023)
U.S. Department of the Interior

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

EXPORT AND RE-IMPORT OF MUSEUM SPECIMENS (ESA)
This form should be used for:
•

ESA-listed specimens only that are currently accessioned in your museum.

This form should NOT be used for:
•
•

For the export or re-import of specimens of ESA-listed species that are not part of your museum collection or have
not yet been collected, use Form 3-200-37e.
Specimens of species are protected by CITES, Marine Mammal Protection Act, Migratory Bird Treaty Act, or Bald
and Golden Eagle Protection Act. You are required to obtain additional authorizations prior to any export or reimport of specimens. Contact DMA for the necessary application(s) and further guidance.

This application can be used for:

☐ New Application

☐ Amend [Permit number: ___________________________]
☐ Renew [Permit number: ___________________________]
1. Authorize for:

☐ All animals

☐ All plants

☐ Both animals and plants

2. If relevant information about the requesting institution or collection is available online, please provide the URL:
_____________________________________________________________
3. Is the requesting institution (either in whole or in part) or the scientific collection an accredited scientific
institution/collection, such as the Alliance of Museums, American Society of Mammalogists, American Society of
Crime Laboratory Directors/Laboratory Accreditation Board (e.g., forensic institutions) or other accrediting entity:

☐ Yes, attach supporting documents, such as a website, copy of accreditation, or other such evidence of the
organization(s) who have given accreditation.

☐ No, provide copies or other evidence of written policies related to the institution’s standards for scientific integrity,
record-keeping, accessibility to, and management of the collection.

4. Are the collections and associated data permanently housed and professionally curated? If yes, how long have the
collections been permanently housed and professionally curated. Provide the physical address for the collection and
the name and contact information for the curator:

☐ Yes, how long have the collections been permanently housed and professionally curated. Provide the physical
address for the collection and the name and contact information for the curator:
Name:

Address:
City, State, Postal Code

☐ No
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FWS Form 3-200-40 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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5. Are all accessions properly recorded in a permanent catalogue?

☐ Yes

☐ No

If the catalogue or collection is available online, provide the URL ______________________________________
6. As appropriate, ENTER approximate number of accessions specimens:
_____________ Mammals
_____________ Birds
_____________ Reptiles/Amphibians
_____________ Fish
_____________ Insects/Arachnids
_____________ Other Invertebrates
_____________ Vascular Plants
_____________ Non-Vascular Plants
_____________ Other (provide description ___________________)
7. Do you maintain any specimens of species protected under the Marine Mammal Protection Act?

☐ Yes

☐ No

If yes, do you intend to export or re-import these specimens? How many specimens are accessioned? __________
If yes, provide a copy of your MMPA authorization for this activity.
8. Do you maintain or intend to obtain any specimens of species protected under CITES?

☐ Yes

☐ No

If yes, do you intend to export or re-import these specimens? How many specimens are accessioned? __________
If yes, provide a copy of your CITES authorization for this activity.
9. Do you maintain any specimens of species protected under the Migratory Bird Treaty Act?

☐ Yes

☐ No

If yes, do you intend to export or re-import these specimens? How many specimens are accessioned? __________
If yes, provide a copy of your MBTA authorization for this activity
10. Do you maintain any specimens of species protected under the Bald and Golden Eagle Protection Act?

☐ Yes
☐ No
If yes, do you intend to export or re-import these specimens? How many specimens are accessioned? __________
If yes, provide a copy of your BGEPA authorization for this activity
11. Are specimens accessible to qualified users from outside your institution?

☐ Yes

☐ No

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

FWS Form 3-200-40 (Rev. 02/2023)
U.S. Department of the Interior

ENTER approximate number

In the United States

Outside the United States

Loans last year
Exchanges last year
Donations last year
12. Are permanent records maintained on specimens that are loaned or transferred?

☐ Yes

☐ No

13. Are specimens acquired primarily for the purpose of research, the results of which are to be reported in scientific
publications?

☐ Yes
☐ No
14. Are specimens prepared and the collections arranged in a manner that ensures their accessibility?
☐ Yes

☐ No

15. Are data on specimen labels, permanent catalogues, and other records as accurate as possible?

☐ Yes
☐ No
16. To the best of your knowledge, were the specimens in the collection acquired legally under the relevant laws of the
country where they were obtained and the United States (e.g., import permits, collection permits, take permits,
landowner permission)?
☐ Yes
☐ No
17. Are all specimens of endangered or threatened species permanently and centrally housed under direct control of the
scientific institution?
☐ Yes

☐ No

18. Are endangered and threatened species intended for exchange managed in such a manner to preclude their use
solely as decorations or trophies, or for other purposes incompatible with the principles of the ESA?

☐ Yes
☐ No
Please attach a statement of how the activities carried out by your institution will enhance or benefit the endangered or
threatened species intended for exchange (e.g., identify recovery tasks from the recovery plan, or describe how the
research activities will benefit the species under the Act).
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).

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OMB Control No. 1018-0093
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FWS Form 3-200-40 (Rev. 02/2023)
U.S. Department of the Interior

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:
Original submission - paper-based: 2 hour
Amended submission - paper-based: 45 minutes
Original submission - electronic: 45 minutes
Amended submission - electronic: 30 minutes
These estimates include 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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