Form 3-200-49 Application - Approval, Amendment, or Renewal of a Coope

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

FWS Form 3-200-49 (Rev. 02/2023)
U.S. Department of the Interior

Approval, Amendment, or Renewal of a Cooperative Breeding Program (WBCA)
☐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 3-200-49 (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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FWS Form 3-200-49 (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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FWS Form 3-200-49 (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
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FWS Form 3-200-49 (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 3-200-49 (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 3-200-49 (Rev. 02/2023)
U.S. Department of the Interior

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

APPROVAL, AMENDMENT OR RENEWAL OF A COOPERATIVE BREEDING PROGRAM (WBCA)
NOTE 1: This application must be approved before import permits can be issued for the purpose of cooperative
breeding. A Cooperative Breeding Program (CBP) must have at least two members. Zoological institutions may be
members of a CBP. Once a program is approved, you must submit application Form 3-200-48 to request import
authorization for specific birds.
NOTE 2: The lead cooperator (as identified on page 3 or 5 or who is set up as the principal officer under the
account in ePermits) for the breeding program must submit this application.
Complete all relevant questions on the application. Mark questions that are not applicable with "N/A". Due to the
length of some questions, please use separate sheets of paper to answer the application questions. On all
attachments or separate sheets you are submitting, please indicate the number of the application question you are
addressing. If requesting authorization for more than one species or subspecies, please answer questions
1, 2, and 3 for each species/subspecies.
I want to:

☐ Establish a new cooperative breeding program (please answer questions 1-5).

☐ Amend an existing cooperative breeding program, CBP# ___________________ (If requesting new species, answer
questions 1 through 6; if requesting to add a member, answer questions 3 and 6.)

☐ Renew an existing cooperative breeding program, CBP# __________________ (If there are no changes to the
membership or species in the CBP, please answer questions 5 and 6).
1. A description of the species/subspecies to be covered (imported) under the program, including:
a. Scientific name (genus, species, and, if applicable, subspecies) and common name
b. Number of birds requested to meet the goals of the program (Note: indicate the total number of birds to be
imported by all the members of the CBP for the life of the program);
c.

The minimum number of participating facilities need to achieve management objectives – provide an explanation
of how this number was derived; and

d. Desired sex ratio.
2. A statement justifying the need for this approval, which includes information on the current U.S. captive population of
the requested species/subspecies and the need for import of additional specimens. Information should include, if
applicable, whether there is high trade of the species; it is being captive-bred for re- introduction purposes; you are
collaborating with other groups to promote in-situ conservation, and the sustainability of the species in the long-term.
a. Provide a description of the cooperative breeding program that includes: managing genetic diversity as an
important component to creating a long-term sustainable captive population; what scientifically grounded
method(s) the CBP intends to use to measure both projected and current levels of genetic diversity within the
population; and for projected gene diversity, the time frame that will be considered (for example, projected gene
diversity at 100 years of 10 generations);
b. Description of the long-term plans for developing and maintaining a self-sustaining population in captivity of the
exotic bird species;
c.

Details on the system of record keeping and tracking of birds and their offspring, including how individual
specimens will be marked or otherwise identified;

d. Explanation on the relationship of the cooperative breeding program to the conservation of the exotic bird species
in the wild. Include information on whether you anticipate importing captive-bred birds or wild caught birds and
include identified sources to ensure that the number of birds that you anticipate needing will be available;
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FWS Form 3-200-49 (Rev. 02/2023)
U.S. Department of the Interior

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e. Information on the long-term funding of the cooperative breeding program to ensure its existence until the CPB’s
breeding goals are met; and
f.

Detailed plans for the placement of the program birds and any offspring, recalling that birds imported as part of
a cooperative breeding program cannot be loaned, sold or otherwise transferred to a non-member without
prior authorization of this office. Additionally, provide a description of how program birds will be dealt with if a
member(s) leaves the program or if the program is voluntary terminated (members decide to disband and the
program is not renewed) or involuntarily terminated (the Service does not renew the CBP).

3. Describe care and maintenance of the requested species/subspecies, and how each prospective member’s facilities
meet professionally recognized standards (if requesting to amend an established CBP by adding new members,
please provide the following for each proposed new member):
a. Name and addresses of each facility where the birds, by species, will be maintained;

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FWS Form 3-200-49 (Rev. 02/2023)
U.S. Department of the Interior

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b. In the table below, please provide the requested information for each type of holding space that will be used to house CBP birds. Use one row for each holding
space type (flight cages with different dimensions should be listed on separate rows as should indoor vs. outdoor aviaries).:
1. CBP
member,
facility name
EXAMPLE

2. Aviary type (outdoor
vs. indoor flight cage,
etc.). Add a separate
row for type of aviary.

3. Dimensions of specific
aviary/holding space (WxLxH).
Please specify units (feet,
inches, etc.)

4. How many
aviaries fit these
specifications?

5. What species will
be housed in this
type of aviary?

6. How many birds will be
housed in each of the
aviaries?

Outdoor flight

10’x10’x8’

4

Amazona
ochrocephala

Up to 4 birds in two of the
flight cages. The two
remaining flight cages will be
vacant for future imports.

Outdoor flight

8’x5’x7’

2

Amazona
ochrocephala

2

7. Will the birds be housed here
permanently? If not, please provide
additional information in the comments
box below (i.e. why will the birds be
moved and for how long).
These cages will be used to socialize
young birds or for surplus birds

These will be permanent breeding cages
and the birds will remain here for multiple
breeding seasons. If these birds are
transferred, we will include that
information in our CBP annual report.

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FWS Form 3-200-49 (Rev. 02/2023)
U.S. Department of the Interior

c.

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For each type of aviary listed above, please provide a photo with a caption indicating the ‘type’ as listed in column
2;

d. Please provide information on where any progeny will be housed;
e. Please provide husbandry practices specific to each species as necessary;
f.

Provide a qualification statement for EACH individual who will be participating in CBP. This statement should
include records showing the participant's prior breeding experience with bird species that are the same or similar to
the species in the CBP.

4. Each CBP must identify an appropriate avicultural, zoological, or conservation organization that has agreed to oversee
its activities. Please provide a statement from the designated oversight organization, on the organization’s letterhead,
that includes at a minimum:
a. Description of the expertise of the organization to serve as an oversight organization;
b. Criteria for acceptance of individuals into the proposed breeding program;
c.

How participation in the program will be monitored; and

d. Relationship of the oversight organization to the CBP in establishing and maintaining a self- sustaining captive
population of the exotic bird species or enhancing the conservation of the species in the wild.
5. Provide a signed and dated statement from each CBP member. The statements must contain the following
information:
a. Member name;
b. Scientific name of all species being requested for the program;
c.

Statement that the member is aware of the purposes of the cooperative breeding program and the Wild Bird
Conservation Act and will abide by the regulations and conditions placed on the program if it is approved.

6. If you are amending or renewing a program, you must also provide the following information in a table format:
a. The number, species, and sex of all birds that have been imported to date for your CBP, including dates of import,
countries of origin, disposition of the imported birds for each importer, and associated permit numbers for each
permit. Identify the number of birds within each species and their sex held at each facility;
b. For each program participant, a summary of any breeding activity that has been achieved with the imported birds,
including the number of eggs and progeny produced, and the disposition of any progeny;
c.

For each program participant, a summary of any mortality, including mortality during transit or quarantine (for birds
that died in quarantine, you must provide appropriate documentation from USDA/Veterinary Services) of birds
imported as part of the approved cooperative breeding program, as well as details of any post-fledging mortality of
their progeny;

d. A summary of progress made towards achieving a self-sustaining captive population of each species;
e. An explanation of any substantive changes that have or will occur regarding any aspect of the approved
cooperative breeding program; and
f.

An official letterhead statement from the designated oversight organization approving the amendment or renewal.

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FWS Form 3-200-49 (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 (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 2.75 hours (electronically) to 3 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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