Form 3-200-53 Application - Export/Re-Export of Live Captive-Held Mari

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

FWS Form 3-200-53 (Rev. 02/2023)
U.S. Department of the Interior

Export/Re-Export of Live Captive-Held Marine Mammals (CITES)
☐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 3-200-53 (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 3-200-53 (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 3-200-53 (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 3-200-53 (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 3-200-53 (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 3-200-53 (Rev. 02/2023)
U.S. Department of the Interior

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

EXPORT/RE-EXPORT OF LIVE CAPTIVE-HELD MARINE MAMMALS (CITES)
Use this application for the export or re-export of captive-held LIVE marine mammals under the jurisdiction of the
FWS (sea otters, marine otter, polar bears, walrus, manatees, and dugong) protected under CITES.
NOTE: Under the MMPA, marine mammals can only be exported for the purposes of public display, scientific research, or
enhancing the survival or species of the stock.
This form should NOT be used for:
•
•
•
•
•
•
•

•

Export/re-export parts or biological samples (use Form 3-200-29)
Introduction from the sea, (use Form 3-200-31).
Import of parts of Appendix I animals (use Form 3-200-37e)
Public display of marine mammals (use Form 3-200-43a).
Scientific research (use Form 3-200-43b), including import/export under the MMPA/ESA for research purposes.
Enhancement under the MMPA and/or ESA, including import/export under the MMPA/ESA for enhancement of
the propagation or survival of the species (use Form 3-200-43c).
A letter of authorization (LOA) under MMPA Sections 109(h)/112(c) rescue, rehabilitation, and release of stranded
marine mammals, including import of live animals and/or import, export or re-export of samples for rescue-rehab
purposes (use Form 3-200-43d).
Activities involving marine mammals under jurisdiction of the National Marine Fisheries Service (NMFS) (whales,
dolphins, porpoises, seals and sea lions); please contact NMFS.

NOTE: Provide a copy of your FWS or NOAA Fisheries permit or authorization with your CITES permit application.
All international shipment(s) must be through a CITES designated port. A list of designated ports (where a wildlife
inspector is posted) is available from the list of designated ports. 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).
Please review the complete application carefully before beginning. Provide complete answers to all questions on
the application. If a question is not applicable, answer with “N/A”. If needed, use additional sheets of paper. If you provide
additional information as attachments, indicate the application question number you are addressing. If you are applying for
multiple species and/or activities, be sure to indicate which species/activity(ies) you are addressing in each response.
1. For what activity are you requesting to carry out (check the appropriate box)?

☐ Export

☐ Re-Export
2. What is the purpose of the export/re-export?

☐ Commercial
☐ Exhibition
☐ Scientific

☐ Breeding

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FWS Form 3-200-53 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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3. Provide the following for EACH animal you are applying:
a. Scientific name (genus, species, and if applicable, subspecies).
b. Common name.
c.

Birth date/Age.

d. Sex (if known).
e. Description (e.g. I.D. #, ISIS #, tattoo #).
f.

Country where the wildlife originated.

g. Indicate if the wildlife was originally taken from the wild or born in captivity.
h. Current location of the specimen.
4. For animals previously taken from the wild or imported, provide a copy of the MMPA permit or other authorization
demonstrating that the specimens were legally obtained.
5. For captive-born wildlife, provide an ARKS/ZIMS report OR:
a. If the animal was born at your facility, please provide a statement that includes:
i. Birth date, sex, and identification number of each specimen;
ii. Name and address of your facility where the animal was born;
iii. Location and source (e.g., captive-born, wild-caught) of parental stock;
iv. Your signature and date.
b. If the animal was born at another facility, provide a signed statement from the facility detailing the origin of the
animal and records that include:
i. The complete name and address of the facility where the animal was born;
ii. Birth date, sex, and identification number of each specimen;
iii. Location and source (e.g., captive-born, wild-caught) of parental stock;
iv. Copies of documentation showing that you acquired the animal from the facility or documentation
demonstrating the history of transactions (chain of ownership of each animal).
6.

If the specimen is being re-exported (exporting a specimen that was previously imported into the United States)
provide: Provide:
a.

1A

copy of the validated foreign CITES export or re-export document (cancelled by OLE) issued by the
appropriate CITES office in the country from which the wildlife was imported, and

b.

1 Wildlife

c.

If you did not make the original import, provide a copy of the importer's documents outlined above and the
invoice or other document that shows you acquired the wildlife from the original importer or history of
transactions that demonstrate chain of ownership. NOTE: Redacted documents can only be accepted if the
information redacted is not needed to determine a legal chain of custody (e.g., declared value of wildlife,
original exporter name provided a copy of the cleared form 3-177 is provided and traceable). All other
redactions will not be accepted. For further instructions contact the permit issuing office directly.

Declaration (Form 3-177), stamped cleared by OLE, (provide either a hard copy or electronic release;
not applicable for plants); OR

1 Permits

cannot be issued without the documents being stamped cancelled and cleared by OLE.
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FWS Form 3-200-53 (Rev. 02/2023)
U.S. Department of the Interior

7.

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Provide the name and address of the person receiving the shipment in the foreign country (if self, provide foreign
address).
Name:
Address:
City:
Country, Postal Code:

8.

If the animal was obtained prior to the date CITES applied to it (“pre-Convention”): provide a signed and dated
statement as well as documents or other evidence to that effect.

9.

For CITES Appendix I species, provide a copy of the foreign CITES import permit, or evidence one will be issued by
the Management Authority of the country to which you plan to export or re-export the wildlife. In accordance with
Article III of the CITES Treaty, it is required that import permits are issued before the corresponding export permit.

10. For whales, dolphins, porpoises, seals, and sea lions, provide either a copy of the NOAA Fisheries letter of
authorization for export or evidence that NOAA Fisheries has been contacted.
QUESTIONS 11 TO 16 APPLY ONLY TO SPECIES UNDER FWS JURISDICTION
11. Provide a copy of the MMPA/ESA permit or authorization for this activity OR provide the appropriate information for
question 12, 13, or 14.
12. If the purpose of the export/re-export is for Public Display, provide certification from the importer’s relevant foreign
authority (e.g. provincial or national government) that:
a. The foreign recipient maintains their facility for public display of marine mammals.
b. The facility is open to the public on a regularly scheduled basis.
c.

Access to such facilities is not limited or restricted other than by charging an admission fee.

d. The recipient offers a program for education or conservation purposes that is based on professionally recognized
standards of the public display community (include copies of outreach/educational materials, photos of signage,
etc., along with an English translation, where applicable).
13. If the purpose of the export/re-export is for Scientific Research, provide information indicating that the export of the
animal meets the MMPA definition of “bona fide research,” (i.e., scientific research on marine mammals), the results
of which:
a. Are likely to be accepted for publication in a referred scientific journal.
b. Are likely to contribute to the basic knowledge of marine mammal biology or ecology; or
c.

Are likely to identify, evaluate, or resolve conservation problems.

14. If the purpose of the export/re-export is for Enhancement, provide an explanation of how the proposed activities:
a. Will contribute significantly to maintaining or increasing distribution or numbers necessary to ensure the survival
or recovery of the species or stock; and
b. Is consistent with any U.S. conservation or recovery plan or the factors that would be addressed in any such plan.

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FWS Form 3-200-53 (Rev. 02/2023)
U.S. Department of the Interior

15. Provide a certification from the appropriate government agency of the importing country to show that:
a. The laws and regulations of that government allow enforcement of the U.S. permit conditions;
b. Such conditions will be enforced;
c.

The government will afford comity to the FWS to amend, suspend or revoke the permit, if issued; and

d. The documents provided by and about the foreign facility are true and correct.
16. Provide a copy of the letter from the USDA/APHIS, confirming that the foreign recipient meets comparable standards
under the Animal Welfare Act for maintenance and care of marine mammals.

FOR ALL APPLICANTS
17. The transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals, FWS
regulations at 50 CFR 14, Subpart J. and in the case of air transport, with the International Air Transport Association
(IATA) live animal regulations (contact airline for information). You must also meet USDA standards for Humane and
Healthful Transport of Marine Mammals. As such, provide:
a. The means and duration of transportation;
b. A description of the type, size, and construction of any shipping container;
c.

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

d. The qualifications of the person(s) accompanying the wildlife;
e. Documentation showing compliance with USDA regulations for transport and care of live marine mammals (7
U.S.C. 2131-2159; 9 CFR 3, Part E).
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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FWS Form 3-200-53 (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:
Original submission - paper-based: 2 hours
Amended submission - paper-based: 1.75 hours
Original submission - electronic: 1.75 hours
Amended submission - electronic: 1.5 hours
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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