Form 3-200-80 Application - Export of Fertilized Live Eggs, Caviar or

Federal Fish and Wildlife Permit Applications and Reports--Management Authority; 50 CFR 13, 15, 16, 17, 18, 22, 23

3-200-80 App - Exp Fertilized Live Eggs Caviar Meat Aquacult Paddlefish Sturgeon 02242023

ePermits Amendment - Export of Fertilized Live Eggs, Caviar or Meat from Aquacultured Paddlefish or Sturgeon (CITES) (Form 3-200-80) - Private Sector

OMB: 1018-0093

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

FWS Form 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

Export of Fertilized Live Eggs, Caviar, or Meat from Aqua-Cultured Paddlefish or Sturgeon (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 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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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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OMB Control No. 1018-0093
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FWS Form 3-200-80 (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 3-200-80 (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 3-200-80 (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

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

FWS Form 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

Signature and date

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FWS Form 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

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

EXPORT OF FERTILIZED EGGS, CAVIAR OR MEAT FROM AQUACULTURED PADDLEFISH OR STURGEON
(CITES)
This form may be used for:
•

Export of aquacultured fertilized eggs, caviar or meat

This form may NOT be used for:
•

Export of live specimens removed from the wild; use Form 3-200-27.

•

Export of wild caught caviar or meat; use Form 3-200-76.

•

Export of aquacultured live specimens; use Form 3-200-24.

•

Re-export of specimens; use Form 3-200-73.

•

Request export or re-export of species listed under the Endangered Species Act; use Form 3-200-37d.

Complete all questions on the application. Mark questions that are not applicable with "N/A". If needed, use separate
sheets of paper. On all attachments or separate sheets you submit, indicate the application question number you are
addressing.
This application can be used to:

☐ Request a single-use permit for export of a specific amount of caviar or meat that is valid for 6 months from the
date of issuance. For re-issuance or amendment of a single use permit, the original permit must be returned with this
completed application form.
☐ Establish a Master File: A “Master File” can authorize exports of specific total amounts of caviar and can be valid for

up to 3 years from the date of issuance. Once the Master File is approved, you must obtain partially completed certificates
to export. Partially completed certificates are valid for 6 months. Certificates must be obtained prior to making any
shipments and must accompany the shipment. Certificates may be applied for AFTER the Master File is established.

☐ Amend an existing Master File: A “Master File” must be amended when there have been any changes to the

information provided in the original application for a Master File. You need only provide the requested information for the
changes that have occurred. However, if you intend to renew your current Master File at the same time you are amending
it, see below.

☐ Renew (or Amend and Renew) a Master File: To renew a Master File that has or will soon expire, you must

complete this entire application, including providing all of the information requested in this form for all specimens to be
included in your Master File and information on any changes to your facility, operations, species, or suppliers for the
specimens that you wish to export.
Once a Master File is established or you are renewing (or amending and renewing) a Master File, you may request singleuse permits using the 3-200-74. Please refer to the fee schedule to determine the cost of each of the above-listed
activities.

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FWS Form 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

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

1. If requesting a single-use permit or master file with only one recipient, provide the name and address of foreign
recipient (if shipping to yourself, include your foreign address): (NOTE: Providing a foreign recipient is not required if
establishing a master file.)
Name:
Business Name:
Address:
Address:
City:
State/Province:
Country, Postal Code:
2. For each species from which product will be exported, provide:
a. Scientific name (genus, species, and if applicable, subspecies) and common name of the fish.
b. State(s) of source specimens.
c.

Address where the facility(s) is located.

d. Product description (e.g., fertilized live eggs, caviar, or meat).
e. Weight to be exported (metric and standard units).
f.

Description of shipping containers to be used (e.g., jars, tins, buckets) and sizes (provide units).

g. Will shipment be fresh, frozen, or pasteurized, or other (describe).
h. Current location of specimen(s).
3. For each facility, provide:
a. Photos and a description.
b. Number of years the facility has maintained the requested species.
c.

Provide a copy of the appropriate state and Federal license(s) for the facility.

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FWS Form 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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4. Provide the following regarding your production estimates for each species being requested and each facility identified
above:
a. Number of brood stock spawned annually.
b. Estimated total weight of eggs produced annually.
c.

Average annual growth rate of fish achieved at the facility.

d. Biomass, by age class and sex, at the beginning of the year; remaining biomass, by age class and sex, at the end
of the year.
e. Total live stock sold by age class and sex.
f.

Total “green” roe harvested annually (by weight).

g. Total roe determined not to be fit for processing and discarded (by weight).
h. Total caviar sold domestically (by weight).
i.

Total caviar sold internationally (by weight).

Estimated number of fry produced annually.

Total meat production.

Total meat sold domestically by sex (live weight is acceptable).

m. Total meat sold internationally by sex (live weight is acceptable).
n. Mortality rates by age class.
o. Information regarding disease outbreak; this information should include the causative agent, if known, percent
mortality, relevant pathological findings, and plan to reduce future disease outbreak.
p. Sacrifice rates by age class and sex.
5. Provide a statement on how your captive population(s) is being managed to maintain genetic viability.
6. Do you supplement from the wild?

☐ No

☐ Yes, provide the following:

a. A copy of the state authorization or collection permit(s) (i.e., aquaculture permit, broodstock permits, and capture
logs).
b. What is the disposition of wild-origin fish (males and females) once they have been used to improve the genetic
viability of your farm-raised population?
c.

When is the last time you supplemented your stock with wild-origin fish?

d. When do you next intend to use wild-origin fish to improve the genetic viability of the population?
7. Provide production records for the previous year.
8.

Are all roe that you are exporting F2 generation or more?

☐ No

☐ Yes

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FWS Form 3-200-80 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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9. If you are the Breeder, sign the following statement:
I hereby certify that the species listed above to be exported were bred and born/hatched from parental stock at my
facility listed below.
Name and address of your facility where the animals were bred and born;
Current location of parental stock:
Signature and date: __________________________________________________________________

10. If you obtained stock from another facility, provide copies of documentation showing that you acquired the specimens
from the breeder or documentation demonstrating the history of transactions (chain of ownership of each specimen)
and a signed statement from the breeder or breeder's record that includes:
a. Complete name and address of the breeder's facility.
b. Scientific and common name of the species.
c.

Statement that the specimen(s) was/were bred and born/hatched at his/her facility.

d. Birth/hatch date, and if applicable band/tag number, or other identifiers.
e. Location (Name, Street address, City, State) of Parental Stock.

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 3-200-80 (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 for individuals and 3 hours for private sector and government
Original submission - electronically: 1.75 hours for individuals and 2.75 hours for private sector and government
Amended submission - paper-based: 2 hours for individuals and 3 hours for private sector and government
Amended submission - electronically: 1.75 hours for individuals and 2.75 hours for private sector and government
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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File Type	application/pdf
Author	Harlow, Caroline I
File Modified	2023-02-24
File Created	2023-01-24