Form 3-200-72 Federal Fish and Wildlife Permit Application Form - Eagl

Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM

OMB Control No. 1018-0167
Expires 07/31/2023

Eagle Nest Take
(Bald and Golden Eagle Protection Act, 50 CFR 22.85)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

BEFORE FILLING OUT THIS FORM, please access
the Return Addresses (to obtain the email/postal
addresses where this form can be returned), and read
the Frequently Asked Questions, Instructions, and
Additional Information. Please retain the "NOTICES"
page for your records.

TYPE OF REQUEST
New Application
Renewal
Amendment

If requesting a renewal or amendment, provide Permit #

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details. See
instruction page(s) for information on how to make your application complete and help avoid unnecessary delays.

Complete if applying as an individual

A.

1.a. Last name

1.b. First name

2. Date of birth (mm/dd/yyyy)

B.

3.b. Alternate telephone number

3.a. Telephone number

1.c. Middle name or initial

1.d. Suffix

3.d. E-mail address

Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution

1.a. Name of business, agency, Tribe, or institution

1.b. Doing business as (dba)

2. Tax identification no.

3. Description of business, agency, or institution

4.a. Principal officer Last name

4.b. Principal officer First name

5. Principal officer title

4.c. Principal officer Middle name/ initial 4.d. Suffix

6. Primary contact name

7.a. Business telephone number 7.b. Alternate telephone number

C.

7.c. Business fax number

7.d. Business e-mail address

All applicants complete address information

1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City

1.c. State

1.d. Zip code/Postal code:

1.e. County/Province

1.f. Country

2.a. Mailing Address (include if different than physical address; include name of contact person if applicable)
2.b. City

D.

2.c. State

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

All applicants MUST complete

1. A nonrefundable processing fee is required to process this permit, please attach check or money order payable to the U.S. FISH AND WILDLIFE
SERVICE. Federal, Tribal, State, and local government agencies, and those acting on behalf of such agencies, are exempt from the processing fee –
Please see details regarding fee exempt status as outlined in 50 CFR 13.11(d). See important permit details including regulations and fee amount
2. Do you currently have or have you ever had any Federal Fish and Wildlife permits?
If yes, list the number of the most current permit you have held or that you are applying to renew/re-issue:
Yes
No
3. 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 of applicant/Principal Officer (No stamped signatures. Electronic signatures accepted.)

Date of signature (mm/dd/yyyy)

Please continue to next page
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OMB Control No. 1018-0167
Expires 07/31/2023

Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM
Eagle Nest Take
(Bald and Golden Eagle Protection Act, 50 CFR 22.85)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

SECTION E. EAGLE NEST TAKE
(Bald and Golden Eagle Protection Act, 50 CFR 22.27)
Note: A Federal eagle nest take permit authorizes the take of eagles nests in limited circumstances. Permits are available to individuals,
agencies, businesses, and other organizations. This permit does not authorize possession of any eagle, eagle parts, or eagle nests.
Please read “What You Should Know About a Federal Permit For Eagle Nest Take” and the pertinent regulations at 50 CFR 22.85 before
you sign and submit your application.
Please provide the information requested below. If additional information needs to be provided that does not fit in the designated spaces,
add additional sheets to your application submission. Please number pages accordingly using the page number box provided at the
bottom of the sheet, and the corresponding question number. We cannot accept pages that are over 8.5” x 11” or non-paper media,
such as DVDs. You should be as thorough and specific as possible in your responses. Incomplete applications will be returned.
Processing fees are not returned for abandoned applications. Processing time depends on the complexity of the request and
completeness of the application.
FOR RENEWAL APPLICATIONS: Please answer all questions in Section E below in addition to filling out Sections A-D above. All
information must be provided, required reporting must be up to date (use report form 3-202-16), and processing fees paid, or the renewal
will not be processed.
In-use nest means a bald or golden eagle nest characterized by the presence of one or more eggs, dependent young, or adult eagles on
the nest in the past 10 days during the breeding season.
Alternate nest is an eagle nest that is not an in-use nest at the current time. When there is no in-use nest, all nests in the territory are
alternate nests.
1. Take Request. Include species, number of nests, and expected nest status (alternate or in-use)
Number of Nests

Species

Expected Nest Status (alternate or
in-use)

2. Which purpose are you requesting?
Check
all that
apply

Purpose
A. To alleviate an existing or rapidly developing safety emergency to alleviate a threat to bodily harm to humans or
breeding eagles (Alternate nest; In-use nest)
B. To ensure public health and safety (Alternate nest only)
C. If built on a human-engineered structure and creates, or is likely to create, a functional hazard that renders the
structure inoperable for its intended use (Alternate nest; In-use nest prior to egg-laying)
D. If necessary to protect an interest in a particular locality and the activity necessitating the take or the mitigation
for the take will, with reasonable certainty, provide a net benefit to eagles. (Alternate nest only)

3. Duration. When do you want your permit to be effective (month/year)? How many month(s) or year(s) do you want your
permit to be valid? Permits may be issued for as short as 1 month or up to 5 years.

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Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

OMB Control No. 1018-0167
Expires 07/31/2023

4. Project Activity. Include any relevant information regarding your activity as it relates to eagles. You must include the
following:
a. Location. Describe location of the project activity, including county/city and, as appropriate, include: maps, digital
photographs, and latitude/longitude geographic coordinates.

b.

Activity Description. A detailed description of your project. Including what is necessitating removing eagle nest(s).

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Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

c.

OMB Control No. 1018-0167
Expires 07/31/2023

Need. An explanation of why the take of eagles is necessary, including what interests will be protected by the project
or activity.
i. If purpose A- Safety Emergency: Describe the safety emergency and why the situation was not foreseeable. Explain
why removal of the nest is necessary to alleviate it. Safety emergency means a situation that necessitates immediate
action to alleviate a threat of bodily harm to humans or eagles.
ii. If purpose B- Public Health & Safety: Describe the situation and why removal of the nest is necessary to alleviate it.
iii. If purpose C- Human Engineered Structure: Describe the structure and situation. Describe how the nest creates, or
is likely to create, a functional hazard that renders the structure inoperable for its intended use.
iv. If purpose D- Protect an Interest: Describe the situation and why removal of the nest(s) is necessary. Describe the
avoidance, minimization, and mitigation measures you have used to reduce the need to take the nest, to offset the
take, and provide a net benefit to eagles (see 50 CFR 22.27(b)(7)).

5. Eagle Activity. Include any known information on eagle activity. You must include the following:
a. Location. Describe the location of eagle nests, roosts, and/or use areas including latitude/longitude geographic
coordinates and, as appropriate, maps, digital photographs, and other information. The Service cannot issue a permit to
disturb a nest if the location of the nest is not provided. (The latitude and longitude coordinates of an eagle nest can be
determined using a hand-held GPS device, or a GPS mapping program on a cell phone. If neither of these are available,
you can use the Google Earth program, available free online from Google for personal use, or at most public institutions
that provide computer access (e.g., public libraries). Google Earth provides detailed satellite images worldwide, and the
scale of the imagery is such that individual trees, cliffs, and other possible nest structures are easily identifiable. In
Google Earth, the geographic coordinates of the computer cursor are provided in the lower right hand corner of the
computer screen, so by placing the cursor on the nest tree you can obtain its geographic coordinates. Google Earth has
a number of options for the coordinates it provides, and the coordinates it displays can be selected by the user. In
Google Earth Pro, the version of Google Earth that is in widest use today, the coordinates that are displayed can be
selected from the "Tools" dropdown menu, under "Options." Within the Options menu, select "3D View". The Service
prefers latitude longitude coordinates in decimal degrees, and this is one of the options that can be selected within the
"Show Lat/Long" box that appears under the 3D View menu. To test whether you are obtaining the correct coordinates,
move your cursor to the Washington Monument -- the coordinates should read latitude 33.889, longitude -77.035.)

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Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

b.

OMB Control No. 1018-0167
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History. If known, include the history of nest occupation, roost use, or important area use.
If known, provide the specific distance and locations of nests and other eagle-use areas from the project footprint.

6. Provide a statement outlining how the eagle’s nest will be removed, destroyed, or relocated.
a. If an in-use nest, describe how you propose to remove the nestlings or eggs and proposed disposition, including the
location of recipient nest(s) and/or name and phone number of the federally permitted rehabilitation facility that is
authorized for the possession of live eagle(s) or eggs.
b. If an eagle nest or eagle parts found in the nest are being donated to a scientific or educational institution, provide the
name and federal permit number of the entity.

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Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

OMB Control No. 1018-0167
Expires 07/31/2023

7. Provide a detailed description of all avoidance, minimization, mitigation, and monitoring measures that you have
incorporated into your planning for the activity that you will implement to prevent the need for eagle nest take and reduce
the likelihood for future take of eagle nests. If the goal is to reduce or remove nesting eagles from the area, how will you
prevent future nesting on the same structure/in the area?

8. Subpermittees. Anyone conducting permitted activities or acting as your agent must be identified by you, in writing, as a
subpermittee under your permit. If the nest will be removed or relocated (rather than destroyed in the course of an activity),
provide the name, address, phone number, and e-mail address of the qualified party conducting the removal and/or
relocation. If nestlings or eggs are to be removed, provide the name of the qualified agent for Service approval.

Your subpermittees must have either a copy of your permit that identifies them as a subpermittee, or a copy of your permit and
a letter from the Permittee (Principal Officer) listing activities (including location and duration) they are authorized to conduct.
The permittee is responsible for ensuring subpermittees are trained and adhere to the conditions of your permit.
Subpermittees must be at least 18 years of age. A permittee or subpermittee must be present when conducting activities
authorized by your permit.
9. Records. You must retain records legibly written or reproducible in English relating to the activities conducted under your
permit for at least 5 years from the date of expiration of the permit.
Is the physical address you provided in Section C on page 1 of this application the address where your records will be
kept?
⬜ Yes ⬜ No If “no,” provide the physical address
10. You are responsible for ensuring that the permitted activity is in compliance with all Federal, tribal, State, and local laws
and regulations applicable to eagles. Have you obtained all required State or Tribal permits or approvals to conduct this
activity?
Indicate “Yes,” Have applied,” or None required.” If “Yes,” attach a copy of the approval(s). If “Have applied,” submit a copy
when issued.
Yes
Have applied
None required
11. Consultant: If you are a consultant submitting this permit application, please provide your name and contact information (phone/email)

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Form 3-200-72 (Rev. 02/2020)
U.S. Department of the Interior

OMB Control No. 1018-0167
Expires 07/31/2023

12. The name and contact information for any U.S. Fish and Wildlife Service employee(s) who has provided technical assistance or
worked with you on this project. You typically need to have a conversation with a U.S. Fish and Wildlife Service Biologist prior to
submitting your application. If you have not yet spoken with Biologist, please contact your regional Migratory Bird Permit Office to
determine the appropriate individual to speak to. If you have received technical assistance for your project from your State Wildlife
agency, please provide the name and contact information for the individual(s).

13. Disqualification factor. A conviction, or entry of 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 disqualifies any such person from
receiving or exercising the privileges of a permit, unless such disqualification has been expressly waived by the Service
Director in response to a written petition. (50 CFR 13.21(c)) Have you or any of the owners of the business, if applying as
a business, been convicted, or entered a plea of guilty or nolo contendere, forfeited collateral, or are currently under
charges for any violations of the laws mentioned above? Indicate “Yes” or “No.”(you must provide an answer). 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. (list all – use additional pages as necessary)

14. Are you eligible for Fee Exempt Status? Fee exempt status applies to government agencies (Federal, State, Tribal, and
municipal governments). Applicants acting on behalf of such agencies must submit 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, or the agencies tax exempt form.
Yes - Government Agency
Yes - Acting on behalf of Government Agency
Documentation Included
No - not eligible for Fee Exempt Status
15. I acknowledge that I have read the form Instructions, Frequently Asked Questions, and Additional Information; and have
accessed the page with the Return Addresses to obtain the address where I should return this form. I have also filled out all
fields and questions in this application. Check this box to acknowledge:

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OMB Control No. 1018-0167
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Form 3-200-72 (Rev. 02/2020)
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
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. The information the individual provides helps the FWS monitor and report on protected species and assesses 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
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to
monitor take and disposition of migratory birds, under the applicable laws governing the requested activity, for which a permit is
requested, and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. 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 above 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. 1018-0167.
ESTIMATED BURDEN STATEMENT
The public reporting burden on the applicant for information collection varies depending on the activity for which a permit is requested.
The relevant burden for this information collection, based on the activity performed, including time for reviewing instructions, gathering
and maintaining data and completing and reviewing the form is as follows:
Eagle Nest Take (Single Nest)
Original submission - paper-based: 14 hours (reporting) and 2 hours (recordkeeping)
Original submission - electronic: 13 hours (reporting) and 2 hours (recordkeeping)
Eagle Nest Take (Multiple Nests)
Original submission - paper-based: 35 hours (reporting) and 5 hours (recordkeeping)
Original submission - electronic: 33 hours (reporting) and 5 hours (recordkeeping)
Amendment - Eagle NestTake (Single Nest)
Original submission - paper-based: 17 hours (reporting) and 3 hour (recordkeeping)
Original submission - electronic: 13 hours (reporting) and 3 hours (recordkeeping)
Amendment - Eagle Nest Take (Multiple Nests)
Original submission - paper-based: 17 hours (reporting) and 3 hours (recordkeeping)
Original submission - electronic: 13 hours (reporting) and 3 hours (recordkeeping)
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.
FREEDOM OF INFORMATION ACT
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request that
you identify any information that should be considered privileged and confidential business information to allow the Service to meet its
responsibilities under FOIA. Confidential business information must be clearly marked "Business Confidential" at the top of the letter or
page and each succeeding page and must be accompanied by a non-confidential summary of the confidential information. The nonconfidential summary and remaining documents may be made available to the public under FOIA [43 CFR 2.26 – 2.33].

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