3-200-14 Federal Fish and Wildlife Permit Application Form - Eagl

Form 3-200-14 (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 Exhibition
(Bald and Golden Eagle Protection Act, 50 CFR 22.21)
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 mail
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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Form 3-200-14 (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 EXHIBITION
(Bald and Golden Eagle Protection Act, 50 CFR 22.21)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

Note: A Federal Eagle Exhibition permit is required to possess and transport eagles for the purpose of educating the public about
the biology, ecology, and conservation needs of eagles. Only zoological parks, scientific or educational institutions, and museums
that meet the definition of “public” under 50 CFR 10.12 are eligible for this permit (50 CFR 22.21) and must complete section B on
page 1 of this application. A minimum of 12 public educational programs per year must be conducted under this permit. If eagles are
on display in an exhibit for educational purposes, you must be open to the public for a minimum of 400 hours per year. You must be
at least 18 years old to apply for a migratory bird permit. Please read “Frequently Asked Questions" 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. You may use as many additional sheets as needed. Please number
pages accordingly using the page number box provided at the bottom of the sheet, and the corresponding question number. You
should be as thorough and specific as possible in your responses. Incomplete applications will be returned.
As the permittee, you are legally responsible for ensuring that your subpermittees, staff, and volunteers adhere to the terms of your
permit.
You must locate live bird(s) and/or specimen(s) to acquire before a permit will be issued. You may not take possession of a bird prior
to approval by your Migratory Bird Permit Office.
FOR RENEWAL APPLICATIONS: In addition to filling out Sections A-D above, if "Live Bird" is selected for question 1, please
answer questions 2(d); 3; 5 (if change in Principal Officer/Primary Caretaker); 6; 7; 8 and 10-14 in Section E below. If anything other
than "Live Bird" is selected for question 1, please answer questions 3 and 10-14 in Section E below. All information must be
provided, required reporting must be up to date (use report form 3-202-13), and processing fees paid, or the renewal will not be
processed.

SECTION E.
Questions:
1) Indicate which you are requesting and the quantity of each:
Golden Eagle

Bald Eagle
Live Bird

Live Bird

Skeleton

Skeleton

Study Skin

Study Skin

Skins for Mounting

Skins for Mounting

Other (describe):

Other (describe):

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Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

2) Attachments - In additions to this form, you should also attach the following to complete your
application:
a)
Provide documentation verifying that you meet the definition of “public” in 50 CFR 10.12. “Public”
as used in referring to museums, zoological parks, or scientific institutions, refers to such as are open to the
general public and are either established, maintained, and operated as a governmental service or are
privately endowed and organized but not operated for profit. Not-for-profit organizations should include a
copy of their IRS Form 990.
b)
If you are requesting to display live eagles: Your application must include a Migratory Bird and
Eagle Acquisition and Transfer Request form (Form 3-202-12) for each bird you wish to acquire.
c)
You must also provide a written recommendation from another Federal permittee with eagle
handling experience.
d)
Attach photographs and diagrams of your permanent facilities/enclosures for housing migratory
birds (both indoor and outdoor). Diagrams must include dimensions (length, width, and height) and a
description of interior and exterior construction materials, such as flooring and netting materials. Indicate the
species or type of species that will be housed in each. Also provide a description of the interior and exterior
construction and housing materials, such as flooring, netting, perching, and watering materials.

3) Any permit issued as a result of this application is not valid unless you also have any required State
or tribal permits or approvals associated with the activity. Have you obtained all required State or tribal
permits or approvals to conduct this activity?
Yes, Have Attached
Not Required
Have Applied, Will Provide Upon Request

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Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

4) Provide a description of the educational message you will deliver and to what type of audience.
a) Provide an outline of your program, including as much detail as possible, and any brochures or other
materials prepared for distribution.

b) If you are requesting live eagles, explain why they are necessary for your program, including how they
will be used and displayed during the presentation to meet this need.

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Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

If you are applying only for dead specimens, skip to Question 9.
5) For static display eagles: The Primary Caretaker must be at least 18 years of age and have a minimum of 300 hours of
experience gained over the course of 2 years working with the eagle species you intend to acquire. This experience is to
include: training the species or similar species you intend to use in educational programs, the care and feeding of eagles,
managing their exhibits (captive husbandry including perching, jessing, etc.) and medical management. A portion of the
experience may be fulfilled by participation in migratory bird/raptor handling seminars and courses.
For using glove-trained eagles in educational programs: In addition to the above requirements, we recommend that the
Primary Caretaker have a total of at least 500 hours of experience with the eagle species you intend to acquire gained
over the course of 2 years, including presenting educational programs using glove-trained eagles. ALSO: You must also
attached a letter of reference from an experience eagle exhibition permittee describing your qualifications for this permit.
a) For each live eagle you propose to use, describe in detail your experience handling and caring for those
species.

b) Provide the name, address, and telephone number of the facility or facilities where your experience was
obtained.

c) Describe your experience in presenting glove-trained programs, including the length of time
you have been presenting programs and the types of audiences.

6) Provide a list of the eagle(s) you will house in each enclosure, including the species, number of eagles, and flight status
(flighted, non-flighted) of each eagle

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Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

7) If live eagles will be displayed outside of the enclosures you described for Question 6 provide a detailed
description of
a) How the eagles will be displayed, and

b) Describe your enclosures for transport of the eagles, including dimensions (length, width, and height)
and the type and number of species that will be transported in each

8) For each live eagle you possess under this permit
a) Describe the diet you will administer and indicate food source.

b) Describe the types of daily enrichment you will provide for each eagle.

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Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

9) If you are requesting to display eagle specimens: List the species and type(s) of specimen(s) and the source's name,
address, and Federal permit number.

10) Anyone who will be responsible for the permitted activities or acting as your agent must either have their own
Federal migratory bird permit for the activity or be identified by you, in writing, as a subpermittee under your permit.
They may also require a State permit. Subpermittees must be at least 18 years old. As the primary permittee, you will be
responsible for ensuring that your subpermittees are properly trained and adhere to the terms of your permit. Provide the
name of any subpermittees who will be conducting activities under your permit. For anyone handling or caring for live birds,
briefly describe what they will be doing and their qualifications.

11) You must retain records legibly written or reproducible in English relating to the activities conducted under your permit for at
least 5 years after the date of expiration of your 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:

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Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

12) Disqualification factor. Have you, the permittee, or your client (if a broker on behalf of your client):
• Been assessed a civil penalty or convicted of any criminal provision of any statue or regulation relating to the activity for
which the application is filed (50 CFR 13.21(b) (1);
• 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. (50 CFR 13.21 (c)(1)):
• Had a permit revoked within the last five years for willfully violating any Federal or State statute or regulation, or any Indian
tribal law or regulation, or any law or regulation of any foreign country, which involves a violation of the conditions of the
permit or of the laws or regulations governing the permitted activity (50 CFR 13.28 (a)(1)) or failing to correct deficiencies
that were the cause of a permit suspension within 60 days (50 CFR 13.28 (a)(2)).
Answer "yes" if ANY of the events listed immediately above have occurred. Answer "no" if none of the events listed immediately
above have occurred.
Yes
No
If you answered “Yes”, provide: a) the individual’s name; b) date of conviction, civil penalty assessment or revocation;
c) charge(s), or reason(s) for revocation; d) location of the incident; e) court (if applicable, ticket, federal/state/tribal court etc.);
and f) legal action taken for each violation (i.e. fine, incarceration, probation…). Please be aware that a “Yes” response does not
automatically disqualify you from getting a permit.

13) 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
14) 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:
Page 8 of 9

Form 3-200-14 (Rev. 02/2020)
U.S. Department of the Interior

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

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 that affect protected
species. The information the individual provides helps the 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
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
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 5 hours (reporting) and 30 minutes (recordkeeping)
Original submission - electronic: 4 hours 30 minutes (reporting) and 30 minutes (recordkeeping)
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.
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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