3-200-82 Federal Fish and Wildlife Permit Application Form - Bald

Form 3-200-82 (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

Bald Eagle or Golden Eagle Transport into the United States for
Scientific or Exhibition Purposes
(Bald and Golden Eagle Protection Act, 50 CFR 22.67)
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 form
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 information 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:
No
Yes
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 3-200-82 (Rev. 02/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM
Bald Eagle or Golden Eagle Transport into the United States
for Scientific or Exhibition Purposes
(Bald and Golden Eagle Protection Act, 50 CFR 22.67)

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

U.S. Fish and Wildlife Service
Division of Migratory Bird Management

A Federal Eagle Transport Permit is required to transport Bald Eagle (Haliaeetus leucocephalus) or Golden Eagle (Aquila
chrysaetos) parts into the United States for scientific or exhibition purposes. The items may remain in the United States on a
temporary basis only; the BGEPA prohibits permanent importation. The item(s) may not change ownership and the same items,
unchanged, must be returned to the sender at the conclusion of the project or exhibit. If you will be transporting species listed under
the Migratory Bird Treaty Act (e.g., songbird, hawk), in addition to Bald Eagle or Golden Eagle parts to the United States, you may
include them in this application. Live eagles or viable eagle eggs cannot be transported into or out of the United States.
Only zoological parks, scientific societies and museums that meet the definition of “public” under 50 CFR 10.12 are eligible for this
permit. (50 CFR 22.67) Therefore, you must complete section B on page 1 of this application.
Note: All raptors, including Bald Eagles and Golden Eagles, are protected under the Convention on International Trade in
Endangered Species (CITES). In addition to a Bald and Golden Eagle Transport permit to transport the eagle parts into the United
States, you will require a CITES Export permit from the exporting country and a CITES/ Eagle Transport for Scientific or Exhibition
Purposes permit from the U.S. Division of Management Authority (DMA) in order to transport/export the items back to the foreign
institution. The CITES/Eagle Transport for Scientific or Exhibition Purposes application can be obtained on the ePermits website.
You will need to include the following information with the 3-200-69 application you submit to DMA prior to
transport/export from the U.S.: (a) a copy of the canceled foreign CITES export or re-export document that accompanied the
shipment into the United States, (b) a copy of the cleared (stamped) U.S. Bald Eagle and Golden Eagle Transport permit, and (c) a
copy of the cleared (stamped) U.S. Declaration for Importation (FWS form 3-177). (If any species you propose to transport/ import/
export is listed in Appendix I of CITES, or listed under the U.S. Endangered Species Act or the Wild Bird Conservation Act, you may
require additional import or export permits under those laws Contact DMA..) All wildlife shipments must enter and exit the United
States through a wildlife port designated in 50 CFR 14.12, unless a port exception is authorized on your permit or you have a
separate exception to designated port permit issued under 50 CFR 14. For more information about importing and exporting
migratory birds, visit our webpage for Importers/Exporters.
You must be at least 18 years old to apply for a migratory bird permit. Please read the pertinent regulations 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.
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 and processing fees paid, or the renewal will not be processed.

SECTION E.

Questions

1) Attachments - In additions to this form, you should also attach the following to complete your application:
a) Attach documentation or other evidence that the specimen/item was lawfully acquired and any available information on the
origin or history of the specimen/item.
b) If applicable, attach a copy of the accession record(s) for the specimen(s)/item(s).
c) Provide documentation verifying that you meet the definition of “public” in 50 CFR 10.12. “Public” refers to museums,
zoological parks, and scientific or educational institutions, that 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.
2) 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
None Required
Have Applied, Will Provide Upon Request
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OMB Control No. 1018-0167
Expires 07/31/2023

Form 3-200-82 (Rev. 02/2020)
U.S. Department of the Interior

3) Provide the following information for each item to be transported into the United States (use a separate sheet if
necessary):
a)

Common and scientific names of species:

b)

Country of origin:

c)

Full description of the item(s), including age

4) Provide the name, address, and telephone number of the foreign institution from which the items are being
transported.
Name:

Telephone number (with country code):

Foreign address:
5) Provide a full description of the scientific or exhibition purpose for which the items are being transported to the
United States:

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

Form 3-200-82 (Rev. 02/2020)
U.S. Department of the Interior

6) Provide the location(s) where the item will be held or exhibited if different from your institution.

7) Anticipated date of departure/arrival:

Anticipated date of return:

8) Enter the U.S. port through which the transport will occur. (All wildlife, including parts and products, must be declared
to and inspected by a Wildlife Inspector from the U.S. Fish and Wildlife Service Office of Law Enforcement at a
designated port (where an inspector is posted)
Port (city & state):
9) Anyone who will be assisting you with 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. Persons under 18 may assist you in
conducting programs, but you or one of your designated subpermittees over the age of 18 must be present and maintain
direct control of them at all times.

10) 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 3-200-82 (Rev. 02/2020)
U.S. Department of the Interior

11)

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

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.

12) 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

13) I acknowledge that I have read the form Instructions, FAQ, 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
Expires 07/31/2023

Form 3-200-82 (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 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 1 hour (paper-based submission) and 45 minutes (electronic
submission). 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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