Fillable Printable Federal Fish and Wildlife Permit Application Form

Federal Fish and Wildlife Permit Application Form

3-200-3 Revised December 2013

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Department of the Interior

U.S. Fish and Wildlife Service

Federal Fish and Wildlife Permit Application Form

OMB Control No. 1018-0092

Expires: 12/31/2016

Return to:

U.S. Fish and Wildlife Service

Office of Law Enforcement

Send to the appropriate Issuing Office listed on

Page 4 for the State you listed in Block B.1.c.

Type of Activity: Import/Export License

New - $100.00

Requesting Renewal of Permit #LE-___________- $100.00

Requesting Change/Amendment of Permit #LE-__________ $50.00

Complete all sections of this application.

See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A. All applicants MUST complete

1. Name of Business (as shown on Company’s invoice and other shipping documents)

2. Federal Tax Identification No. or Social Security No.

3. Date of Birth (mm/dd/yyyy) 4. Description of Business

5.a. Principal Officer Last Name 5.b. Principal Officer First Name 5.c. Principal Officer Middle Name 5.d. Suffix

6. Principal Officer Title

7. Primary Contact Name

8.a. Business Telephone Number 8.b. Alternate Telephone Number 8.c. Business Fax Number

8.d. Business E-mail Address

B. All applicants MUST complete

1a. Address (No P.O. Boxes, Retail Postal or Mail Service Center) (as shown on Company’s invoice and other shipping documents) Normally where you

will receive all official notices sent from the Service.

1.b. City

1.c. State 1d. Zip code/Postal Code 1.e. County/Province

1.f. Country (If not US)*

*See Page 2; Question 1

2a. Mailing Address (include ONLY if different than above and this is where you want to receive all official notices from the Service) Include name of

contact person.

2.b. City

2.c. State 2d. Zip code/Postal Code 2.e. County/Province 2.f. Country (If not US)*

*See Page 2; Question 1

C. All applicants MUST complete

Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount listed above. Application fees are non-

refundable.

Do you currently have or have you ever had any Federal Fish and Wildlife permits?

Yes If yes, list the number of the most current permit you have held: ________________________

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 (in blue ink) of applicant/person responsible for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)

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IMPORT/EXPORT LICENSE APPLICATION CONTINUATION SHEET

SECTION D: ALL APPLICANTS MUST COMPLETE

NOTE: An Import/Export License is required ONLY if you commercially import (bring into the U.S. from

another country) or export (send out from the U.S. to another country). No Import/Export License is required if

your business ships exclusively within the U.S. (or its Territories).

U.S. address (not a P.O. Box,

Retail Postal or Mail Service Center) for foreign applicant. (50 CFR 13.12

requires this information for issuance). This is the mailing address where you will receive all official notices sent

from the Service. Question 7 must also be completed. NOTE: No Import/Export License will be issued

without this information.

_________________________________________________________________________________________________

Name, street address (not a P.O. Box, Retail Postal or Mail Service Center), telephone, fax number, and email

address of additional partners and principal officers of the entity applying for this license. If the applicant is the

sole owner, indicate “same as Page 1."

_________________________________________________________________________________________________

Street address (not a P.O. Box, Retail Postal or Mail Service Center), telephone, and fax number of the

location(s) where business records concerning imports or exports of wildlife will be kept. If the location(s) is the

same as on the first page, indicate “same as Page 1". 50 CFR 13.46 describes the required records that are to be

maintained five (5) years from date of expiration of the license.

_________________________________________________________________________________________________

Street address (not a P.O. Box,

Retail Postal or Mail Service Center), telephone, and fax number of the

location(s) wildlife inventories will be kept. If the location(s) is the same as on the first page, indicate “same as

Page 1”.

_________________________________________________________________________________________________

General description of the wildlife or wildlife products to be imported/exported. (Choose all that apply)

Live

Dead

Products (Describe: sport hunted trophies, jewelry, footwear, carvings, etc.)__________________

______________________________________________________________________________

Other (Describe)_________________________________________________________________

b. Fish Coral Reptiles Amphibians

Mammals Birds Insects/Arachnids Other________________

c. Venomous

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6. Location of the U.S. Fish and Wildlife Service Port of Entry you wish to import/export your goods through

(check all that apply):

Anchorage, Alaska Honolulu, Hawaii New Orleans, Louisiana

Atlanta, Georgia Houston, Texas New York, NY

Baltimore, Maryland Los Angeles, California Newark, NJ

Boston, Massachusetts Louisville, Kentucky Portland, Oregon

Chicago, Illinois Memphis, Tennessee San Francisco, California

Dallas/Ft. Worth, Texas Miami, Florida Seattle, Washington

Locations listed below may require an additional Designated Port Exception Permit (Form 3-200-2)

Blaine, Washington Dunseith, North Dakota Port Huron, Michigan

Brownsville, Texas El Paso, Texas San Diego, California

Champlain, New York Laredo, Texas Sweetgrass, Montana

Denver, Colorado Minneapolis, Minnesota Tampa, Florida

Detroit, Michigan Nogales, Arizona Guaynabo, Puerto Rico

Dulles, Virginia Pembina, North Dakota Tamuning, Guam

Other_________________________________________________________________________________

Applicants residing or located outside the United States. The name, physical address (no P.O. Box,

Retail

Postal or Mail Service Center address) and telephone and fax numbers of your agent that is located in the United

States who will maintain your records for five (5) years from the expiration of the permit. If the location is the

same as Question 1, then indicate “same as Question 1". (50 CFR 13.12 and 13.46 requires this information for

issuance). NOTE: No Import/Export License will be issued without this information.

_________________________________________________________________________________________________

Certification of U.S. Agent:

I hereby agree to be U.S. Agent for __________________________________________________________________.

(Print name of Business listed in Block A on Page 1 of this application)

Acting in the capacity of U.S. Agent includes maintaining complete and accurate records of any taking, possession, transportation,

sale, purchase, barter, exportation or importation of wildlife for the above mentioned Business for a period of five (5) years from

the date of the expiration of this Import/Export License. Such records shall be kept current and shall include names and addresses

of persons with whom any wildlife has been purchased, sold, bartered, or otherwise transferred, and the date of such transaction,

and other information as may be required or appropriate. Such records shall be legibly written or reproducible in English. The

name, address and telephone number listed above in #7 is complete and accurate and is not a retail postal or mail service center.

____________________________________________________________________

Printed Name of Responsible Person from #7 Above

___________________________________________________________________

Signature Date

NOTE: You must notify the U.S. Fish and Wildlife Service immediately of any change in U.S. Agent

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3-200-3 Revised December 2013

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Office of Law Enforcement Regional Permit Offices

Region 1: Guam, Hawaii, Idaho, Oregon, & Washington

U.S. Fish & Wildlife Service

Office of Law Enforcement

911 NE 11th Ave.

Portland, OR 97232

Tel: (503) 231-6899

Fax: (503) 231-2193

Email: permitsR1L[email protected]

Region 2: Arizona, New Mexico, Oklahoma, & Texas

U.S. Fish & Wildlife Service

Office of Law Enforcement

2545 W. Frye Road

Suite 8

Chandler, AZ 85224-6273

Tel: (480) 967-2007

Fax: (480) 966-9766

Email: permitsR2LE@fws.gov

Region 3: Illinois, Indiana, Iowa, Michigan, Minnesota,

Missouri, Ohio, & Wisconsin

U.S. Fish & Wildlife Service

Office of Law Enforcement

5600 American Blvd, West, Suite 990

Bloomington, MN 55437-1458

Tel: (612) 713-5356

Fax: (612) 713-5283

Email: permitsR3L[email protected]

Region 4: Alabama, Arkansas, Florida, Georgia,

Kentucky, Louisiana, Mississippi, North Carolina,

South Carolina, Puerto Rico, & Tennessee

U.S. Fish & Wildlife Service

Office of Law Enforcement

1875 Century Blvd, Suite 380

Atlanta, GA 30345

Tel: (404) 679-7195

Fax: (404) 679-7065

Email: permitsR4LE@fws.gov

Region 5: Connecticut, District of Columbia, Delaware,

Maine, Maryland, Massachusetts, New Hampshire, New

Jersey, New York, Pennsylvania, Rhode Island,

Vermont, Virginia, & West Virginia

U.S. Fish & Wildlife Service

Office of Law Enforcement

70 E. Sunrise Hwy, Suite 419

Valley Stream, NY 11580

Tel: (516) 825-3950

Fax: (516) 825-3597

Email: permitsR5L[email protected]

Region 6: Colorado, Kansas, Montana, Nebraska, North

Dakota, South Dakota, Utah, & Wyoming

U.S. Fish & Wildlife Service

Office of Law Enforcement

P.O. Box 492098

Attn: Wildlife Inspector (DIA)

Denver, CO 80249

Tel: (303) 342-7430

Fax: (303) 342-7433

Email: permitsR6LE@fws.gov

Region 7: Alaska

U.S. Fish & Wildlife Service

Office of Law Enforcement

P.O. Box 190045

Anchorage, AK 99519-0045

Tel: (907) 786-3311

Fax: (907) 786-3313

Email: permitsR7L[email protected]

Region 8: California and Nevada

U.S. Fish & Wildlife Service

Office of Law Enforcement

2800 Cottage Way, W-2928

Sacramento, CA 95825

Tel: (916) 414-6660

Fax: (916) 414-6715

Email: permitsR8LE@fws.gov

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PERMIT APPLICATION FORM INSTRUCTIONS

The following instructions pertain to the form 3-200-3 that must be completed as an application for a U.S. Fish and Wildlife Service

permit. The General Permit Procedures in 50 CFR 13 address the permitting process.

GENERAL INSTRUCTIONS:

 Complete all blocks/lines/questions in Sections A through D.



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.



Print clearly or type in the information. Illegible applications may cause delays.



Sign the application in blue ink. Faxes or copies of the original signature will not be accepted.



Mail the original application to the appropriate address on the attached address list. The application is to be submitted to the

issuing office address in the Region your company is located.



Keep a copy of your completed application.



Please plan ahead. Allow at least 60 days for your application to be processed. (50 CFR 13.11)



Applications are processed in the order they are received.

COMPLETE SECTION A:



Enter the complete name of the business who will be the Licensee if an Import/Export License is issued. If no company name

exists, then use the Name (Last, First, Middle) of the owner of the business. Enter personal information that identifies the

applicant.



If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing

power of attorney must be included with the application.



Give a brief description of the type of business in which the applicant is engaged (Taxidermy, Jewelry, Apparel, etc.).



Doing business as (dba): dba’s are not accepted. The name on the Import/Export License must match the invoice and other

shipping documents that accompany the shipment to or from the United States.



Principal Officer is the person in charge of the listed business. The principal officer is the person responsible for the

application and any permitted activities. Often the principal officer is a Director or President. Primary Contact is the

person at the business who will be available to answer questions about the application or permitted activities. Often this is the

preparer of the application.

COMPLETE SECTION B:



Mailing address: This is the address where you will receive all official notices sent from the Service (ONLY if different than

address listed in Block 1.a.).

COMPLETE SECTION C:

Application processing fee:



An application processing fee is required at the time of application. The fee does not guarantee the issuance of a permit.

Fees will not be refunded for applications that are approved, abandoned, or denied. We may return fees for withdrawn

applications if no significant processing has occurred.

Federal Fish and Wildlife permits:



List the number(s) of your most current Service permit or the number of the most recent permit if none are currently valid.

CERTIFICATION:



The individual identified in Section A or person with a valid power of attorney (documentation must be included in the

application) must sign and date the application in blue ink. This signature binds the applicant to the statement of

certification. This means that you certify that you have read and understand the regulations that apply to the permit. You

also certify that everything 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 the application.

COMPLETE SECTION D:



Question 1. Foreign Applicant ONLY: Enter the complete U.S. address. This is the address where you will receive all

official notices sent from the Service. 50 CFR 13.12 requires this information for issuance.



Question 7. Foreign Applicant ONLY: Enter the complete name, physical address, telephone and fax numbers of your agent

located in the United States where your records (as defined in 50 CFR 13.46) will be maintained for five (5) years from the

date of expiration of the license. This can be a customshouse broker, relative, etc. It cannot be a retail postal or mail service

center. 50 CFR 13.12 requires this information for issuance.

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APPLICATION FOR A FEDERAL FISH AND WILDLIFE PERMIT

Paperwork Reduction Act, Privacy Act, and Freedom of Information Act – Notices

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and the Privacy Act of 1974 (5 U.S.C. 552a), please be

advised:

1. The gathering of information on fish and wildlife is authorized by:

a. Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;

b. Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50CFR 17;

c. Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;

d. Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), 50 CFR 18;

e. Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15;

f. Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;

g. Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), http://www.cites.org/ , 50 CFR 23;

h. General Provisions, 50 CFR 10;

i. General Permit Procedures, 50 CFR 13; and

j. Wildlife Provisions (Import/export/transport), 50 CFR 14.

2. 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. Response is not required unless a currently valid Office of Management and Budget (OMB) control number is

displayed on the form.

3. Certain applications for permits authorized under the Endangered Species Act of 1973 (16 U.S.C. 1539) and the Marine Mammal Protection Act of 1972

(16 U.S.C. 1374) will be published in the Federal Register as required by the two laws.

4. Disclosures outside the Department of the Interior may be made without the consent of an individual under the routine uses listed below, if the

disclosure is compatible with the purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003)

a. Routine disclosure to subject matter experts, and Federal, tribal, State, local, and foreign agencies, for the purpose of obtaining advice relevant to

making a decision on an application for a permit or when necessary to accomplish a FWS function related to this system of records.

Routine disclosure to the public as a result of publishing Federal Register notices announcing the receipt of permit applications for public

comment or notice of the decision on a permit application.

c. Routine disclosure to Federal, tribal, State, local, or foreign wildlife and plant agencies for the exchange of information on permits granted or

denied to assure compliance with all applicable permitting requirements.

d. Routine disclosure to Captive-bred Wildlife registrants under the Endangered Species Act for the exchange of authorized species, and to share

information on the captive breeding of these species.

e. Routine disclosure to Federal, tribal, State, and local authorities who need to know who is permitted to receive and rehabilitate sick, orphaned, and

injured birds under the Migratory Bird Treaty Act and the Bald and Golden Eagle Protection Act; federally permitted rehabilitators; individuals

seeking a permitted rehabilitator with whom to place a bird in need of care; and licensed veterinarians who receive, treat, or diagnose sick,

orphaned, and injured birds.

f. Routine disclosure to the Department of Justice, or a court, adjudicative, or other administrative body or to a party in litigation before a court or

adjudicative or administrative body, under certain circumstances.

g. Routine disclosure to the appropriate Federal, tribal, State, local, or foreign governmental agency responsible for investigating, prosecuting,

enforcing, or implementing statutes, rules, or licenses, when we become aware of a violation or potential violation of such statutes, rules, or

licenses, or when we need to monitor activities associated with a permit or regulated use.

h. Routine disclosure to a congressional office in response to an inquiry to the office by the individual to whom the record pertains.

i. Routine disclosure to the Government Accountability Office or Congress when the information is required for the evaluation of the permit

programs.

j. Routine disclosure to provide addresses obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a

debtor to collect or compromise a Federal claim against the debtor or to consumer reporting agencies to prepare a commercial credit report for

use by the FWS.

5. For individuals, personal information such as home address and telephone number, financial data, and personal identifiers (social security number,

birth date, etc.) will be removed prior to any release of

the application.

6. 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 an Import/Export license application is 1.25 hours. This burden estimate includes time for reviewing instructions, gathering and

maintaining data and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of the form

to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, MS 2042-PDM, 4401 North Fairfax Drive, Arlington, VA 22203

(mail); or [email protected] (email). Please include “1018-0092” in the subject line of your comments.

Freedom of Information Act – Notice

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 non-confidential summary and remaining documents may be made

available to the public under FOIA [43 CFR 2.13(c)(4), 43 CFR 2.15(d)(1)(i)].

(Authorizing statutes can be found at: http://www.gpoaccess.gov/cfr/index.html and http://www.fws.gov/permits/ltr/ltr.shtml.)