Form 0920-0199 Application for Permit to Import or Transfer Live Bats 2

8/23/2018

Bats Form - CDC_IPP2

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APPLICATION FOR PERMIT TO IMPORT OR TRANSFER LIVE BATS
SECTION A

SECTION B

SECTION C

SECTION D

SECTION E

Section A
PERSON REQUESTING PERMIT IN U.S.A.
1. Permittee's Last Name 
https://eipp.cdc.gov/Bats

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2. Permittee’s First Name 

3. Permittee’s Organization 

4. Address (NOT a post office box) 

5. City 

6. State 

-- Select an option-https://eipp.cdc.gov/Bats

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7. Zip Code 

_____-____

8. Permittee’s Telephone Number 

(___)___-____ext._____

9. Permittee’s Email 

10. Secondary Contact’s Name

11. Secondary Contact’s Telephone Number

(___)___-____ext._____

https://eipp.cdc.gov/Bats

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12. Secondary Contact’s Email

Section B
SOURCE OF BATS
1. Last Name of Sender 

2. First Name 

3. Organization 

4. Address (NOT a post office box) 
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5. City 

6. State/Province

7. Postal Code

8. Country 

-- Select an option--

9. Telephone

https://eipp.cdc.gov/Bats

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____________________

10. Email

Section C
DESCRIPTION OF BATS
Indicate Species of Bats and Total Number to be Imported

Species

Common Name

Family

Count

 Add From Template

 Add Bat

5. Source 
Wild Caught
Captive Bred

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6. Proposed use of bats 

-- Select an option-Education
Exhibition
Scientific
Other
If other, please describe:
Please describe

Note

If use is scientific research, attach research proposal and IACUC documentation.

7. Describe how bats will be used 

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8. Will animals be captive bred? 
Yes
No

9. Intended final disposition 

-- Select an option-Euthanasia
Transfer
Institutional use in perpetuity

Section D
TYPE OF PERMIT AND SHIPMENT INFORMATION
1. Import or Transfer? 
Importation into U.S
Transfer within the U.S.

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2. Size of transport container(s): 

3. Number of bats per container(s): 

__________

4. Method of transport: 

-- Select an option--

Section E
BIOSAFETY MEASURES FOR FACILITIES AND TECHNICAL PERSONNEL
1. Description of 180-day quarantine laboratory facilities and equipment: 

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1A. Animal Biosafety level (ABSL) of 180-day quarantine facility
-- Select an option-1B. Personal Protective Measures to be used
Check all that apply
Gloves
Protective Clothing
Goggles
Face Shield
Facemask
N95 or N100 Respirator
Powered Air Purifying Respirator (PAPR)
Other

2. Description of post-quarantine housing 

https://eipp.cdc.gov/Bats

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2A. Biosafety level of post-quarantine facility
-- Select an option-2B. Personal Protective Measures to be used
Check all that apply
Gloves
Protective Clothing
Goggles
Face Shield
Facemask
N95 or N100 Respirator
Powered Air Purifying Respirator (PAPR)
Other

3. Name of attending veterinarian 

4. Affiliation 

5. Address (NOT a post office box) 

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6. City 

7. State 

-- Select an option--

8. Zip Code 

_____-____

9. Telephone Number 

(___)___-____ext._____

10. Email 

11. Is this IACUC approved? 
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Yes
No
N/A

12. Is the organization accredited? 
Yes
No

13. Describe the qualifications and experience of technical personnel handling the bats 

14. Have all personnel that will be working with bats received rabies immunizations? 
Yes
No

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 Signature
Certification: I hereby certify that the information submitted in this application is complete and accurate to the best of my knowledge and belief. I agree to comply with
the conditions listed in the application and all restrictions and precautions that may be specified in the permit, in addition to all applicable regulations which govern this
transfer. I understand that failure to comply with the importation requirements may subject me to criminal penalties pursuant to 42 U.S.C. 271. I understand that any false
statement made in this application may subject me to criminal penalties pursuant to 18 U.S.C. 1001.

Signature of Respondent:

Title:

Degrees:

Date:
08/23/2018

FORM APPROVED
OMB NO. 0920-0199
EXP DATE 04/30/2021
Public recording burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer; 1600 Clifton Road NE, MS D-74,
Atlanta, Georgia 30333; ATTN: PRA (0920-0199).

https://eipp.cdc.gov/Bats

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 Save Draft

 Submit to IPP

DSAT Contact Information

Centers for Disease Control and Prevention
Import Permit Program
1600 Clifton Road, NE, Mailstop A-46
Atlanta, GA 30329
Telephone: 404-718-2000
Email: importpermit@cdc.gov

Help and Support

eFSAP Customer Support Request Form (https://www.cdc.gov/phpr/ipp/support.htm)
Telephone: (833) 271-8310
Email: eIPPSupport@cdc.gov

© 2017 - CDC - Import Permit Program
https://eipp.cdc.gov/Bats

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https://eipp.cdc.gov/Bats

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