Form 3-200-6 Federal Fish and Wildlife Permit Application Form - Migr

FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM

OMB Control No. 1018-0022
Expires ##/##/####

Migratory Bird Import/Export
(Migratory Bird Treaty Act, 50 CFR 21.21)
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 form Frequently Asked Questions and
Instructions. 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.f. Country

1.e. County/Province

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 link for processing fee cost and fee exempt status as outlined in 50 CFR 13.11(d). Click here for Processing Fees
2. Do you currently have or have you ever had any Federal Fish and Wildlife permits?
Yes
No
If yes, list the number of the most current permit you have held or that you are applying to renew/re-issue:
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. 1018-0022
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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM
Migratory Bird Import/Export
(Migratory Bird Treaty Act, 50 CFR 21.21)
U.S. Fish and Wildlife Service
Division of Migratory Bird Management

Note: A Federal Migratory Bird Import/Export permit is required to import or export migratory birds into or out of the United States
(see 50 CFR 10.12 for definition of United States). This application form does not apply to Bald Eagles, Golden Eagles, or species
protected under the Convention on International Trade in Endangered Species, the U.S. Endangered Species Act, or the Wild Bird
Conservation Act. All wildlife shipments must enter and exit the United States through a wildlife port designated in 50 CFR 14.12
(http://www.fws.gov/le/ports-contact-information.html) unless you have a separate exception to designated port permit issued by
the Office of Law Enforcement under 50 CFR 14. There are a number of exceptions for import/export permits; for more
information, visit https://www.fws.gov/birds/policies-and-regulations/permits/import-and-export.php. You are responsible for
reviewing and understanding these regulations before you request and accept a permit. Check with your State agriculture
department for any additional State restrictions on wildlife imports. You must be at least 18 years old to apply for a migratory bird
permit. Please read “Frequently Asked Questions” and 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.

SECTION E.
Questions

1) Indicate whether you are requesting a permit to Import, Export, or both.

Import
Export
Both

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. 1018-0022
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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

SECTION E.

MIGRATORY BIRD IMPORT/EXPORT

(Migratory Bird Treaty Act, 50 CFR 21.21)
3) For each shipment you propose to import or export, provide:
a) Approximate date(s) of shipment

b) Country of origin

c) Common name and scientific name (genus and species)

d) Type and quantity of specimen (e.g., live, dead, part, nest, or egg) by species

e) Source (wild-caught or captive-bred)

f) Band number(s), if applicable

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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022
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4) Explain the purpose for the importation or exportation.

5) If you are requesting an Import Permit, provide the following information:
a) Name and address of the person or organization in the foreign country from whom you are importing.

b) Your Federal and State permit numbers or other authorization to lawfully acquire and possess the birds upon their
arrival in the United States.

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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022
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6) If you are requesting an Export Permit, provide the following information:
a) Name and address of the person or organization in the foreign country to which you are exporting.

b)
States.

The Federal and State permit numbers or other authorization under which the birds were taken and held in the United

7) If you reside or are located outside of the United States: provide the name of a contact, address, and telephone number
where you can be reached in the United States. If conducting commercial activities, provide the name and address of your
agent that is located in the United States.

8) Provide the intended U.S. port of entry or exit. If you plan to enter or exit the United States through a port that is not a
wildlife designated port listed in 50 CFR 14.12 (http://www.fws.gov/le/ports-contact-information.html), you will require a port
exception permit from the Office of Law Enforcement (https://www.fws.gov/le/designated-port-exception-permit.html). If you
already have a valid port exception permit, provide the permit number.

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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022
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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.

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 physical
address

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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022
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11) 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 and FAQ, 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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FWS Form 3-200-6 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0022
Expires ##/##/####

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. 1018-0022.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 1 hour
Amended submission - paper-based: 45 minutes
Original submission - electronic: 45 minutes
Amended submission - electronic: 36 minutes
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/PERMA (JAO), Falls Church, VA 22041-3803, or via email at
Info_Coll@fws.gov. Please do not send your completed form to this address.
FREEDOM OF INFORMATION ACT STATEMENT
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request you
identify any information that should be considered privileged and confidential information to allow the Service to meet its
responsibilities under the Freedom of Information Act (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 2.26 – 2.33].

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