3-200-37h Application - Interstate Commerce of Transfer of Captive

FWS Form 3-200-37h (Rev. 05/2022) OMB Control No. 1018-####

U.S. Department of the Interior Expires ##/##/20##

INTERSTATE COMMERCE OR TRANSFER OF CAPTIVE-HELD AFRICAN

ELEPHANTS UNDER THE U.S. ENDANGERED SPECIES ACT (ESA)

New Reissue/Renew Amendment

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C.^**

A. Complete if applying as an individual
1.a. Last name			1.b. First name		1.c. Middle name or initial	1.d. Suffix
2 Date of birth (mm/dd/yyyy)	5.a. Telephone number	5.b. Alternate telephone number		6. E-mail address

B. 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.a. Description of business, agency, Tribe, or institution				3.b. Website URL (if applicable)
4.a. Principal officer (P.O.) last name	4.b. P.O. first name		4.c. P.O. middle initial		4.b. P.O. Title
5. Primary contact name			6. Primary e-mail address
7.a. Business telephone number		7.b. Alternate phone no.		8.a. Primary contact telephone no.

C. 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	2.c. State	2.d. Zip code/Postal code	2.e. County/Province	2.f. Country

D. All applicants MUST complete

1. Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, a nonrefundable processing fee [50 CFR 13.11(d)(4)]. Federal, Tribal, State, and local government agencies, and those acting on behalf of such agencies, are exempt from the processing fee – attach documentation of fee exempt status as outlined in instructions. (50 CFR 13.11(d))

2. If you are requesting a reissue/renew/amendment, what is your permit/file number?

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.

The individual/principal officer of the business must print and sign the application. (No photocopied or stamped signatures) Date (mm/dd/yyyy)

**Further instructions for the above application may be found on our ePermits website. See the NOTICES section on the last page for information on the Privacy Act, Paperwork Reduction Act, Estimated Burden, and Freedom of Information Act aspects of this application form.

Mail your application(s) to Division of Management Authority, Branch of Permits, MS:IA 5275 Leesburg Pike, Falls Church, VA 22041-3803.

E. INTERSTATE COMMERCE OR TRANSFER OF CAPTIVE-HELD AFRICAN ELEPHANTS UNDER THE U.S. ENDANGERED SPECIES ACT (ESA)

PURPOSE

Use this application for the export or domestic transfer of live captive-held African elephants.

This application covers activities involving the export and/or transport and/or interstate or foreign commerce of captive-held African elephants (Loxodonta africana). This applies to both wild-sourced and captive-born African elephants. The African elephant is listed under the U.S. Endangered Species Act as threatened with a special rule [50 CFR 17.40(e)]. For these activities, the Service must make both an enhancement finding as well as the CITES “appropriate and acceptable destination” annotation.

This form should NOT be used for:

• The import of live African elephants, use Form 3-200-37f.

Please review the complete application carefully before beginning. Provide complete answers to all the questions on the application. If a question is not applicable, answer with “N/A”. If needed, use additional pieces of paper. On all attachments or separate sheets you submit, indicate the application question number you are addressing. If you are applying for more than one animal , be sure to answer all relevant questions for each animal.

Please allow at least 90 days for the application to be processed.

1. Name and address where you wish the permit to be mailed, if different from physical address. If you would like expedited shipping, please enclose a self-addressed, pre-paid, computer-generated, courier service airway bill. If unspecified, all documents will be mailed via the U.S. Postal Service.

2. Who should we contact if we have questions about the application (name, phone number, and e-mail)?

3. Have you or any of the owners of the business (if applying as a business, corporation, or institution), been assessed a civil penalty or convicted of any criminal provision of any statute or regulation relating to the activity for which the application is filed; 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; forfeited collateral; OR are currently under charges for any violation of the laws mentioned above?

___ No ___ Yes

If you answered “Yes” to Question 3, provide: a) the individual’s name; b) date of charge; c) charge(s); d) location of incident; e) court, and f) action taken for each violation. Please be aware that a “Yes” response does not automatically disqualify you from obtaining a permit.

4. Type of activity requested (check appropriate box):

___ Export

___ Interstate commerce or Transport

5. The current location of the animal(s) (if different from the physical address):

Name:

Address:

City:

State/Province:

Postal Code:

Country:

6. Provide name and physical address of the recipient:

Name:

Address:

City:

State/Province:

Postal Code:

Country:

7. For each animal involved in the export/transport, provide the following information (you may use the table below):

1. Scientific name (genus, species, and if applicable, subspecies)

2. Common name

3. Approximate birth date (mm/dd/yyyy)

4. Wild or captive-born

5. Quantity

6. Sex (males.females, e.g., 10.2)

7. Permanent markings or identification (microchip #, leg band #, tattoos, studbook #, etc.).

	b. Common Name	c. Approximate Birth Date (mm/dd/yyyy)	d. Wild (W) or Captive- born (C)	e. Quantity	f. Sex (male. female., ex:1.0)	g. Permanent markings/ID Information (e.g., microchip #, leg band #, tattoos, studbook #)
EXAMPLE: Pan troglodytes	Chimpanzee	08/01/2006	C	1	1.0 OR male	Studbook# 152; Microchip# 00056321-00
Loxodonta africana	African elephant

Source of Specimen

8. For each captive-born animal, provide a signed and dated statement from the breeder or other appropriate documentation (e.g. Species 360 report) that includes the following:

1. Scientific name (genus, species, and if applicable, subspecies),

2. Common name,

3. Name and address of the facility where the animal was bred and born,

4. Birth date (mm/dd/yyyy),

5. Identification information (studbook #, tattoo, microchip, leg band #, etc.),

6. Name and address of the facility where the parental stock is located,

7. A statement from the breeder that the animal was bred and born at the breeder’s facility (including the facility’s name and address), and

8. If you are not the breeder, documentation demonstrating the history of transactions (e.g., chain of custody or ownership of the animal).

9. For each animal that is wild-sourced, provide:

1. Scientific name (genus, species, and if applicable, subspecies),

2. Common name,

3. If the animal was imported to the U.S., provide a copy of the permit authorizing the import of the elephant(s).

Description and Justification for Requested Activity

9. Please provide a detailed description on how the proposed activities will enhance or benefit the wild population within its native range (e.g., direct or indirect conservation efforts) and provide documentation (e.g., signed memorandums of understanding) demonstrating your commitment to supporting the program and how the program contributes directly to the species identified in your application.

11. If conservation education and/or zoological display, provide:

1. Objectives of proposed activity in support of an education program,

2. Copies of educational materials (e.g., handouts, text of signage or public presentations), incorporating the following information:

   1. Status in the wild

   2. Current threats

   3. Conservation efforts

11. If captive propagation for the conservation and survival of the species, provide:

1. A description of how the species will be propagated (e.g., artificial insemination, natural breeding pairs/groups),

2. Documentation showing your participation in an established breeding program, including name of program, program coordinator, breeding guidelines/agreements, list of program participants, and other relevant program information.

3. A copy of your breeding protocol including information regarding separation of mother and young, use of cameras, etc.

4. How your breeding stock is managed to maintain genetic vitality, including:

4. avoidance of inbreeding,

5. considerations of average kinship,

6. differences in paternal and maternal average blood relationships/relatedness,

7. carrying capacity of your facility,

8. disposition of progeny.

5. Plans and agreements for future re-introduction (if applicable).

Technical Expertise & Facilities

• For export, provide the following information for the receiving institution.

• For interstate commerce and/or transport to another facility(ies), provide information for all receiving institutions.

13. Provide copies of or cite any elephant care/husbandry manuals, protocols, or guidelines that are used at the facility.

14. Describe the facility’s record keeping.

15. Provide a CV or resume outlining the technical experience and expertise of each caretaker, veterinarian, and administrator with direct oversight of the elephants who will be working with, maintaining, and/or propagating each species, as it relates to the proposed activities, including experience with similar species.

16. Provide a current inventory of the species or similar species at the facility (males, females; e.g., 10.2),

17. Number of years the species or similar species have been maintained at the facility,

18. Number of births by species or similar species per year over the last 3 years at the facility,

19. Number of mortalities by species or similar species per year over the last 3 years and steps taken to avoid, decrease, or mitigate such mortalities,

20. A detailed description, diagrams, and photos clearly depicting the existing facilities where the species will be maintained, including dimensions, type of construction materials, structures for the provision of food and water, climate conditions, and protective measures from the elements (e.g., direct sun, rain, snow). Do not provide blueprints.

21. Approximate carrying capacity for the species at the facility.

22. Describe any plans for ongoing staff training with regard to safety, security, record keeping, or animal management.

23. Describe any plans for ongoing animal training with regard to husbandry behaviors (e.g., crate or chute acclimation) or veterinary procedures (e.g., health exam or blood collection).

24. Describe how the dietary needs of the species will be met.

25. Describe how the facility addresses the social well-being and behavior of the species such as social grouping, methods of integration, and appropriate social and behavioral enrichment.

26. Will this transfer affect the current specimens at the facility? Are there any planned transfers of specimens currently at the facility? If so, provide detailed information regarding the transfer plans.

27. If accredited by a regional or national animal care organization, please identify the organization and provide proof of accreditation.

28. Please provide copies of any State or Federal licenses to display, exhibit, or hold elephants, as well as a copy of the most recent USDA APHIS inspection report.

Appropriate and Acceptable Destination

For export/transport of live African elephants, a determination that the receiving facility meets the CITES “appropriate and acceptable destination” annotation must be made.

For additional information, please see: Conf. 11.20 (Rev. CoP18) on Definition of the term ‘appropriate and acceptable destinations’.

29. Identify all persons and/or facilities who will be receiving a specimen, including persons and/or facilities who are likely to receive a specimen within 1 year after the elephant arrives in the United States.

30. For each person and/or facility identified in question 29, please provide the following information:

    1. Description of the facility, including diagrams, photographs, or construction plans,

    2. Description of the enclosures and their construction and maintenance, including information on whether or not there is sufficient space provided to the specimen(s) to allow each animal to make normal postural and social adjustments with adequate freedom of movement,

    3. Description of the adequacy of the enclosures or holding areas to prevent escape or unplanned exchange of genetic material with specimens of the same or similar species outside the facility,

    4. Description of environmental enrichment elements provided to the specimen(s).

31. If the specimen(s) is/are on public display, provide a description of any off-exhibit area, consisting of indoor and outdoor accommodations, as appropriate, that can house the specimen(s) on a long-term basis, if necessary.

32. Provision of water and nutritious food of a nature and in a way that are appropriate for the species (if grazing in natural areas, provide information on the natural vegetation present).

33. Copies of all Standard Operating Procedures (protocols) used at the facility for the care and housing of the animal(s). Examples include, but are not limited to quarantine, diet, veterinary care, animal and staff training, enrichment, daily and seasonal routines, emergency measures, record keeping, routine medical examinations, etc.

34. Description and resumes of the recipient staff who will care for the specimen(s), including information on staffs’ training and experience in providing proper daily care and maintenance for the animal(s) being imported, or for a closely related species,

35. Readily available veterinary care or veterinary staff experienced with the species or a closely related species, including emergency care (e.g., veterinarian names, clinic/facility names and locations, full-time or part-time vets, staff or contract vets, 24/7 availability),

36. Security measures to prevent theft or harm of specimens and measures taken to rectify any previous theft, harm or security problems involving elephants,

37. Survival rate of specimens of the same species or, alternatively, closely related species at the facility, mortalities for the previous 3 years, significant injuries to wildlife, occurrence of significant disease outbreaks during the previous 3 years, and measures taken to prevent similar mortality, injury, damage, or disease. (Note: Significant injury, damage, or disease outbreaks are those that are permanently debilitating or re-occurring),

38. Sufficient funding on a long-term basis to cover the cost of maintaining the facility and the specimens imported.

39. Written documentation demonstrating that the proposed activity would promote in-situ conservation of the species.

Transport/Shipment of Live Animals

29. Transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals. All air transport must also comply with the International Air Transport Association (IATA) live animal regulations (contact airline for information). As such, provide:

1. Duration of the trip (including airline flights and ground transport).

2. The type, size, and construction of any shipping container and,

3. The arrangements for watering, feeding, or otherwise caring for the wildlife during transport.

4. Will a veterinarian or animal keeper accompany the specimen and be able to provide any necessary care?

5. Will the animals be sedated? If so, what is the duration of the entire time animals will be sedated (minimum and maximum)?

6. CV or resume of the individual(s) arranging and/or conducting the transport of the specimen(s).

For additional information, please see the CITES guide for transport of live specimens.

All international shipment(s) entering the United States must be through a designated port. A list of designated ports (where an inspector is posted) is available. If you wish to use a port not listed, contact the Office of Law Enforcement for a Designated Port Exemption Permit (form 3-200-2).

Imports must also comply with U.S. Department of Agriculture, Animal and Plant Health Inspection Service inspection and quarantine requirements. For additional information, please visit the USDA Import/Export website.

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 Marine Mammal Protection Act (16 U.S.C. 1361, et seq.), 50 CFR 18; 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 which affect protected species. This helps 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

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501 et seq.) in order provide the U.S. Fish and Wildlife Service the information necessary, under the applicable laws governing the requested activity, for which a permit is requested. 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 applicable 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-####.

ESTIMATED BURDEN STATEMENT

We estimate public reporting for this collection of information to average 4 hours (paper-based reporting) or 3 hours 15 minutes (electronic reporting), and 2 hours for recordkeeping. These time 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 Info_Coll@fws.gov. Please do not mail your completed application to this address.

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