Download:
pdf |
pdfFWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
FEDERAL FISH AND WILDLIFE PERMIT APPLICATION FORM
Type of Activity: Designated Port Exception Permit*
Return to:
U.S. Fish and Wildlife Service
Office of Law Enforcement
*If you import/export through a Designated Port, you do not need this permit.
New - $100.00
Renewal of Permit #LE-______________________________ $100.00
Amendment to Permit #LE- _____________________________ $50.00
(no fee)
Name/Address Change ONLY of Permit #LE-
Send to the appropriate Issuing Office listed on
Page 5 for the State where you (or U.S. Agent for
foreign applicant) are located.
See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.
A.
Complete only if applying as an individual (Non-commercial)
Last name
First name
Date of birth (mm/dd/yyyy)
Last 4 of Social
Security No.
Telephone Number
Alternate telephone number
B.
Middle name
Occupation
E-mail address
Complete if a business, corporation, public agency or institution
Name of Business (must match Company’s invoice, I/E License (if applicable) and other permits/shipping documents)
Complete Federal Tax Identification No. or last 4 of SSN
Owner or Principal Officer Last Name Sole Owner? Yes
Owner or Principal Officer
Date of Birth (mm/dd/yyyy)
Description of Business
Owner or Principal Officer First Name
Principal Officer Email Address
URL/Web Address
Principal Officer Title
Primary Contact Name
Principal Officer Telephone Number
Alternate Telephone Number
Owner or Principal Officer Middle Name
Primary Contact Telephone Number
Primary Contact Email Address
All applicants MUST complete
C.
Address (No P.O. Boxes, Retail Postal, or Mail Service Center) (as shown on Company’s invoice, I/E License (if applicable) and other permits/shipping documents)
Where you will receive all official notices sent from the Service (Except for foreign entities).
City
State/Province
D.
1.
2.
Zip code
County (U.S.)
Country
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 nonrefundable.
Do you currently have or have you ever had any Federal Fish and Wildlife permits?
Yes
If yes, list the number of the most recent license/permit you have held:
No
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 Individual/Principal Officer/U.S. Agent** (No photocopied or stamped signatures)
** (Foreign applicants only – A copy of the Power of Attorney naming foreign entity and U.S. Agent must accompany this application.)
Date of Signature (mm/dd/yyyy)
Please continue to next page
Page 1 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
DESIGNATED PORT EXCEPTION PERMIT APPLICATION CONTINUATION SHEET
SECTION E: ALL APPLICANTS MUST COMPLETE
1.
Port(s) of entry where importation/exportation is requested (See Section E instructions):
2.
Address one of the following as the primary reason for your request to be allowed an exception from the
designated port requirement. Supporting documentation must include current information and should be attached
to this application. All supporting documentation that is attached will be considered a part of the application.
Scientific Purposes (50 CFR 14.31): Provide a detailed written statement of the scientific purpose or use
of the wildlife to be imported or exported outlining the benefits to the bona fide research project and why
importation or exportation should be allowed at the requested port rather than a FWS designated port.
Statement, as described above, is attached. No permit will be issued without this statement.
To minimize deterioration or loss (50 CFR 14.32): Provide a detailed written statement for the purpose
or use of the wildlife to be imported or exported, and show how import or export at a designated port
would result in substantial deterioration or loss of wildlife (attach copies of carrier
routings/schedules/timelines/etc. to show the difference in travel time between designated ports and
requested FWS non-designated port listed in the table above). NOTE: provide a separate written
statement specific to every FWS non-designated port location requested in Question 1.
Statement(s), as described above, are attached. No permit will be issued without the statement(s).
To alleviate undue economic hardship (50 CFR 14.33): Include a detailed written statement that
provides a description of the form in which the item(s) are to be imported/exported (live, frozen, raw
hides, full description of any manufactured products – can also use #8 and #9 below). Information must
be included to show the monetary difference between the cost of importation or exportation at the port
requested and the lowest cost of importation or exportation at a designated port (attach copies of quotes
from common carriers/freight forwarders, etc.). NOTE: provide a separate written statement specific
to every FWS non-designated port location requested in Question 1.
Statement(s), as described above, are attached. No permit will be issued without the statement(s).
3.
Are you keeping your records concerning imports and/or exports of wildlife under this permit at the same
location as Block C on page 1 of this application? Yes
No
(must check one)
(NOTE: Foreign applicants only – see Question 12)
50 CFR 13.46 describes the required records that are to be maintained for five (5) years from date of expiration of the
Designated Port Exception Permit.
If no, provide location of records (list all – use additional pages as necessary):
Name:
Primary Contact Name:
Address/City/State/Zip (No P.O. Box, Retail Postal or Mail Service Center):
Phone Number:
Email address:
Please continue to next page
Page 2 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
DESIGNATED PORT EXCEPTION PERMIT APPLICATION CONTINUATION SHEET
4.
Is this request for commercial shipment(s)?
Yes
No (must check one)
If “Yes”, you must provide a copy of your valid Import/Export License with this application.
5.
Is this request for a single shipment of wildlife or wildlife products?
Yes
If yes, please provide estimated date of arrival/departure for your shipment.
6.
Is this request for a series of shipments? Yes
No (must check one)
If yes, provide approximate number of shipments and frequency (weekly/monthly/etc.)
7.
Is this request for shipments over a specified period of time?
If yes, provide date(s) involved:
8.
General description of the wildlife or wildlife products to be imported/exported. (Choose all that apply)
Perishable
Live (50 CFR 13.41 requires wildlife possessed under a FWS permit must be maintained under humane
and healthful conditions)
Venomous
Dead
Products (Describe: sport hunted trophies, jewelry, footwear, carvings, etc.)
Yes
No (must check one)
No (must check one)
Other (Describe:)
9.
Type of animal to be used as described in #8 above. (Choose all that apply)
Fish
Coral
Reptiles
Mammals
Birds
Insects/Arachnids
Other
10.
50 CFR 14.31 – 14.33 requires that you provide number and kinds of wildlife described by scientific and common
names to be imported or exported where such number and kinds can be determined (Use additional pages as
necessary):
Amphibians
Molluscs (Shells)
Scientific Name:
Common Name:
Quantity: (Use metric, if appropriate)
Country of Species Origin:
Country of Re-export: (If applicable)
Scientific Name:
Common Name:
Quantity: (Use metric, if appropriate)
Country of Species Origin:
Country of Re-export: (If applicable)
Please continue to next page
Page 3 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
DESIGNATED PORT EXCEPTION PERMIT APPLICATION CONTINUATION SHEET
11.
Disqualification Factor. An applicant with a conviction, or entry of 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
disqualifies any such person from receiving or exercising the privileges of a permit, unless such disqualification
has been expressly waived by the Service Director in response to a written petition (50 CFR 13.21(c)). Have you
or any of the owners of the business, if applying as a business, been convicted, or entered a plea of guilty or nolo
contendere, forfeited collateral, or are currently under charges for any violations of the laws mentioned above?
Yes
No (must check one)
If you answered “Yes” 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 (list all – use additional pages as necessary).
12.
Foreign Applicants ONLY
U.S. Agent Designation
A Designated Port Exception Permittee is required to maintain complete and accurate records of any taking,
possession, transportation, sale, purchase, barter, exportation or importation of wildlife for a period of five (5)
years from the date of the expiration of their Designated Port Exception Permit. 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 and in English. The name, address and telephone number of
U.S. Agent must be complete and accurate and cannot be a retail postal or mail service center.
Name of U.S. Agent
(This name will show up as c/o on the face of the Non-Designated Port Permit)
Address/City/State/Zip (No P.O. Box, Retail Postal, or Mail Service Center):
Phone Number:
Email address:
I hereby agree to be U.S. Agent for
.
(Name of Applicant listed on Page 1 of this application)
I acknowledge the above responsibilities and will comply with the above requirements on behalf of the
applicant.
Printed Name of U.S. Agent
Signature of U.S. Agent (No photocopied or stamped signatures)
Date of Signature (mm/dd/yyyy)
NOTE: You must notify the U.S. Fish and Wildlife Service immediately of any change in U.S. Agent
Please continue to next page
Page 4 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
Office of Law Enforcement Permit Offices
https://www.fws.gov/le/regional-permit-offices.html
Please send your application to the appropriate office.
If you (or U.S. Agent for foreign applicant) are located in the following states, send your application to the address below:
Alabama, Arkansas, Connecticut, District of Columbia, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky,
Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey,
New York, North Carolina, Ohio, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, U.S. Virgin
Islands, Vermont, Virginia, West Virginia, Wisconsin
U.S. Fish & Wildlife Service
Office of Law Enforcement
1875 Century Boulevard, Suite 380
Atlanta, GA 30345-3324
Phone: (404) 679-7195
Fax: (404) 679-7065
Email: permitsEastLE@fws.gov
If you (or U.S. Agent for foreign applicant) are located in the following states, send your application to the address below:
Alaska, Arizona, California, Colorado, Guam, Hawaii, Idaho, Kansas, Montana, Nebraska, Nevada, New Mexico, North
Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, the Pacific Trust Territories
U.S. Fish & Wildlife Service
Office of Law Enforcement
2800 Cottage Way, W-2928
Sacramento, CA 95825-1846
Phone: (916) 414-6660
Fax: (916) 414-6715
Email: permitsWestLE@fws.gov
Please continue to next page
Page 5 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to Form 3-200-2 that must be completed as an application for a U.S. Fish and Wildlife
Service Designated Port Exception Permit. Reminder: It is a violation to import or export fish and/or wildlife through
any port listed on page 2 of this application prior to obtaining an Designated Port Exception Permit.
GENERAL INSTRUCTIONS:
• Complete all applicable blocks/lines/questions in Sections A through E.
• An incomplete application may cause delays in processing or may be returned to the applicant.
• Be sure you are completing the appropriate application form for the proposed activity.
• Print clearly or type in the information. Illegible applications may cause delays.
• Sign the application. Scans, faxes or copies of the original signature will not be accepted.
• No Designated Port Exception Permit will be issued if any information is missing from the application or if
justification in Question E2 is incomplete.
• Mail the original application to the appropriate address on the attached address list.
• Keep a copy of your completed application.
• 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 (ONLY if applying as an individual – e.g. noncommercial import/export):
• Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal
information that identifies the applicant.
• If you are a U.S. Agent applying on behalf of a foreign entity, the personal information must pertain to the foreign
entity, and a document evidencing power of attorney must be included with the application.
COMPLETE SECTION B:
• Enter the complete name of the business who will be the permittee if a Designated Port Exception Permit is issued.
• Except for U.S. Agent applying for a foreign entity, we no longer will accept applications signed by anyone other
than the sole owner or principal officer. 50 CFR 13.12 clearly states that the applicant must certify they read and are
familiar with applicable parts of subchapter B of Chapter I of Title 50, Code of Federal Regulations. No broker,
freight forwarder, etc., can certify in the applicant’s place. This section of the regulations also calls for the signature of
the applicant.
• Give a brief description of the type of business in which the applicant is engaged (e.g. Taxidermy, Jewelry, Apparel,
etc.).
• Doing business as (dba): dbas are not accepted. The name on the Designated Port Exception Permit must match any
I/E License (if applicable), invoice(s) 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.
o Primary Contact for foreign entity is the U.S. Agent who will be available to answer questions about the
application or permitted activities and can be the preparer of the application.
COMPLETE SECTION C:
• This is the address of the applicant where you will receive all official notices sent from the Service, which must match
the invoice(s) and other shipping documents that accompany the shipment to or from the United States.
o Foreign entities: This is the foreign address of the applicant, which must match the invoice(s) and other
shipping documents that accompany the shipment to or from the United States. This is not the address that
will show up on the Designated Port Exception Permit, if issued. The U.S. Agent’s address will be used to
send the Designated Port Exception Permit and all other official notices from Service. Your Designated Port
Exception Permit will read: Foreign Entity c/o U.S. Agent Name, U.S. Agent Address, City, State, Zip Code.
Please continue to next page
Page 6 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
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 of your most recent Permit/License even if it is no longer valid.
CERTIFICATION:
• The individual identified as sole owner or principal officer must sign and date the application. 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.
o Foreign entities: The U.S. Agent designated in Question 12 can sign on your behalf. A copy of a Power of
Attorney naming the foreign entity and the U.S. Agent must accompany this application. You must provide
(in writing) a revised list of additional partner(s) or principal officer within 10 days of any changes.
COMPLETE SECTION E:
• All questions must be answered. Provide additional pages as necessary.
o Foreign Entities – U.S. Agent designated in E 12 will be where you will receive all official notices sent from
the Service. Your Designated Port Exception Permit will read: Foreign Entity c/o U.S. Agent Name, U.S.
Agent Address, City, State, Zip Code.
o You must notify FWS/OLE immediately of any change in U.S. Agent.
Please continue to next page
Page 7 of 8
FWS Form 3-200-2 (Rev. 09/2022)
U.S. Department of the Interior
OMB Control No. 1018-0092
Expires 05/31/2025
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 process applications and to verify the individual has an eligible permit to conduct activities that
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 and Case Investigative Files, FWS-20.
Disclosure: The information requested in this form is voluntary. However, submission of the 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, et seq.), the U.S. Fish and Wildlife Service collects information necessary to
consider a permit application, 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. 1018-0092.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 1.25 hours (reporting)
Original submission - electronic: 1 hour (reporting)
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 Info_Coll@fws.gov. 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 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)].
Page 8 of 8
File Type | application/pdf |
File Title | Microsoft Word - 3-200-2 DPEP application 2016 DRAFT.docx |
Author | slynn |
File Modified | 2022-10-07 |
File Created | 2022-09-23 |