Form 3-200-33 Application - Export of Artificially Propagated Plants (

OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

Export of Artificially Propagated Live Plants or Plant Parts (CITES) (Single and Multiple Commercial
Shipments)
☐New ☐Reissue/Renew ☐Amendment
APPLICATION FORM INSTRUCTIONS
The following instructions pertain to U.S. Fish and Wildlife Service (FWS) permit applications. The General Permit Procedures in 50
CFR 13 address the permitting process. For simplicity, all licenses, permits, registrations, and certificates are referred to as a permit.
If you are an individual, who would be named on the face of the permit, you need to complete the Individual Applicant section of this
application.
If you are an individual seeking permits issued to yourself for activities not associated with your business or institution, you need to
complete the Individual Applicant section as an individual permittee.
If you are an individual associated with a business or institution, and the business or institution’s name would appear on the face of the
permit, you need to complete the Business Applicant section of this application.
If you are a business applying on behalf of an individual, you need to complete the Business Applicant section of this application and
include a limited power of attorney from the person for whom you represent.
A person/entity is qualified to obtain a U.S. Fish and Wildlife Service permit or license when they are "subject to the jurisdiction of the
United States", per 16 USC 1532(13). A foreign person/entity with no permanent physical presence in the United States only qualifies
for an import/export license when they physically enter or exit the U.S. with the wildlife items. The foreign entity is required to designate
a U.S. agent for purposes of record keeping.
GENERAL INSTRUCTIONS:
•

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. Items marked with an asterisk (*) are required fields.

•

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

•

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

•

If you choose to mail your submission, mail the original application to the address listed below or, if applicable, on the attached
address list. We encourage electronic filing in the ePermits system.

•

Keep a copy of your completed application.

•

Please plan ahead. Unless otherwise indicated, allow at least 60 days for your application to be processed, however, some
applications may take longer than 90 days to process (50 CFR 13.11). Longer processing times will be noted on those applications.

•

Applications are processed in the order they are received.

Individual or Business Applicants:
Individual Applicant. Complete if applying as an individual [do not complete this application if applying for Import/Export License (3200-3) or a Designated Port Exception Permit (3-200-2)]:
•

Enter the information requested. Required fields must be completed. This is used to create your profile and consumer information
in the ePermits system. If you do not have an email address, enter not applicable.

•

Doing business as (dba) / Affiliation: The Division of Management Authority (DMA) and the Office of Law Enforcement (OLE) do
not accept doing business as affiliations for individuals seeking permits on behalf of themselves. “Doing business as” affiliations
apply to individuals seeking permits for a business, agency, Tribe, organizational, or institutional affiliation directly related to the
activity requested in the application. For example, a taxidermist is an individual whose business can directly relate to the requested
activity of exporting taxidermy (dba relevant permit); however, said taxidermist should not apply as a business for permits to nonbusiness related travel with their pet exotic parrot (dba is not relevant to the permit; complete the Business Applicant section).

Page 1 of 13

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Business Applicant. Complete if applying as a business, corporation, public agency, Tribe, or institution:
•

Enter the information requested. Required fields must be completed. This is used to create your contact and account information in
the ePermits system. If you do not have an email address, enter not applicable.

•

If you are applying on behalf of a client, a document evidencing power of attorney must be included with the application.

•

Principal Officer is the person in charge of the listed business, corporation, public agency, Tribe, or institution. The principal
officer is the person responsible for the application and any permitted activities. Often the principal officer is a Director or President.

•

The Contact is the person at the business, corporation, public agency, or institution who will be available to answer questions
about the application or permitted activities. Often this is the preparer of the application. Each person that is associated with the
business that would need to access the business account needs to create their own contact in the ePermits system.

Application processing fee:
•

An application processing fee is required at the time of application, unless exempted under 50 CFR 13. The application processing
fee is assessed to partially cover the cost of processing a request. The fee does not guarantee the issuance of a permit, nor
will fees be refunded for applications for which processing has begun. Checks or money orders must be for the exact
amount for each application submitted. If you are making more than one request, you must submit a separate payment
for each request, otherwise your application will be returned.

•

Documentation of fee exempt status is not required for applications submitted by Federal, Tribal, State, or local
government agencies; but must be supplied by those applicants acting on behalf of such agencies. Such applications
must include 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.

CERTIFICATION:
•

The individual identified in the Individual Applicant Section, the principal officer named in the Business Applicant Section, or person
with a valid power of attorney (documentation must be included in the application) must sign and date the application. This
signature legally binds the applicant to the statement of certification. You are certifying that you have read and understand the
regulations that apply to the permit. You are also certifying that all information 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.

ALL APPLICANTS COMPLETE THE QUESTIONS ASSOCIATED WITH YOUR APPLICATION
Please continue to next page. DO NOT RETURN THIS PAGE WITH THE APPLICATION
Mail applications to: U.S. Fish and Wildlife Service; Division of Management Authority; Branch of Permits, MS:IA; 5275 Leesburg
Pike; Falls Church, Virginia 22041-3803 or as directed by specific applications.
If you would like expedited mailing, 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.
Please refer to the fee schedule for the appropriate fees for the activity you are requesting.

If you are making more than one request, you must submit a separate payment
for each request, otherwise your application will be returned.

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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

INDIVIDUAL APPLICANTS
*First Name

Middle Name

*Last Name

*Email Address

Telephone Number

*Street Address

*City

*State/Province

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, 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.

Have you or your client (if a broker applying on behalf of your client), 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”, 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 getting a permit.

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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

Certification Statement
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 and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
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))
*Required fields. Applications without this information are subject to delays or returns.

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FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

BUSINESS APPLICANTS
*Business Name

doing business as (dba)

*Indicate your business type:
__ Business or other for profit
__ Farm

__ Small business

__ Government (Federal/State/Local/Tribal)

__ Not-for-profit institution

Name that will appear on the permit if you are applying on behalf of an individual/business

*Primary Contact Name

*Primary Contact Email Address

*Business Email Address

*Preferred Contact Method (e.g. phone, email)

*Principal Officer Name

*Principal Officer Title

*Principal Officer Email

Tax ID Number

*Business Phone

Alternate Phone

*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, 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.

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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

Have you or your client (if a broker applying on behalf of your client), 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”, 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 getting a permit.

Certification Statement
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 and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
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))
*Required fields. Applications without this information are subject to delays or returns.

Page 6 of 13

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

EXPORT OF ARTIFICIALLY PROPAGATED LIVE PLANTS OR PLANT PARTS (CITES)
This form should be used for the commercial export of cultivated specimens (i.e., species, hybrids, cultivars) of CITESlisted species that meet the criteria of ‘artificially propagated’, as defined by CITES Resolution Conf. 11.11 (Rev. CoP18);
on Regulation of trade in plants. To determine whether a plant species is regulated under CITES, when the species was
listed, and whether exemptions apply to the species or specimens you are requesting and would therefore not require a
CITES permit, see the CITES Checklist of Species. If you have any questions regarding your export, contact the Division
of Management Authority at managementauthority@fws.gov.
This form should NOT be used to:
•
•
•
•

Request authorization to re-export artificially propagated plants; or to export/re-export wild-collected plants or plant
parts or plants produced through assisted production; or to export /re-export plant products (e.g., extracts, powders,
wood products). For such exports, applicants should complete application form 3-200-32.
Request authorization for plants listed in the Endangered Species Act. For such export, applicants should complete
form 3-200-36.
Request authorization for the import of wild-collected CITES Appendix I plants. For such imports, applicants should
complete form 3-200-35.
Request additional partially completed certificates for artificially propagated plants under your existing Master File.
Applicants should complete application form 3-200-74.

Use this form to: (check one)
☐ Request a single-use permit for commercial export of artificially propagated plants or plant parts that is valid
for 6 months from the date of issuance. For re-issuance or amendment of a single use permit, the original permit must
be returned with completed application form.
☐ Establish a Master File: Authorization of a Master File with an approved plant list is valid for up to 3 years from the
date of issuance. Once approved, you may obtain partially completed certificates to export approved plants or plant
parts. Partially completed certificates are valid for 6 months (see the fee schedule). Certificates must be obtained prior
to making any shipment and must accompany the shipment.
☐ Amend an existing Master File: A Master File must be amended when there have been changes to the species or
supplier information authorized in your current Master File. You need only provide the requested information for the
species or suppliers to be amended (i.e., you do not need to provide information for all of the plants on your approved
Master File plant list if it has not changed). However, if you intend to renew your current Master File at the same time
you are amending, see below.
☐ Renew (or Amend and Renew) a Master File: To renew a Master File that has or will soon expire, you must
complete this entire application, including providing all information requested in this form for all plants to be
included in your Master File and information on any changes to your facility, operations, species, or suppliers for the
plant specimens that you wish to export.
Complete the following sections of this application form as it relates to your shipment:
All applicants complete “General Information” and “Part IV, Supplier Information”; and complete the following, as applicable:
•

Part I, to export interspecific and intergeneric hybrids of Appendix-II CATTLEYA, CYMBIDIUM, DENDROBIUM (D.
phalaenopsis and D. nobile only), ONCIDIUM (non-native species only), PHALAENOPSIS, or VANDA, and

•

Part II, to export other plants produced at your facility.

•

Part III, to export plants purchased and produced at different facility.

Page 7 of 13

FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

GENERAL INFORMATION (TO BE COMPLETED BY ALL APPLICANTS)
If more space is needed to respond to any questions in this application, attach separate sheets and cross-reference any
separate pages by numbering them according to the question you are responding to. You may upload inventories,
photographs, or receipts/invoices electronically with your application.
1. Provide the Master File or permit number of any current or previously established CITES Master Files or permits you
have held.
2. Describe your business operation, including how long you have been in business; and the number, location(s),
size(s), and type(s) of growing facilities. Briefly explain the methods you use and how long you have (a) propagated,
(b) grown, and/or (c) purchased the plants or plant parts to be shipped and your annual production capacity for each
species.
3. Provide current photographs of your growing facilities, parental stock, and plants to be exported, with descriptions for
each photo. Clearly indicate which species/hybrids/cultivars are depicted in the photos. If you purchase from a
different facility, please provide such photographs from that supplier(s).
4. Provide copies of the following documentation (cross-reference all document(s) by numbering them according to
the question number or plant item number that the document responds to):
a.

Your current State nursery license.

b.

Your current U.S. Department of Agriculture Protected Plant Permit.

c.

Validated CITES import permits and Phytosanitary Certifications with inventory lists for all plants or plant
parts imported to the United States (including imports used to establish parental stock).

d.

Authorizations (e.g., collection permits, land-owner permission, salvage permits) for any wild plants or plant
parts collected in the United States used to establish parental stock.

e.

Invoices or other documentation from suppliers (persons or businesses) of the plants or plant parts to be
shipped under this permit, or plants or plant parts used to establish parental stock at your facility. Invoices
should show the name and address, a telephone number or e-mail address of the supplier(s) (persons or
businesses) for purchases of any of the plants or plant parts to be shipped or used to establish the parental
stock at your facility. Be sure to list these suppliers in Part IV of this application form. If a receipt is not
available, provide a signed and dated statement that includes the following information:
i.

Propagator’s contact information (name, telephone number or e-mail, and business, if applicable);

ii.

Recipient’s and, if different from the applicant, contact information (name, telephone number or e-mail,
and business, if applicable);

iii.

Species, quantity, and what plant parts were sold;

iv.

Location and quantity of parental stock plants;

v.

Year the parental stock was established at above location;

vi.

Whether the parental stock is wild or cultivated;

vii.

Date of purchase; and

viii. Signature of seller and date signed.
5. For goldenseal (Hydrastis canadensis), provide documentation to trace back to the original collector, reflecting full
chain of custody.Include receipts or propagator or collector’s statements with information outlined in question 4.e,
above.
6. Describe the type of shipping containers and the arrangements for LIVE plant care during shipment.

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FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

PART I. Hybrids of certain non-native, CITES Appendix II Orchids: For the following genera or types below, provide information requested in Table 1. All
parents must be from these groups, including interspecific and intergeneric hybrids. Refer to Codes below for sections b-d and specify your answer in the space
provided if you select “other”. For all other plants, including other orchid hybrids, U.S. native Oncidium, or Appendix I orchids, proceed to Part II.
TABLE 1. HYBRIDS of NON-NATIVE, CITES APPENDIX-II CATTLEYA, CYMBIDIUM, DENDROBIUM phalaenopsis and D. nobile types, ONCIDIUM,
PHALAENOPSIS, or VANDA
Item a. Name of Hybrid (Include parental b. Plant Description at the
No. genera or grex)
time of export
specify code

c. Growing Environment
specify code

d. Propagation Method(s) e. Name of Propagating
specify code
Facility
(Provide complete address in
Table 4)

Codes to use in table above:
b. Plant Description: 1=Seedling; 2=Juvenile; 3=Mature/flowering; 4=Cutting/division; 5=Root/rhizome; 6= Other (specify)
c. Growing Environment: 1 = Greenhouse; 2 = Shadehouse; 3 = Lab; 4 = Field; 5 = Other (specify).
d. Propagation Method to produce the specimens to be exported: 1 = Seeds; 2 = Stem or root/rhizome cuttings/divisions; 3 = In vitro; 4 = Other (specify).

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FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Part II. Plants propagated and grown at applicant’s facilities (excluding hybrids in Part I): Refer to the Codes below Table 2; if “other,” explain your answer. For goldenseal
(Hydrastis canadensis), provide information to trace back to the original collector and provide full chain of custody, and see footnote 1.
Table 2. DESCRIBE YOUR PROPAGATION METHODS AND SOURCE OF PARENT PLANTS. Provide supplier or collector contact details in Part IV.

Information about the plants to be exported

Item
No.

a. Scientific & Common b. Description
Names (If hybrid,
specify code
parental species & hybrid
names)

c. Setting
d. Propagation
specify code Method specify
code

Information about the Parental Stock
e. No. of f. Setting
Parent specify
Plants
code

g. Origin of Parental Stock
Supplier Name

h. Dates i.
j. Description k. Purchase or
If wild, specify country acquired Quantity specify code collection
frequency
obtained
and see footnote1

Codes to use in table above:
b. Description (Plant or plant parts to be shipped): 1=Seedling; 2=Juvenile; 3=Mature/flowering; 4=Cutting/division; 5=Root/rhizome; 6= Other (specify)
c. Setting (Growing environment of plants): 1=Greenhouse; 2=Shadehouse; 3=Lab; 4=Field; 5=Other (specify)
d. Propagation Method to produce the specimens to be exported: 1=Seeds; 2=Stem or root/rhizome cuttings/divisions; 3=In vitro; 4=Other (specify)
f. Setting (Growing environment of plants): 1=Greenhouse; 2=Shadehouse; 3=Lab; 4=Field; 5=Other (specify)
j. Description (Plant part obtained): 1=Seeds; 2=Flasks; 3=Seedlings; 4=Juvenile size; 5=Mature/flowering size; 6=Cuttings/divisions; 7=Roots/rhizomes; 8=Other (specify).
k. Frequency = How often additional parent stock is purchased or collected.
1

For planting stock collected/harvested from the wild in the United States, provide additional information with your application to include: the number and age class of specimens collected; the specific
location (including city and county) and date(s) of collection for each specimen; the name, address, and phone number of the collector; collection/harvest methods; and the estimated number of plants and
the proportion of plants collected/harvested at each location. If wild-origin planting stock is from non-U.S. origin, copies of the validated CITES documentation will be adequate.

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FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Part III. Plants produced at facilities other than the applicant’s (excluding hybrids in Part II): Refer to the Codes below Table 3; if “other,” explain your answer. Use the same plant item
number from Table 2, if the plant is the same. If you obtain plants from more than one supplier, use the same item number, but separate lines for each supplier. For goldenseal (Hydrastis
canadensis), provide information to trace back to the original collector and provide full chain of custody, and see footnote 2.
Table 3. DESCRIBE YOUR PROPAGATION METHODS AND SOURCE OF PARENT PLANTS. Provide supplier or collector contact details in Part IV.

Information about the plants to be exported

Item
No.

a. Scientific & Common
Names (If hybrid, parental
species & hybrid names)

b. Description
specify code

c. Setting
specify code

Information about the Parental Stock

d. Propagation
e. No. of
Method specify code Parent
Plants

f. Setting
g. Origin of Parental Stock
specify code
Supplier Name
If wild, specify country
and see footnote1

h. Dates i. Quantity j. Description
acquired obtained specify code

k. Purchase or
collection
frequency

Codes to use in table above:
b. Description (Plant or plant parts to be shipped): 1=Seedling; 2=Juvenile; 3=Mature/flowering; 4=Cutting/division; 5=Root/rhizome; 6= Other (specify)
c. Setting (Growing environment of plants): 1=Greenhouse; 2=Shadehouse; 3=Lab; 4=Field; 5=Other (specify)
d. Propagation Method to produce the specimens to be exported: 1=Seeds; 2=Stem or root/rhizome cuttings/divisions; 3=In vitro; 4=Other (specify)
f. Setting (Growing environment of plants): 1=Greenhouse; 2=Shadehouse; 3=Lab; 4=Field; 5=Other (specify)
j. Description (Plant part obtained): 1=Seeds; 2=Flasks; 3=Seedlings; 4=Juvenile size; 5=Mature/flowering size; 6=Cuttings/divisions; 7=Roots/rhizomes; 8=Other (specify).
k. Frequency = How often additional parent stock is purchased or collected.
2

For planting stock collected/harvested from the wild in the United States, provide additional information with your application to include: the number and age class of specimens collected; the specific location (including
city and county) and date(s) of collection for each specimen; the name, address, and phone number of the collector; collection/harvest methods; and the estimated number of plants and the proportion of plants
collected/harvested at each location. If wild-origin planting stock is from non-U.S. origin, copies of the validated CITES documentation will be adequate.

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FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Part IV. Supplier Information (To be completed by all applicants). Provide the information requested in Table 4. Use the same plant item number from Tables 1, 2, or 3, as
applicable. If you obtain plants or plant parts from more than one supplier, use separate lines for each supplier. Be sure to include copies of supporting documentation (invoices,
receipts, statements) corresponding to each purchase from these suppliers.
Table 4. Supplier Contact Details
Item No.
Name of Supplier

Physical Address
(street, city, state, country, zip code)

Telephone Number E-mail Address

Website URL
(if known)

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FWS Form 3-200-33 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

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 (PRA; 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 PRA, 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. 1018-0093.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 2 hours
Amended submission - paper-based: 1 hour 45 minutes
Original submission - electronic: 1 hour 45 minutes
Amended submission - electronic: 1 hour 30 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 (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.
Questions regarding permits from Management Authority should be sent to managementauthority@fws.gov.

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