Form 3-200-70 Application - Export/Re-Import/Transport of Bald and Gol

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

FWS Form 3-200-70 (Rev. 02/2023)
U.S. Department of the Interior

Transport of Bald/Golden Eagles from and to the United States for Native American Religious
Purposes (CITES)
☐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).

•

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 (3-2003) 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 non-business related travel with their pet exotic parrot (dba is not relevant to the permit; complete
the Business Applicant section).
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FWS Form 3-200-70 (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.
No processing fee for this application.

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 3-200-70 (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 3-200-70 (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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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-70 (Rev. 02/2023)
U.S. Department of the Interior

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 3-200-70 (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.

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FWS Form 3-200-70 (Rev. 02/2023)
U.S. Department of the Interior

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

EXPORT, RE-IMPORT or TRANSPORT OF BALD AND GOLDEN EAGLE FOR NATIVE
AMERICAN RELIGIOUS PURPOSES (CITES)
This application is for a permit under the Convention on International Trade in Endangered Species of Wild
Fauna and Flora (CITES) and the Bald and Golden Eagle Protection Act (BGEPA) for transport of bald eagle
(Haliaeetus leucocephalus) or golden eagle (Aquila chrysaetos) parts from or to the United States for Indian
religious purposes. BGEPA regulations provide that bald and golden eagle items may be temporarily transported
out of the United States; the same items, unchanged, must be re-imported. A permit, if issued, allows for onetime travel to a specific location noted in the permit.
If you will be transporting any other species listed under CITES (e.g., river otter), or other species listed under
the Migratory Bird Treaty Act (e.g., songbird, hawk), in addition to bald or golden eagle parts, you may include
them in this application.
Complete all questions on the application. Mark questions that are not applicable with "N/A". If needed, use
separate sheets of paper. On all attachments or separate sheets you submit, indicate the application question
number you are addressing.
NOTE: A CITES permit is only required if the feathers are leaving and re-entering the United States from a foreign nation
that is not Mexico or Canada.
1. Provide the following (use a separate sheet if necessary):
a.
Scientific and common names of species that are found on the items in this application.
b.
Full description of each item (e.g., feather, fan, head dress), including age, country of origin, and NUMBER of
feathers on item(s).
c.
Documentation or other evidence that the specimen/item was lawfully acquired and any available information
on the origin of the specimen/item (e.g., a permit or a receipt from the National Eagle Repository). If the item
2. If you have a Federal Eagle Permit for Indian Religious Purposes for eagle feathers received from the
National Eagle Repository, please attach a copy of your permit. If you do not have such a permit, please
attach a completed Certificate of Enrollment (copy attached) certifying that you are an enrolled member of a
federally recognized Tribe, band, nation, or other organized group or community eligible to receive services
from the Bureau of Indian Affairs.
3. How long will the items be out of (or in) the United States?

4. Anticipated date of departure/arrival:
5. Anticipated date of return:
6. Where will you be staying while outside of the United States (e.g., hotel, house)?
Name:
Address:
City:
State/Province:
Country, Postal Code:
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FWS Form 3-200-70 (Rev. 02/2023)
U.S. Department of the Interior

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

7. Please explain in detail your purpose for traveling abroad with your regalia:
8.

For Re-export: Provide a copy of the validated foreign CITES export or re-export document
[cancelled by FWS Office of Law Enforcement (OLE)] issued by the appropriate CITES office in the
country from which the wildlife was imported, and a copy of the *Wildlife Declaration (Form 3-177),
stamped cleared by OLE. NOTE: Permits cannot be issued without the documents being stamped
cancelled and cleared by OLE.

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

FWS Form 3-200-70 (Rev. 02/2023)
U.S. Department of the Interior

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) 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. 1018-0093.

ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 30 minutes (electronically) to 45 minutes (paperbased), including 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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