Form 3-200-37f Application - Import of Live African Elephant from Botsw

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

FWS Form 3-200-37f (Rev. 02/2023)
U.S. Department of the Interior

Import of Live African Elephants from Botswana, Namibia, South Africa, and Zimbabwe; Southern
White Rhinoceros from Namibia, eSwatini, and South Africa (CITES/ESA)
☐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).

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FWS Form 3-200-37f (Rev. 02/2023)
U.S. Department of the Interior

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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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FWS Form 3-200-37f (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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FWS Form 3-200-37f (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 3-200-37f (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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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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FWS Form 3-200-37f (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 3-200-37f (Rev. 02/2023)
U.S. Department of the Interior

Import of Live African Elephants from Botswana, Namibia, South Africa, and Zimbabwe; Southern White
Rhinoceros from Namibia, eSwatini, and South Africa (CITES/ESA)
General Information
This application covers activities involving the import of live African elephant (Loxodonta africana) from Botswana,
Namibia, South Africa, and Zimbabwe and Southern white rhinoceros (Ceratotherium simum simum) from Namibia,
eSwatini, and South Africa. The African elephant is listed as threatened under the U.S. Endangered Species Act (ESA) as
threatened with a special rule (50 CFR 17.40(e)) and the Southern white rhino is listed as threatened due to similarity of
appearance (50 CFR 17.52). The FWS must make both an enhancement finding as well as the CITES “appropriate and
acceptable destination” annotation.
Review this application carefully and provide complete answers to all questions. If more space is needed, attach a
separate sheet with your responses numbered according to the questions.
Please be aware that any permit request involving an ESA endangered species must be published in the Federal Register
for a required 30-day public comment period.
Please allow at least 90 days for the application to be processed.
If you have any questions regarding an action you are requesting authorization for please contact the Division of
Management Authority at managementauthority@fws.gov.
1. The current location of the animal(s) (if different from the physical address):
Name:
Address:
City:
State/Province:
Postal Code:
Country:
2. Sender (Provide name and physical address of the sender in the foreign country):
Name:
Address:
City:
State/Province:
Postal Code:
Country:

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FWS Form 3-200-37f (Rev. 02/2023)
U.S. Department of the Interior

3. For each animal involved in the import, provide the following information (you may use the table below):
a. Scientific name (genus, species, and if applicable, subspecies)
b. Common name
c.

Approximate birth date (mm/dd/yyyy)

d. Wild or captive-born
e. Quantity
f.

Sex (males.females.juveniles, e.g., 10.2.3)

g. Permanent markings or identification (microchip #, leg band #, tattoos, studbook #, etc.).
a. Scientific name
b. Common
(genus, species, and if Name
applicable,
subspecies)

c. Approximate d. Wild
Birth Date
(mm/dd/yyyy) (W) or
Captiveborn (C)

e.
Quantity

f. Sex (male. g. Permanent markings/ID
female.
Information (e.g., microchip #,
juvenile,
leg band #,tattoos, studbook #)
ex:1.0.0)

EXAMPLE:

08/01/2006

1

1.0.0 OR

Studbook# 152;

male

Microchip# 00056321-00

Chimpanzee

C

Pan troglodytes
Loxodonta africana

African
elephant

Ceratotherium simum Southern white
simum
rhinoceros

Source of Specimen(s)
4. For each captive-born animal(s), provide a signed and dated statement from the breeder or other appropriate
documentation (e.g. Species 360 report) that includes the following:
a. Scientific name (genus, species, and if applicable, subspecies);
b. Common name;
c.

Name and address of the facility where the animal was bred and born;

d. Birth date (mm/dd/yyyy);
e. Identification information (studbook #, tattoo, microchip, leg band #, etc.);
f.

Name and address of the facility where the parental stock is located;

g. 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
h. If you are not the breeder, documentation demonstrating the history of transactions (e.g., chain of custody or
ownership of the animal).
5. For each animal(s) taken from the wild, provide:
a. Scientific name (genus, species, and if applicable, subspecies);
b. Common name;
c.

Specific location (e.g. county, state, province, country) where the animal was removed from the wild;
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d. The name of the individual(s) who collected the animal(s) and their authorization to do so, including copies
of foreign and domestic (Federal, State, and/or Tribal) government collecting permits, licenses, contracts
and/or agreements;
e. Method of collection: capture protocol, approximate length of time held in captivity, and any injury and
mortality experienced during collection, transport, and holding;
f.

Information related to any remuneration, either financial or in-kind, provided for acquiring the animal(s); and

g. Efforts to use captive specimens (e.g., captive-born, captive-held), in lieu of taking animals from the wild.
Description and Justification for Requested Activity
Describe the purpose of your proposed activity.
6. If scientific research, provide:
a. A copy of the research proposal (outlining the purpose, objectives, and methods);
b. Detailed information on capture methods including;
c.

Who will be capturing the animals;

d. Equipment used;
e. Measures taken to prevent injuries and mortalities;
f.

An explanation of whether other similar work has already been conducted or is currently being conducted;

g. A copy of the study’s Institutional Animal Care and Use Committee (IACUC) form (if applicable);
h. Peer-reviewed scientific papers published from this research (if applicable).
7. If conservation education and/or zoological display, provide:
a. Objectives of proposed activity in support of an education program;
b. Copies of educational materials (e.g., handouts, text of signage or public presentations), incorporating the
following information:
i. Status in the wild,
ii. Current threats,
iii. Conservation efforts,
8. If captive propagation for the conservation and survival of the species, provide:
a.

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

b. 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;
c.

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

d. How your breeding stock is managed to maintain genetic vitality, including:
i. Avoidance of inbreeding,
ii. Considerations of average kinship,
iii. And differences in paternal and maternal average blood relationships/relatedness,
iv. Carrying capacity of your facility,
v. Disposition of progeny.
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e. Plans and agreements for future re-introduction (if applicable).
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.
Technical Expertise & Facilities
●

For import, provide answers to Questions 10-25 for your institution.

●

For imports to multiple facilities, provide answers to Questions 10-25 for all receiving institutions.

10. Provide copies of or cite any elephant and rhino care/husbandry manuals, protocols, or guidelines that are used at the
facility.
11. Describe the facility’s record keeping.
12. CV or resume outlining the technical experience and expertise of each caretaker, veterinarian, and administrator with
direct oversight of the elephants or rhinos working with, maintaining, and/or propagating each species/specimen, as it
relates to the proposed activities, including experience with similar species.
13. Current inventory of the species or similar species at the facility (males.females.unknown; e.g., 10.2.3),
14. Number of years the species or similar species have been maintained at the facility,
15. Number of births by species or similar species per year over the last 5 years at the facility,
16. Number of mortalities by species or similar species per year over the last 5 years and steps taken to avoid, decrease,
or mitigate such mortalities,
17. A detailed description, diagrams, and photos clearly depicting the existing facilities where the specimens 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.
18. Approximate carrying capacity for the species at the facility.
19. Describe any plans for ongoing staff training with regard to safety, security, record keeping, or animal management.
20. 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).
21. Describe how the dietary needs of the species will be met.
22. 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.
23. Will this import 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.
24. If accredited by a regional or national animal care organization, please identify the organization and provide proof of
accreditation.
25. Please provide copies of any State or Federal licenses to display, exhibit, or hold elephants or rhinos, as well as a
copy of the most recent USDA APHIS inspection report.

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U.S. Department of the Interior

Transport/Shipment of Live Animals
26. Transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals. All air
transport must also comply with our regulations at 50 CFR 14, Subpart J and the International Air Transport
Association (IATA) live animal regulations (contact airline for information). As such, provide:
a. Duration of the trip (including airline flights and ground transport);
b. The type, size, and construction of any shipping container and;
c.

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

d. Will a veterinarian or animal keeper accompany the specimen and be able to provide any necessary care?
e. CV or resume of the individual(s) arranging and/or conducting the transport of the specimen(s).
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.
Appropriate and Acceptable Destination
For import of live African elephant from Botswana, Namibia, South Africa, and Zimbabwe and Southern white rhinoceros
from Namibia, eSwatini, and South Africa, a determination that the importing 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’.
NOTE: For any CITES permit authorizing trade of live rhinoceroses under an “appropriate and acceptable destination”
annotation, the rhinoceros horn from these animals and their progeny may not enter commercial trade and the animals
may not be sport hunted outside of their historic range.
27. 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 it arrives in the United States.
28. For each person and/or facility identified in question 27, please provide the following information:
a. Description of the facility, including diagrams, photographs, or construction plans;
b. 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;
c.

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;

d. Description of environmental enrichment elements provided to the specimen(s);
e. 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;
f.

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);

g. Copies of all Standard Operating Procedures (protocols) used at the facility for the care and housing of the
specimen(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.;

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

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);

j.

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

k.

Survival rate of specimens of the same species or, alternatively, closely related species at the facility, mortalities
for the previous 5 years, significant injuries to wildlife, occurrence of significant disease outbreaks during the
previous 5 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);

l.

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

m. Written documentation demonstrating that the proposed activity would promote in-situ conservation of the
species.
All international shipment(s) must be through a designated port. A list of designated ports (where a wildlife inspector
is posted) is available. If you wish to use a port not listed, please contact the Office of Law Enforcement for a Designated
Port Exemption Permit (Form 3-200-2).

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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 45 minutes (electronically) to 1 hour (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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