Form 3-200-41 Application - Captive-Bred Wildlife Registration (U.S. E

Federal Fish and Wildlife Permit Applications and Reports--Management Authority; 50 CFR 13, 15, 16, 17, 18, 22, 23

3-200-41 App - CBW Registration 02242023

ePermits Application - Captive-Bred Wildlife Registration/CBW (Form 3-200-41) - Private Sector

OMB: 1018-0093

Document [pdf]

Download: pdf | pdf

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

FWS Form 3-200-41 (Rev. 02/2023)
U.S. Department of the Interior

Captive-Bred Wildlife Registration (CBW) (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).

Page 1 of 10

FWS Form 3-200-41 (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.

Page 2 of 10

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

FWS Form 3-200-41 (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.

Page 3 of 10

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

FWS Form 3-200-41 (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.

Page 4 of 10

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

FWS Form 3-200-41 (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

Page 5 of 10

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

FWS Form 3-200-41 (Rev. 02/2023)
U.S. Department of the Interior

Signature and date

Page 6 of 10

FWS Form 3-200-41 (Rev. 02/2023)
U.S. Department of the Interior

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

CAPTIVE-BRED WILDLIFE REGISTRATION (ESA)
Please use the following application for all CBW requests. The CBW registration was designed to facilitate export, reimport, and interstate and foreign commerce of exotic species that are captive born in the U.S. Obtaining a registration
under the permitting regulations found at 50 CFR 17.21(g) means that otherwise prohibited activities are allowed for the
purpose of enhancing the propagation or survival of the species (conservation breeding). Therefore, your application must
show how your activities will either enhance organized breeding programs or in situ projects to enhance the survival of the
species in the wild. Loans and donations are not prohibited by the ESA.
A CBW Registration remains valid for five years and may be renewed once for a total validity of ten years, after which the
CBW Registration number will be retired and you must apply for a new CBW Registration.
NOTE: If a renewal application is submitted thirty days or more prior to the CBW Registration expiring, the applicant
may continue to conduct previously authorized activities during the renewal process. However, if the application is
submitted fewer than thirty days prior to expiration, activities must cease at the time the registration expires until the
renewal process is completed.
Use this form for:

☐ New application – complete Parts 1 and 2 of the application.

☐ Amendments [Permit number:_____________________________] – complete Parts 1 and 2 of the application.
☐ Renew [Permit number:_____________________________]
•

•

You may renew your CBW once after 5 years, but after a CBW registration has been valid for 10 years,
you must submit a completely new application, responding to all questions.
If it has been less than 10 years since you submitted a completely new application, complete Parts 1 and 3
of this application.

NOTE: If you have a change of mailing address, you must notify the FWS within 10 days. If your facilities move, you will
need to apply for an amendment.
If you maintain exotic wildlife in a natural setting, such as a ranch, complete Parts 1 and 2, and Part 4 of the
application.

Part 1: All Applicants Must Complete
1. Provide copies of any license or registration under USDA Animal Welfare Act regulations (9 CFR 2) (if required)
and/or any State license or registration required to maintain or breed the species requested in Part 2 or Part 3 below.
If available, provide a copy of your last two (2) USDA AWA inspection reports.
2. The exact location(s), including address(es), where the wildlife requested in this application will be maintained. If more
than one location exists, list all that apply. NOTE: You must report any change in address or location of facilities to the
Division of Management Authority within 10 days of such change taking place.
3. Provide a current inventory, including those out on loan, for each of the exotic ESA-listed species you are requesting
to include or have already been approved to hold (if currently holding a valid CBW registration) on your CBW
registration.
4. Attach a brief resume for all senior animal care staff or personnel that will be working with or maintaining each
species, including the number of years’ experience with this species or similar species.

Page 7 of 10

FWS Form 3-200-41 (Rev. 02/2023)
U.S. Department of the Interior

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

Part 2: New Application, Amendment, or Renewal of CBW which are older than 10 years:
FOR EACH SPECIES BEING REQUESTED for inclusion in a registration, whether a new application or
amendment, complete each of the following questions. Signify that you have read each question by writing “N/A” if nonapplicable. If submitting hard copy pages, please indicate the species and the application question number you are
addressing.
5. The scientific name (genus, species and, if applicable, subspecies) and common name of each species for which you
wish to be registered.
6. Provide the name, address, and CBW registration number of the person(s) or institution(s) from whom you plan to
acquire the wildlife, including the sale or loan agreements for the specimens. If currently unknown, describe your
efforts, including documentation, to acquire appropriate specimens for your breeding efforts.
7. Indicate if there is an organized breeding program that you are currently involved with or if you have communicated
with other breeding organizations regarding your potential participation in those programs. Provide documents to
show you are currently involved with a breeding program or include any communication you have had with breeding
organizations that you wish to be involved.
8. Provide a description of how your proposed activities are going to facilitate captive breeding for conservation
purposes of this species, including your long-term goals for your breeding program and intended disposition of
any progeny. Be specific.
9. Provide a detailed description and documentation showing how your captive population is being managed to maintain
its genetic vitality. If you do not currently maintain a sufficient number of specimens for each species being requested
to successfully maintain the genetic viability of the species, you must participate in an organized breeding program.
Please identify this program and provide documentation describing the objectives and goals of the program, and
confirmation that you are a participant in this program.
10. If your activities include the holding of surplus animals (i.e., not currently needed in and not being bred) for an
organized breeding program, document how your acquisition of such wildlife will relieve crowding at the locations from
which the wildlife will be obtained, and thereby assist the breeding program for the species involved. Provide
documentation that you are a participant in an organized breeding program where the holding of surplus wildlife has
been identified as a necessary objective of the breeding program. Provide a description of how you will restrict/control
breeding at your facility.
11. For each requested species, provide a description of your experience in maintaining and propagating the requested
species or similar species, including:
a. The number of years you or the facility has/have maintained the requested species or similar species.
b. During the past five years, how many (by species, by year) successful births/hatchings of each requested
species or similar species have occurred at your facility? How many survived beyond 30 days?
c.

How many mortalities of requested species or similar species have occurred at your facility during the past five
years? What were the causes? What measures have you taken to prevent future mortality?

d. Provide a detailed description, including size, construction materials, and protection from the elements, as well
as photographs and detailed diagrams (no blueprints) clearly depicting your existing facilities, including space for
future progeny, where the wildlife will be maintained.

Page 8 of 10

FWS Form 3-200-41 (Rev. 02/2023)
U.S. Department of the Interior

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

Part 3: Applications to Renew CBW registrations that are 5 years old or less:
12. Have there been any changes to your operation such as reconstruction or new construction, new facilities, or other
physical changes?
☐ No

☐ Yes, please describe them.

13. Have there been any changes to senior staff or personnel changes that would affect how your operation handles the
species included in the registration?
☐ No

☐ Yes, please describe these changes.

14. Have there been any changes to your inventory that have not been reflected in your annual reports or the current
inventory list provided to the Service?
☐ No

☐ Yes, please describe these changes.

15. Is there any additional information that you believe the Service should be aware of regarding your operation, facilities,
inventory, or business model?
☐ No

☐ Yes, please provide additional information.
Part 4: Applications for wildlife that is maintained in a natural setting:

16. Provide a specific description of how your proposed activities are going to facilitate captive breeding for conservation
purposes of this species including your long-term goals for your breeding program and intended disposition of any
progeny. Be specific.
17. How often do you conduct surveys of your wildlife?
18. How do you determine and identify which specimens are surplus to your operation?
19. What is the approximate maximum number of specimens of each species your facility can support?
20. What are you doing to prevent predation of stock?
21. Provide a detailed description as well as photographs clearly depicting your existing facilities, including space for
future progeny, where the wildlife will be maintained.

Page 9 of 10

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

FWS Form 3-200-41 (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 as follows:
Original submission - paper-based: 2 hours
Original submission - electronic: 1.75 hours
Amended submission - paper-based: 1.75 hours
Amended submission - electronic: 1.5 hours
These burden 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.

Page 10 of 10

File Type	application/pdf
Author	Harlow, Caroline I
File Modified	2023-02-24
File Created	2023-01-24