Form 3-200-85 Application - Establishment of a Master File for the Exp

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

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

Establish a Master File for Export of Live Animals Bred in Captivity (CITES) (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 12

FWS Form 3-200-85 (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 12

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

FWS Form 3-200-85 (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 12

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

FWS Form 3-200-85 (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 12

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

FWS Form 3-200-85 (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 12

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

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

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.

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 12

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

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

ESTABLISHMENT OF A MASTER FILE FOR THE EXPORT OF LIVE ANIMALS BRED-IN-CAPTIVITY IN THE UNITED
STATES (CITES)
This application allows you set up a Master File for exports of live animals bred in captivity under CITES. The Master File
is valid for three years and is renewable. Once the Master File is approved you must obtain single- use permits, valid for 6
months, for each export (50 CFR 13.11).
Note 1: Species that are listed on pages 8 and 9 of this application are currently eligible for inclusion in a master file. This
list contains species where it has been determined that specimens were born or hatched from parents mated in captivity
in the United States and qualify as Bred-in-Captivity in accordance with CITES Resolution Conf. 10.16 (Rev.) These
species are therefore eligible for issuance of certificates under the provisions of CITES Article VII, paragraph 5. If a
species you are interested in including on a master file is not listed, you may either submit application form 3-200-24 or
complete questions 11 through 15 of this application to request that specimens produced at your facility be considered
Bred-in-Captivity. If it is determined that your specimens do not meet the criteria under Resolution Conf. 10.16 (Rev.), you
may still be eligible to obtain individual export permits for the specimens.
Note 2: We may not be able to issue CITES documents for the commercial export of Appendix-I specimens, unless the
specimens were produced at a commercial breeding operation that is registered with CITES Secretariat. For more
information on registering commercial breeding operation for Appendix-I wildlife, contact the Division of Management
Authority at managementauthority@fws.gov.
This application can be used to:
Establish a new Master File: This application allows you set up a Master File, valid for one year and renewable, for
exports of live animals bred in captivity in the United States under CITES. Once the Master File is approved, you will
need to obtain single-use permits, valid for 6 months, for each export (50 CFR 13.11)
Renew and/or amend an existing Master File, # ___________________________________
Once a Master File is established or you are renewing (or amending and renewing) a Master File, you may request singleuse permits using the 3-200-74. Please refer to the fee schedule to determine the cost of each of the above-listed
activities.
1. For each wildlife species to be shipped, provide the following information:
a. Scientific name (genus, species, and, if applicable, subspecies);
b. Common name;
c.

Typical description of specimens to be exported (e.g., hatchlings, sub-adults; typical size);

d. Estimated annual production of specimens;
e. Estimated annual export of specimens; and
f.

Normal mortality rates at your facility.

2. Where are the specimens currently located? (e.g., physical address of facility including county).
Name:
Street Address:
City/Province:
State:
Country, Postal Code:
3. As the Breeder, sign (in ink) the following statement:
I hereby certify that the species listed above to be exported were bred and born/hatched from parental stock at my
facility listed below. (Additional information on the parental stock may be requested upon receipt of your application).

Page 7 of 12

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

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

a. Name and address of your facility where the animals were bred and born/hatched:
Name of facility/operation:
Street Address:
City, State, Zip Code:
b. Current location of parental stock:
Street Address:
City, State, Zip Code:
Signature: _______________________________________________________ Date: __________________
4. If you are NOT the breeder of the specimen(s), provide copies of documentation showing that you acquired the
Animal(s) from the breeder or documentation demonstrating the history of transactions (chain of ownership of each
animal) and a signed statement from the breeder or breeder's record that includes:
a. That the animal was bred and born/hatched at his/her facility;
b. Birth/hatch date, and, if applicable, band/tag number, or other identifiers;
c.

Sex of each specimen he/she bred;

d. Location (name, street address, city, state) of parental stock;
e. Complete name and address of the breeder's facility.
5. Provide labeled photographs depicting the facilities for the specimens described in your application.
6. If the species you intend to export appears on the attached list, skip questions 8–12.
7. For species that are NOT included on the attached list: As stated above, in order to establish a master file, the
species being proposed for export must be on the attached list (see SPECIES THAT QUALIFY AS CAPTIVE-BRED).
For species that are NOT included on the attached list, you can request that the species be approved for your facility
by completing the questions 8-12:
As a Separate Document:
8. Provide information about the breeding facility, including:
a. Property size;
b. Size and type of facility buildings (such as, food prep room and incubation facilities);
c.

Size and type of cage or enclosure used to house juveniles, adults, hatchlings, as appropriate;

d. Are the cages or enclosures indoors or outdoors?
e. How many cages and enclosures does the facility provide?
f.

How is the location secured (i.e., fence, guard dog, electric wire, etc.) from both theft and natural disaster?

g. How are animals uniquely identified (pit tags, leg bands, notching, photos)?
9. Provide documentation that demonstrates that the founder stock was legally obtained in accordance to CITES and
with foreign, State and local laws (all original stock used to produce the offspring even if now dead or no longer able
to breed). Examples of documentation include CITES Permits, State Collecting Permits, receipts, or letters of affidavit
from original breeder on how they obtained these animals, and receipts showing the chain of custody.

Page 8 of 12

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

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

10. Provide any available documentation that the breeding stock was acquired in a manner that was not detrimental to the
species. Examples of documentation include information on status of the species in the wild, the availability of the
species in the domestic and international trade, and the ease and difficulty of breeding the species in captivity.
11. Provide evidence on the ability to consistently produce offspring of second or subsequent generations (F2 or greater)
in a controlled environment, or management in a way that has been demonstrated to be capable of reliably producing
second generation offspring and has produced first-generation offspring, including:
a. List of breeding stock that includes identification (name or number) of specimens, born/hatched date, location
born/hatched, and sex;
b. Pedigrees of the breeding stock;
c.

How long has the breeder bred the species?

d. How many generations has the breeder produced (F1, F2, F3, etc.)?
e. How many breeding females and breeding males are currently maintained?
f.

Has offspring been held back to be parental stock? If so, how many male and females?

g. What is the estimated annual production?
h. Average mortality rate/year (juveniles and adults)?
i.

What is the anticipated annual export amount?

12. What are the future plans for supplementing breeding stock, especially as it pertains to introducing wild-origin stock?
a. Will specimens be added either to prevent or alleviate deleterious inbreeding?
b. Is there captive stock available in the United States or elsewhere such that supplementation from the wild is not
necessary?
All Applicants complete the following:
13. The transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals or, in
the case of air transport, with the International Air Transport Association (IATA) live animal regulations (contact airline
for information). As such, describe:
a. The type, size, and construction of any shipping container; and
b. The arrangements for watering or otherwise caring for the wildlife during transport.
14. Attach copies of any applicable State permits or licenses, such as commercial breeding or sales licenses (contact
your State for information).
15. If the species is part of an approved WBCA Cooperative Breeding Program, identify the breeding operation and
provide an explanation of how the specimen is surplus to the operation.
All international shipment(s) must be through a designated port. A list of designated ports (where an 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).

Page 9 of 12

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

FOR THE PURPOSE OF EXPORT FROM THE UNITED STATES
SPECIES THAT QUALIFY AS CAPTIVE-BRED
IN ACCORDANCE WITH CONF. 10.16

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

MAMMALS
Order Primates
Callithrix jacchus - Common marmoset [App. II]
Cercocebus agilis – Agile mangabey [App. II]
Lophocebus spp. – Mangabeys [App. II]
Erythrocebus patas - Patas monkey [App. II]
Macaca fascicularis - Crab-eating macaque [App. II]
Macaca mulatta - Rhesus monkey [App. II]
Order Carnivora
Caracal (=Felis) caracal - Caracal [excluding Asian population]
Leptailurus (=Felis) serval - Serval [App. II]
Order Artiodactyla
Antilope cervicarpa - Blackbuck [App. III]
Hexaprotodon liberiensis- Pygmy hippopotamus [App. II]
Hippopotamus amphibius - Hippopotamus [App. II]
Lama guanicoe - Guanaco [App. II]
BIRDS
Order Anseriformes
Cygnus melanocoryphus - Black-necked swan [App. II]
Order Falconiformes
Buteo buteo - European buzzard [App. II]
Order Galliformes
Argusianus argus - Great argus pheasant [App. II]
Gallus sonneratii - Sonnerat'sjunglefowl, Gray junglefowl [App. II)
Polyplectron bicalcaratum - Gray peacock pheasant [App. II]
Polyplectron germaini - Germain's peacock pheasant [App. II]
Polyplectron malacense - Malaysian peacock pheasant [App. II]
Order Psittacifornies
Agapornis roseicollis - Peach-faced lovebird [App. II]
Aratinga jandaya - Jendaya parakeet [App. II]
Barnardius zonarius barnardi - Malice ringneck parrot [App. II]
Bolborhynchus lineola - Lineolated parakeet [App. II]
Cyanoramphus auriceps - Yellow-fronted parakeet [App. II] (excluding C. a. forbesi)
Forpus coelestis - Pacific parrolet [App. II]
Neophema bourkii – Bourke’s parrot [App. II]
Neophema chrysostoma - Blue-winged parrot [App. II]
Neophema elegans - Elegant parrot [App. II]
Neophema pulchella - Turquoise parrot [App. II]

Page 10 of 12

FWS Form 3-200-85 (Rev. 02/2023)
U.S. Department of the Interior

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

Neophema splendida - Scarlet-chestedparrot [App. II]
Platycercus adscitus - Pale-headed rosella [App. II]
Platycercus elegans - Crimson rosella [App. II]
Platycercus eximius - Eastern rosella [App. II]
Platycercus icterotis - Western (Stanley) rosella [App. II]
Platycercus venustus - Northern rosella [App. II]
Polytelis alexandrae - Princess parrot [App. II]
Polytelis anthopeplus - Regent parrot [App. II]
Polytelis swainsonii - Superb parrot [App. II]
Psephotus haematonotus - Red-rumped parakeet [App. II]
Psephotus varius - Mulga parakeet [App. II]
Psittacula eupatria - Alexandrine parakeet [App. II]
Purpureicephalus spurius - Red-capped parrot [App. II]
Trichoglossus chlorolepidotus - Scaly-breasted lorikeet [App. II]
Order Passeriformes
Poephila cincta cincta - Parson finch [App. II]
REPTILES
Order Squamata
Antaresia childreni - Children's python [App. II]
Antaresia maculosa - Spotted python [App. II]
Antaresia perthensis - Pygmy python [App. II]
Boa constrictor - Boa constrictor [App. II] (includes B. c. constrictor, B. c. imperator, B. c. melanogaster, B.
c. mexicana, and B. c. ortonii)
Eryx johnii - Blunt-tailed sand boa [App. II] (includes E. j. johnii and E. j. persicus)
Eunectes murinus - Green anaconda [App. II] (includes E. m murinus, E. m. gigas, and E. m. noteaus)
Morelia spilota variegata - Carpet python [App. II]
Python curtus - Sumatran short-tailed python [App. II] (includes P. c. curtus, P. c. breitensteini, P. c.
brongersmai)
Python reticulatus - Reticulated python [App. II]
Python molurus bivittatus - Burmese python [App. II]
Python regius - Ball or royal python [App. II]
Python sebae - African rock python [App. II]
Python sebae natalensis - Southern African rock python [App. II]
AMPHIBIANS
Order Caudata

Ambystoma mexicanum - Axolotl [App. II]

Page 11 of 12

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

FWS Form 3-200-85 (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:
Original submission - paper-based: 1.5 hours for individuals and 2.5 hours for private sector and government
Original submission - electronically: 1.25 hours for individuals and 2.25 hours for private sector and government
Amended submission - paper-based: 1.5 hours for individuals and 2.5 hours for private sector and government
Amended submission - electronically: 1.25 hours for individuals and 2.25 hours for private sector and government
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 12 of 12