Form 3-200-43b Application - Take/Import/Export of Marine Mammals for S

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

FWS Form 3-200-43b (Rev. 02/2023)
U.S. Department of the Interior

TAKE/IMPORT/EXPORT OF MARINE MAMMALS FOR SCIENTIFIC RESEARCH (MMPA/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 to 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 mailing your submission, mail the original application to the address listed below or, if applicable, on the attached address
list.

•

Keep a copy of your completed application.

•

Please plan ahead. 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 (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 3-200-43b (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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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 3-200-43b (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 3-200-43b (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 3-200-43b (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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FWS Form 3-200-43b (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 3-200-43b (Rev. 02/2023)
U.S. Department of the Interior

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

Take/Import/Export of Marine Mammals for Scientific Research (MMPA/ESA)
Allow at least 4 to 6 months for the application to be processed. Applications for marine mammal permits must be
published in the Federal Register for a 30-day public comment period.
Use this application to request the public display of live marine mammals under the jurisdiction of the U.S. Fish &
Wildlife Service (sea otters, marine otter, polar bears, walrus, manatees, and dugong) for purposes of bona fide scientific
research. This application may be used for the renewal and/or amendment of an existing permit for these activities.
NOTE: Renewal and amendment requests require responses to all questions pertaining to your requested activity.
This form should NOT be used for:
•
•
•

•
•
•

Public display of marine mammals (use Form 3-200-43a), including import for public display under the
MMPA/ESA.
Enhancement under the MMPA and/or ESA, including import/export under the MMPA/ESA for enhancement of the
propagation or survival of the species (use Form 3-200-43c).
A letter of authorization (LOA) under MMPA Sections 109(h)/112(c) rescue, rehabilitation, and release of stranded
marine mammals, including import of live animals and/or import, export or re-export of samples for rescue-rehab
purposes (use Form 3-200-43d).
Domestic transfer of specimens (parts/samples), domestic live marine mammal transfers and non-releasability
requests (use Form 3-200-87).
Commercial or educational photography (use Form 3-200-86).
Activities involving marine mammals under jurisdiction of the National Marine Fisheries Service (NMFS) (whales,
dolphins, porpoises, seals and sea lions); please contact NMFS.

If you already have MMPA/ESA authorization and need a CITES permit:
•
•

•
•

Export or re-export of captive-held live animals: (use Form 3-200-53)
Export or re-export of parts or biological samples:
o marine mammals listed on CITES Appendix II or III (use Form 3-200-29).
o marine mammals listed on CITES Appendix I (use Form 3-200-37e).
For CITES introduction from the sea (use Form 3-200-31).
Provide a copy of your FWS or NOAA Fisheries MMPA/ESA authorization with your CITES application.

All international shipment(s) must be through a CITES designated port. A list of designated ports (where a wildlife
inspector is posted) is available from the list of designated ports. 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).
Please review the complete application carefully before beginning. Provide complete answers to all questions in
the sections relevant to the activity for which you are requesting authorization. If a question is not applicable,
answer with “N/A.” If you provide additional information as attachments, indicate the application question number you are
addressing. If you are applying for multiple species and/or activities, be sure to indicate which species/activity(ies) you are
addressing in each response.

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OMB Control No. 1018-0093
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FWS Form 3-200-43b (Rev. 02/2023)
U.S. Department of the Interior

Scientific Research of Marine Mammals
This application is for (choose all that apply):

☐ A new permit
☐ Renewal of permit # ____________________________
☐ Amendment of permit # __________________________
As an attachment, provide the following information for each species for which you are applying:
Species

Quantity

Sex

Birth Date

Description (e.g., ID,
ISIS, Transponder,
and/or Tattoo #’s

Country of
Origin

Source*

Current location of
the animal

* (i.e., Wild, Captive-born, Captive-bred)

Facility Information (attach appropriate documents):
1. A complete description, including photographs and/or diagrams (no blueprints), of the area and facilities where the
animals will be held (including the dimensions of pools and haul-out areas).
2. The number of animals of the same species (include age and sex) presently maintained at the facilities and
information indicating whether there is space for additional animals without exceeding USDA/Animal and Plant Health
Inspection Service (APHIS) limits (i.e., provide the maximum # of animals of each species that could be held).
3. A list of all animal caretakers and a description of their specific duties/responsibilities.
4. A description of the animal caretakers’ experience in the care, handling, and maintenance of the marine mammal
species that is/are the subject of this application (complete the qualification section for each caretaker).
5. A description of specific State requirements regarding who (e.g., attending veterinarians, vet technicians, researchers)
may handle and administer certain drugs.
6. A list of all marine mammals under the jurisdiction of FWS maintained at the facility (specify whether they are held in
the same exhibit/holding area as the target animals will be held and maintained).
7. A description of all deaths of FWS-jurisdiction marine mammal species at the facility within the past five years and the
steps taken to prevent or decrease similar mortality.
8. For U.S. facilities, provide information to show that the facility:
a. Is open to the general public without limitations or restrictions (other than by the charging of an admission fee).
b. Offers a program for education or conservation purposes that is based on professionally recognized standards of
the public display community (include copies of outreach/educational materials and photos of signage).
c. Is registered or holds a license issued by the USDA Animal and Plant Health Inspection Service (APHIS) under the
Animal Welfare Act (AWA).

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FWS Form 3-200-43b (Rev. 02/2023)
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Marine Mammals that are CURRENTLY HELD in a CAPTIVE ENVIRONMENT (including, but not limited to import into
the U.S. of captive-held animals/specimens).
9. For captive-born animal(s), provide a breeder’s statement, ARKS/ZIMS specimen report, or other information that
documents the animal was born in captivity, location of birth, and information on the source of the parental stock (e.g.,
captive-born, wild).
10. For captive-held animal(s) already taken from the wild, provide either:
a. Information (e.g., ARKS/ZIMS specimen report(s)) on the source of the animal, including when the animal was
removed from the wild, by whom, and the location OR
b. A copy of the MMPA permit or LOA under which the animal is currently being held in captivity or a copy of the
MMPA permit or authorization for removal of the animal from the wild.
11. Has the FWS deemed the animal(s) non-releasable to the wild?

☐ Yes; provide a copy of the official letter confirming the animal’s non-releasable status.

☐ No; if you are requesting to have the animal(s) deemed non-releasable at this time, provide an explanation of the

following:
• why release of the animal to the wild will not likely be successful given its physical condition;
• why release of the animal to the wild will not likely be successful given its behavior, including adverse
interactions with humans or marine mammals; or
• why release of the animal to the wild may jeopardize the wild population of the species.
Marine Mammals that will be taken FROM THE WILD and brought into captivity

12. Information on the actual or proposed date(s) and location(s) of collection.
13. The numbers of animals of each age class and sex to be taken from the wild (include a definition of each of these age
classes by range of months and/or years).
14. An estimate of the species’ population stock in the wild.
NOTE: stock assessment reports might assist you with this information and are available at the following FWS field
offices, depending on the species involved:
• Southern sea otter: Ventura Fish and Wildlife Office
• Northern sea otter: Washington Fish and Wildlife Office
• Northern sea otter, walrus, polar bear: Alaska Marine Mammals Management Office
• Manatee: North Florida Ecological Service Office
15. A list of all non-target marine mammals and ESA-listed species that might occur in your project area or might be
affected by your activities.
16. The maximum number of animals of each non-target marine mammal and ESA-listed species (# per species) that
might be harassed by your activities, the precautions that you will take to minimize the likelihood that harassment will
occur, the actions that you will take should harassment occur.
17. The maximum number of animals of each non-target marine mammal and ESA-listed species (# per species) that might
be taken (e.g., killed, injured, feeding activities disrupted, etc.) by your activities, your precautions to minimize the
likelihood that take will occur, and your actions should take occur.
18. A description of the efforts made to acquire captive-held animals in lieu of taking animals from the wild.
19. A description of the manner in which the animal will be captured, type of gear used, and deployment method (e.g.,
from shore or boat approach and net deployment).
20. Methods of restraint and holding, including dimensions/type of holding container, if used.
21. The holding time required prior to transport or release of the animal.
22. Number and roles of personnel participating in the captures.
23. Duration of restraint/holding from capture to release.
24. The number of non-target individual animals of the target species that will be incidentally harassed during capture
activities, and precautions you will take to minimize incidental harassment of non-target animals.
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FWS Form 3-200-43b (Rev. 02/2023)
U.S. Department of the Interior

25. If capturing females with calves/pups/cubs, describe:
a. How calves/pup/cubs will be held.
b. Describe the procedures which will be conducted on them.
c. The duration of time the pair will be separated.
d. Procedures used to reunite the pair, and if they do not reunite, explain the disposition of the calf/pup/cub.
26. A description of the use of drugs during capture, including:
a. Name of each drug/chemical used, its dosage rate (ml/kg), method of administration (IV, IM, SQ, topical and
whether remotely deployed IM), and purpose of the drug.
b. Duration of drug and required holding time.
c. The names of the personnel who would administer the drugs.
d. Provisions to minimize adverse reaction(s), including the use of appropriate drug reversals.
e. Procedures to be used to minimize the chance that drugged animals will escape or enter the water prior to
complete immobilization; and
f. Measures to be taken to ensure that the animal is fully recovered prior to release.
g. What emergency procedures would be employed (e.g., drugs, bagging, CPR, etc.) if an animal’s condition
starts deteriorating during capture activities?

Marine Mammals that will be IMPORTED
27. The proposed date of import.
28. The name and address of the foreign exporter, including the country of export.
29. For wild-sourced animal(s), a description of the manner in which it was taken from the wild and a copy of the foreign
collecting/capture authorization(s).
30. The age (approximate or known) of the animal at the time of removal from wild or from its mother.
31. The age (approximate or known) of the animal at time of weaning; and
32. For females:
•

At the time of removal from the wild, was the female pregnant?

☐ No ☐ Yes

• At the time of the proposed import, will the female be pregnant? ☐ No ☐ Yes
A description of the means and duration of the transportation used to move and import the animals.
A description of the type, size, and construction of all shipping containers used to transport the animals.
A description of the arrangements for watering or otherwise caring for the animals during transport.
A description of the qualifications of each person accompanying the animal that demonstrates their ability to address
the animal’s needs during transport.
37. A copy of the transport plan.
38. Quarantine plans, including location and timeframe.
39. Any additional documentation showing compliance with U.S. Department of Agriculture (USDA) regulations for
transport and care of live marine mammals (7 U.S.C. 2131-2159; 9 CFR 3, Part E).
NOTE: A separate CITES permit will be required from the U.S. Division of Management Authority prior to the import of live
CITES Appendix I species.
33.
34.
35.
36.

Attachment checklist:
 Table of information for each species for which you are applying
 Facility information
 Breeder’s statement, ARKS/ZIMS specimen report, or other information that documents the animal was born in
captivity
 Copy of any other applicable Federal, local, or state
 Copy of the facility’s USDA/APHIS, Animal Welfare Act (AWA) license and the most recent APHIS inspection
report.
 Copy of appropriate MMPA permits or LOAs
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FWS Form 3-200-43b (Rev. 02/2023)
U.S. Department of the Interior

Qualifications
Instructions: Please fill out the table below and enclose it in your application package. A separate form must
be completed for each person requesting to be listed as a principal investigator or co-investigator. Please only
add one (1) qualification form per individual.
Persons authorized as the Principal Investigator 1 (PI) and Co-Investigators 2 (CI) must demonstrate
qualifications commensurate with their duties. If sufficient experience is not provided, personnel may not be
authorized to conduct the proposed activities.
NOTE: All documentation submitted will be publicly available. DO NOT include personal information (e.g.,
social security number, date of birth, home phone).
Check one:

☐ Principal Investigator

Relevant Education

Degree/Certifications

Relevant Experience
Permit
Activity
requesting
to be a
PI/CI for

Job Title

☐ Co-Investigator

Major/Field of Study

Job work experience
related to the permit
activity

Institution and Location

Affiliation

Location
(City, State,
Country)

Dates
(Year/Month/
Day)

Year Received

Current Level of
Experience1

1Select

the level of experience:
Level 1: I have received education/training in performing this procedure but have not successfully performed the
procedure.
Level 2: I have performed this procedure while under supervision or training of an expert (e.g., PI, CI, or
veterinarian).
Level 3: I have performed this procedure without supervision by a PI/CI.
Level 4: I am considered an expert in performing this procedure, and I have supervised or trained others in performing
this procedure.

1

The individual primarily responsible for the take, import, export, and any related activities conducted under a permit/authorization. There can only be
one PI on a permit/authorization.
2 Individuals who are qualified and authorized to conduct or directly supervise activities conducted under a permit/authorization without the on-site
supervision of the PI.

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Note that phrases such as “assisted with,” or “participated in,” which qualify only as Level 1 experience and will not
adequately demonstrate your experience performing the procedure if you have Level 2 experience or above.

Relevant Training, Certificates, or Licenses
Include additional information to support your qualifications including specialized training (e.g., intrusive tagging, biopsy
sampling, Unmanned Aircraft Systems) and certificates or licenses (e.g., diver certification, Federal Aviation
Administration certification) received relevant to the activities identified in the table directly above. For training,
include description of training, year(s) received, and institution or expert who trained you. For certificates or licenses,
include year received and expiration date. For UAS pilots, include your total flight hours and FAA certification.

Relevant Peer-reviewed Publication History
List your relevant publication history to support your qualifications. This list need not be exhaustive but should
demonstrate that you have published and are reasonably likely to publish in peer-reviewed journals or make results of
permitted research available (2 page maximum).

Relevant Reports and Presentations
List other reports or presentations to support your qualifications as described above (1 page maximum).

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FWS Form 3-200-43b (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:
Paper-based: 2 hours for individuals and 10 hours for private sector and government
Electronic: 1.75 hours for individuals and 9.75 hours for private sector and government
These estimates include time for reviewing instructions, gathering and maintaining data and completing and
reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the Service
Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB
(JAO/3W), Falls Church, VA 22041-3803, or via email at Info_Coll@fws.gov. Please do not send your completed form to
this address.
Questions regarding permits from Management Authority should be sent to managementauthority@fws.gov.

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