Form 3-200-43c Application - Take/Import/Export of Marine Mammals for E

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

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

TAKE/IMPORT/EXPORT OF MARINE MAMMALS FOR
ENHANCEMENT OF SURVIVAL OR RECOVERY (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 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 3-200-43c (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.

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

INDIVIDUAL APPLICANTS
*First Name

Middle Name

*Last Name

*Email Address

Telephone Number

*Street Address

*City

*State/Province

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, please enclose a self-addressed, pre-paid, computer-generated, courier service
airway bill. If unspecified, all documents will be mailed via the U.S. Postal Service.

Have you or your client (if a broker applying on behalf of your client), been assessed a
civil penalty or convicted of any criminal provision of any statute or regulation relating
to the activity for which the application is filed; been convicted, or entered a plea of
guilty or nolo contendere, for a felony violation of the Lacey Act, the Migratory Bird
Treaty Act, or the Bald and Golden Eagle Protection Act; forfeited collateral; OR are
currently under charges for any violation of the laws mentioned above?
☐ No ☐ Yes
If you answered “Yes”, provide: a) the individual’s name; b) date of charge; c) charge(s);
d) location of incident; e) court and f) action taken for each violation. Please be aware
that a “Yes” response does not automatically disqualify you from getting a permit.

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

Certification Statement
Certification: I hereby certify that I have read and am familiar with the regulations
contained in Title 50, Part 13 of the Code of Federal Regulations and the other applicable
parts in subchapter B of Chapter I of Title 50, and I certify that the information submitted in
this application for a permit is complete and accurate to the best of my knowledge and
belief. I understand that any false statement herein may subject me to the criminal
penalties of 18 U.S.C. 1001.

Signature and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
Federal, Tribal, State, and local government agencies, and those acting on behalf of such
agencies, are exempt from the processing fee – attach documentation of fee exempt
status as outlined in instructions. (50 CFR 13.11(d))
*Required fields. Applications without this information are subject to delays or returns.

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

BUSINESS APPLICANTS
*Business Name

doing business as (dba)

*Indicate your business type:
__ Business or other for profit
__ Farm

__ Small business

__ Government (Federal/State/Local/Tribal)

__ Not-for-profit institution

Name that will appear on the permit if you are applying on behalf of an individual/business

*Primary Contact Name

*Primary Contact Email Address

*Business Email Address

*Preferred Contact Method (e.g. phone, email)

*Principal Officer Name

*Principal Officer Title

*Principal Officer Email

Tax ID Number

*Business Phone

Alternate Phone

*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, please enclose a self-addressed, pre-paid, computer-generated, courier service
airway bill. If unspecified, all documents will be mailed via the U.S. Postal Service.

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

FWS Form 3-200-43c (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 3-200-43c (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 Enhancement of Survival or Recovery (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 take/import/export for enhancement of survival or recovery of marine
mammals or their stock, under the jurisdiction of the FWS (sea otters, marine otter, polar bears, walrus,
manatees, and dugong) for enhancement purposes. 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.
• Scientific research (use Form 3-200-43b), including import/export under the MMPA/ESA for research purposes.
• 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 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).
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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FWS Form 3-200-43c (Rev. 02/2023)
U.S. Department of the Interior

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

This application is for (choose all that apply):

☐ A new permit
☐ Renewal of permit # ____________________________
☐ Amendment of permit # __________________________
If requesting renewal and/or amendment of your current permit, provide an update of any activity that has
occurred under the permit since your last report.
1. List the scientific name (genus, species, and, if applicable, subspecies) and common name of each species for which
you are applying.
2. Provide a copy of any other applicable Federal, local, or state permissions (e.g.: National Wildlife Refuge Special Use
permit, NOAA National Marine Sanctuary permit) required to conduct your proposed work, OR indicate whether you
have applied for, secured, or will apply for such permissions (please provide contact information).
3. Is/are the species or population stock(s) for which you are applying listed under the ESA, a species proposed for
listing, or a candidate species?

☐ No
☐ Yes, complete a-d below:

a. Attach a justification for taking an ESA-listed species and explain why your proposed activities are not
appropriate for a similar non-ESA-listed species.
b. Describe both the short-and long-term anticipated effects of each of your activities alone or cumulatively on
the behavior and physiology of the target animals and critical habitat or proposed critical habitat for the
species.
c. Describe how the animals will react to your actions and the consequences of those reactions.
d. Identify how you would mitigate any potential negative effects.
4. Do you plan to conduct activities with marine mammals in their natural environment (i.e., in the wild) where “nontarget” marine mammals and ESA-listed species occur in the United States? (“Non-target” species are species that
are not the subject of your activities.)

☐ No
☐ Yes, answer a-c below so we can assess the impacts to marine mammals and ESA-listed species that are not

subject to your activities:
a. A list of all non-target marine mammals and ESA-listed species that might occur in your project are or might
be affected by your activities;
b. 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, and
c. 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) by your activities, your precautions to
minimize the likelihood that take will occur, and your actions should take occur.
NOTE: The following link provide access to resources that might be useful for gathering the required information to
answer this question, including links to FWS and NMFS offices responsible for managing marine mammal stocks, and
Stock Assessment Reports, which provide population status information on marine mammal stocks.

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

5. Do you plan to conduct your MMPA enhancement activities with marine mammals that are currently held in a
captive environment (including, but not limited to import into the U.S. of captive-held live animals/specimens)?

☐ No
☐ Yes, specify the number of captive individuals for each species of interest: _________ and for each individual

animal of each species of interest, respond to a-j below: You may provide the information in tabular form as illustrated
below:

a. Species

b. Sex

C. Birth
Date

d. Description (e.g., ID #,
ISIS #, Transponder #,
Tattoo #)

e. Country
of Origin

f. Source
(e.g., Wild,
captiveborn,
captiveheld)

Ex: Enhydra lutris
kenyoni

F

~04/09/
2010

House # xxx123
Transponder # 45678
“Sandy”

USA

Wild

g. Facility
that is
proposing
to import or
transfer the
animal to a
captive
facility

Sea Life
Center of
Boston

h. Current or
proposed facility
that would
captive-hold the
marine mammal

ABC
Aquarium,
Anchorage,
AK

For captive-born or captive-bred animal(s), provide the 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).
j. For captive-held animal(s) already taken from the wild, provide:
i. Information (e.g., ARKSA/ZIMS specimen report(s)) on the source of the animal, including when the animal was
removed from the wild, by whom, and the location.
ii. 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.
iii. A copy of the FWS’s letter confirming the non-releasable status of the animal. If you are requesting to have the
animal deemed non-releasable at this time, provide an explanation of the following:
a. Why release of the animal to the wild will not likely be successful given its physical condition;
b. 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
c. Why release of the animal to the wild may jeopardize the wild population of the species.
6. For animal(s) to be taken from the wild and brought into a captive environment for MMPA enhancement
activities, provide for each species:
a. Information on the actual or proposed date(s) and location(s) of collection;
b. The numbers of animals of each age class and sex to be taken from the wild (include a definition of each age
class by range of months and/or years).
c. 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:
i.

• 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
d. A description of the efforts made to acquire captive-held animals in lieu of taking animals from the wild. For
holding and maintaining animals you must also provide the information requested in question 11.

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

OMB Control No. 1018-0093
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7. Are you requesting to capture live marine mammals in the wild for MMPA enhancement?

☐ No
☐ Yes, specify the number of individuals to be captured for each species of interest: ____________ and provide

responses to a-i below:
a. Describe the manner in which the animal will be captured, type of gear used, and deployment method (e.g., from
shore, boat approach, net deployment). Also describe how the manner of capture includes methods that would
cause the least amount of pain/suffering to the animal(s);
b. Methods of restraint and holding, including dimensions/type of holding container, if used;
c. The holding time required prior to transport or release of the animal;
d. Number and roles of personnel participating in the capture(s);
e. Duration of restraint/holding from capture to release;
f. 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.
g. If capturing females with calves/pup/cubs, describe:
i. How calves/pup/cubs will be held;
ii. Which procedures will be conducted on them;
iii. The duration of time the pair will be separated, and
iv. Procedures used to reunite the pair, and if they do not reunite, explain the disposition of the calf/pup/cub.
h. A description of the use of drugs during capture, including:
i. 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;
ii. Duration of drug and required holding time;
iii. The names of the personnel who would administer the drugs;
iv. Provisions to minimize adverse reaction(s), including the use of appropriate drug reversals;
v. Procedures to be used to minimize the chance that drugged animals will escape or enter the water prior to
complete immobilization; and
vi. Measures to be taken to ensure that the animal is fully recovered prior to release.
i. What emergency procedures would be employed (e.g., drugs, bagging, CPR) in the event that an animal’s
condition starts deteriorating during capture activities?
8. Are you requesting to import live marine mammals (for enhancement purposes)?

☐ No
☐ Yes, specify the number of individuals to be captured for each species of interest: ____________ and provide
responses to a-m below:
a. The proposed date of import;
b. The name and address of the foreign sender, including the country of export;
c. 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);
d. The age (approximate or known) of the animal at the time of removal from the wild or from its mother;
e. The age (approximate or known) of the animal at the time of weaning;
f. For females:

☐ No ☐ Yes
• At the time of the proposed import, will the female be pregnant? ☐ No ☐ Yes

• At the time of removal from the wild, was the female pregnant?
g.
h.
i.
j.

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;
k. A copy of the transport plan;
l. Quarantine plans, including location and timeframe; and
m. Any additional documentation showing compliance with 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 our office prior to the import CITES Appendix I specimens.
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FWS Form 3-200-43c (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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9. Are you requesting to import parts/specimens of/from marine mammals?

☐ No
☐ Yes, provide responses to a-m below:
a.
b.
c.
d.
e.

The proposed date of import;
The name and address of the foreign sender, including the country of export;
The current location of the specimens;
The country of origin of the animals from which specimens were/will be collected;
List the number of animals by species, age class/life stage, and sex from which parts/specimens are sought. If
you are requesting opportunistic sample import, you may request an unlimited number of samples from a
specified number of animals, by taxa (e.g., unlimited samples from up to 100 polar bears annually);
f. The types of specimens to be imported (e.g., blood, skin biopsy, carcasses) and number of each type from each
animal;
g. The source of the specimens to be imported (wild, captive-bred, or captive born);

h. At the time of sample collection, will the animals be ☐ alive or ☐ dead?
i. Provide a detailed description of the source of the specimens to be imported and the manner in which the sample
was/will be taken or collected. For example, this might include the following sources:
i. Animals in captivity (samples taken during routine husbandry procedures or under separate authorization;
distinguish between permanently captive in public display or research facility and temporarily captive in
rehabilitation facility);
ii. Animals in foreign countries stranded alive or dead or that died during rehabilitation;
iii. Animals killed during legal subsistence harvests;
iv. Animals killed incidental to legal commercial fishing operations;
v. Samples from other authorized researchers or collections;
vi. Soft or hard parts that are sloughed, excreted, or discharged naturally.
j. Provide a copy of the foreign collecting/capture authorization(s) (if not required, indicate “not required”);
k. If importing samples from subsistence-hunted marine mammals in foreign countries, describe the subsistence
method. Include documentation, if available, that verifies that the takin was/will be conducted in a humane
manner (i.e., using the method that involves the least possible degree of pain and suffering;
l. If importing samples from live animals, describe how the samples were/will be collected, including animal
handling and sample collection protocols. This should include a description of how the take was humane; and
m. Describe how the specimens will be preserved, shipped, and stored/curated.
NOTE: A separate CITES permit will be required from our office prior to the import CITES Appendix I specimens.
10. Are you requesting to export or re-export parts/specimens of/from marine mammals?

☐ No
☐ Yes, provide responses to a-e below:
a.
b.
c.
d.
e.

The types of specimens and quantity of each to be exported/re-exported;
The complete name and address of person/facility receiving the specimen(s);
A description of the origin of the specimens to be exported/re-exported;
The name(s) of the facility/institution that currently holds the specimens; and
Whether a portion of the specimen will need to be re-imported following export/re-export.

NOTE: A separate CITES permit will be required from our office prior to the export/re-export of specimens of all CITES
listed species.

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

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

11. Are you a facility requesting maintenance of live animals (i.e., holding and caring for animals) for MMPA
enhancement activities?

☐ No
☐ Yes, specify the number of individuals to be held for each species of interest: _________________; provide
responses to a-h below:

a. 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);
b. 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/APHIS limits (i.e.,
provide the maximum # of animals of each species that could be held).
c. A list of all animal caretakers and a description of their specific duties/responsibilities;
d. 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);
e. A description of specific State requirements regarding who (e.g., attending veterinarians, vet technicians,
researchers) may handle and administer certain drugs;
f. 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 that would be held and maintained);
g. 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;
h. A copy of the facility’s USDA/APHIS Animals Welfare Act (AWA) license and the most recent APHIS inspection
report.
12. If you are a facility requesting maintenance of live animals for which the primary purpose is enhancement of the
survival or recovery of the species, are you seeking approval to publicly display the subject animals?

☐ No
☐ Yes, provide responses to a-c below:

a. The facility is open to the general public without limitations or restrictions (other than by the charging of an
admission fee);
b. The facility offers a program for education or conservation purposes that is based on professionally recognized
standards of the public display community; and
c. Such display will not interfere with attainment of the objective of the permitted/authorized activity.
This section of the application is for MMPA enhancement of survival or recovery of a species or stock.
NOTE: Questions 13 & 14 should be completed ONLY if you are specifically requesting MMPA enhancement activities.
This section is not intended for those parties requesting to conduct rescue, rehabilitation, and release activities for marine
mammals.
13. Provide information to show that your proposed activities are likely to contribute significantly to maintaining or
increasing the distribution or population numbers necessary to ensure the survival or recovery of the species or stock
in the wild.
14. Provide information to show that your proposed activities are consistent with any conservation or recovery plan for the
species or stock. If no plans are available, provide information that the activity is consistent with the actions required
to enhance the survival or recovery of the species or stock which would be addressed in a conservation or recovery
plan. For activities that involve captive maintenance of live animals:
a. Provide an explanation on the benefit of removing animals from the wild into captivity;
b. Include a description of the plans in place for returning animals and any offspring to the wild;
c. Provide the information requested in question 11.

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

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

For each activity being requested throughout the application, submit the enclosed qualification form and ensure
that the form details the qualifications of each principal investigator and/or co-investigator for each activity.

Qualifications
Instructions: Please fill out the 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.
NOTE: 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.

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

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

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

FWS Form 3-200-43c (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 9.75 hours (electronically) to 10 hours (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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