Embarking on the journey of obtaining a Federal Fish and Wildlife Permit, particularly the 3-200-41 form, under the U.S. Fish and Wildlife Service encapsulates a critical process for individuals and entities aiming to engage in activities involving captive-bred wildlife. Situated under the Department of the Interior, this form serves as a gateway for compliance with the U.S. Endangered Species Act, ensuring that the involved parties adhere to the regulations safeguarding threatened and endangered species. Structured to be completed by either individuals or businesses, the form requires an array of detailed information ranging from personal identification or corporation details to specifics about the wildlife intended to be bred and the facilities to be used. Moreover, applicants must reveal any previous permits held, further indicating a history of engagement with wildlife activities which could influence the current application's outcome. The necessity of enclosing a processing fee, unless exempted, coupled with the rigorous certification and attestation to the accuracy of the provided information, underscores the seriousness and commitment required from applicants. This form not only enables regulatory oversight but also facilitates a controlled environment where captive breeding under professional and ethical standards can contribute to conservation efforts. Including sections that necessitate a comprehensive understanding of one's capacity, such as detailing breeding plans and demonstrating facility adequacy, the 3-200-41 form strikes a balance between regulatory compliance and the noble goal of species preservation and recovery.
| Question | Answer |
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| Form Name | Form 3 200 41 |
| Form Length | 7 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 45 sec |
| Other names | CBP captive bred wildlife registration form |
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Department of the Interior |
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U.S. Fish and Wildlife Service |
Federal Fish and Wildlife Permit Application Form |
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Return to: Division of Management Authority (DMA) |
Type of Activity: |
U.S. Fish and Wildlife Service |
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4401 N. Fairfax Drive, Room 700 |
(U.S. Endangered Species Act) |
Arlington, VA 22203 |
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Expires June 30, 2007 OMB No.
Complete sections A OR B, and C and D of this application. Note: if a field is "gray," no answer is required. Application will not be considered
complete without all sections. See additional instructions on attached pages.
A. |
Complete if applying as an individual (Provide a U.S. address) |
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1.a. Last name |
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1.b. First name |
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1.c. Middle name or initial |
1.d. Suffix |
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2.a. Street address (line 1) |
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2.b. Street address (line 2) |
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2.c. Street address (line 3) |
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3.a. City |
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3.b. Province |
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3.c. State |
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3.d. Zip code/Postal code: |
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3.e. Country |
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4. Date of birth (mm/dd/yyyy) |
5. Social Security No. |
6. Occupation |
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7.a. Home telephone number |
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7.b. Work telephone number |
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7.c. Fax number |
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9. County |
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10. List any business, agency, organizational, or institutional affiliation associated with the wildlife |
11. Doing business as (dba) |
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or plants to be covered by this permit (see C.1.) |
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B. |
Complete if applying as a business, corporation, public agency or institution |
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1.a. Name of business, agency, or institution
1.b. Doing business as (dba)
2.a. Street address (line 1)
2.b. Street address (line 2)
2.c. Street address (line 3)
3.a. City
3.b. Province
3.c. State
3.d. Zip code
3.e. Country
4. Tax identification no.
5. Describe the type of business, agency, or institution and provide state of incorporation
6.a. Principal officer (President, director, etc) Last name
6.b. First name
6.c. Middle name or initial
6.d. Suffix
7. Principal officer title:
8. Home telephone number
9. Work telephone number
10. Fax number
11.
12. County
C. |
All applicants complete |
1.Do you currently have or have you had any Federal Fish and Wildlife permits? (For simplification, all licenses, permits, registrations, and certificates will be referred to as a permit.)
Yes |
If yes, list the number of the most current permit you have held: ___________________________________ |
No |
2.Have you obtained all required State, Federal, or foreign government approval(s) to conduct the activity you propose?
Yes If yes, provide a copy of the approval(s). |
Have applied |
Not required |
3.Enclose check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount of $25 [50 CFR 13.11(d)(4)]. Institutions which qualify under 50 CFR 13.11(d)(3) may be exempt from the application processing fee.
4.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.
5.Signature (in blue ink) of applicant/person responsible for permit in Section A or B. (Photocopied signatures are not accepted.)
6. Date (mm/dd/yyyy):
Rev 6/2004 |
Please continue to Section D on next page |
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D.
Please provide the following information on separate sheet(s) of paper: On all attachments or separate sheets you are submitting, please indicate the application question number you are addressing.
1.The scientific name (genus, species and if applicable, subspecies) and common name of each species you are seeking to have covered by the registration.
2.The exact location (address) where the wildlife requested in this application will be maintained. If more than one location exists, list all that apply. Note: You must report any change in address to the Division of Management Authority within 10 days.
3.The name, address, and CBW registration number of the person(s) or institution(s) from whom you plan to acquire the wildlife.
4.Provide a specific description of how your proposed activities are going to facilitate captive breeding of the species you identified in your response to question one, above, including your
a.Provide documentation showing how your captive population is being managed to maintain its genetic vitality. If you are participating in an organized breeding program or contributing data to a studbook, please indicate this and provide documentation describing the objectives and goals of the program.
b.If your activities include the holding of surplus wildlife for an organized management program, document how your acquisition of such wildlife will relieve crowding at the locations from which the wildlife will be obtained, and thereby assist the breeding program for the species involved. If applicable, provide documentation that you are a participant in a Species Survival Plan, contributing data to a studbook or participating in an organized breeding program for the species where the holding of surplus wildlife has been identified as a necessary objective of the breeding program.
5.For each requested species, provide a description of your experience in maintaining and propagating the requested species or similar species, including:
a.The number of years you or the facility has/have maintained the requested species or similar species.
b.Resume for all animal care staff (keepers and vets) of each species requested.
c.During the past five years, how many (by species, by year) successful births/hatches of each requested species or similar species have occurred at your facility? How many survived beyond 30 days?
d.How many mortalities of requested species or similar species, have occurred at your facility during the past five years? What were the causes? What measures have you taken to prevent future mortalities?
6.Provide an inventory of all species listed on the U.S. Endangered Species Act you currently possess including those out on loan.
7.If you conduct research directly related to maintaining and propagating the types of wildlife sought to be covered, provide a complete description of your research goals and methods as well as any related published papers you have written.
8.A detailed description (including size, construction materials, protection from the elements, etc.) and photographs or detailed diagrams (no blueprints) clearly depicting your existing facilities where the wildlife will be maintained.
9.Provide a copy of your license or registration, if any, under the Animal Welfare Act regulations of the U.S. Department of Agriculture (9 CFR 2) and/or any State license or registration you may have.
10.Address where you wish permit mailed (if different than page 1):
_________________________________________________________________________.
Rev. 6/2004 |
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11.If you wish the permit to be mailed other than by regular mail, provide air bill,
________________________________________________________________________________.
12.Who should we contact if we have questions about the application? (Include name, phone number, and email): ____________________________________________________________________________.
The Division of Management Authority annually distributes a list of
If you are not a business or organizational entity, and are applying for the CBW registration as an individual, please indicate which of the following you prefer:
_____ YES, the Service should include my complete address in its CBW registration list.
If your mailing address is different than the address of your facility, please indicate which address you would like included on the registration list:
____Please use my mailing address. ____Please use my facility address.
_____ NO, the Service should not include my complete address in its CBW registration list.
For information not included on the list (address), the Service will only release such information as provided in the Privacy Act, or under the Freedom of Information Act upon a determination that the release would be in the public interest.
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PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to the standard permit form
•Complete all appropriate blocks/lines/questions in Sections A OR B, and C and D. Print clearly or type in the information. An incomplete application may cause delays in processing or may be returned to the applicant. Note: if a field is "grayed in", no answer is required.
•Sign the application in blue ink and send the original to the address at the top of the application. Faxes or copies of the original signature will not be accepted.
•Please plan ahead. Allow at least 60 days for your application to be processed (50 CFR 13.11). However, some applications may take longer than 90 days to process. Applications are processed in the order they are received.
•Additional forms and instructions are available from http://permits.fws.gov/ .
Most of the application form is
COMPLETE EITHER SECTION A OR SECTION B:
Section A. "Complete if applying as an individual" - Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal information that identifies the applicant. All blocks must be completed. If you are applying on behalf of a client, the personal information must pertain to the client; and a document evidencing power of attorney must be included with the application.
Section B. "Complete if applying as a business, corporation, public agency, or institution" - Enter the complete name and address of the business, agency or institution that will be the permittee if a permit is issued. Give a brief description of the type of business the applicant is engaged in, the name and phone number of the person in charge (i.e., principal officer), and if the company is incorporated, the State in which it is incorporated.
ALL APPLICANTS COMPLETE SECTION C:
Section C.1 "Do you currently have or have you had any Federal Fish and Wildlife permits? List the number(s) of your most current FWS or CITES permit or the number of the most recent permit if none are currently valid. If applying for a renewal of a CITES permit, the original permit must be returned with this application.
Section C.2 "Have you obtained all required State, Federal or foreign government approval to conduct the activity you propose?" (Please be aware that there may be other requirements necessary to conduct this activity such as a hunting license, import permit, or collection permit.) If "yes," list the state, Federal or foreign countries involved and type of document required. Include a copy of these documents with the application. If you have applied for the documents, check the “have applied” box and list the state, Federal or foreign countries involved and type of documents required. If the proposed activity is not regulated check "not required."
Section C.3 "Check or money order (if applicable)" There is an application processing fee unless you are applying as a Federal, State or tribal government agency or you are an individual or institution under contract to such agency for the proposed activities. (See 50 CFR 13.11(d)(3) for fee schedule.) Proof of status as a Federal, State or tribal government agency or contractor to such agency should accompany your application. 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. It will not be refunded regardless of whether a permit is issued, abandoned, or denied. See the accompanying section APPLICATION PROCESSING FEE for the fee to process this application. Make your check or money order payable to the “U.S. Fish and Wildlife Service” and attach it to the application form.
Section C.4 "CERTIFICATION" The individual identified in Section A, the principal officer named in Section B, or person with a valid power of attorney (documentation must be included in the application) must sign and date the application in blue ink. This signature binds the applicant to the statement of certification. This means that you certify that you have read and understand the regulations that apply to the permit. You also certify that everything included in the application is true to the best of your knowledge. Be sure to read the statement and
ALL APPLICANTS COMPLETE SECTION D:
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Provide any required additional information outlined in Section D. of the application form. Be as complete and descriptive as possible. If there is any doubt as to the information's relevance, include it with the application. Please do not send videotapes or DVDs.
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APPLICATION FOR A FEDERAL FISH AND WILDLIFE PERMIT
Paperwork Reduction Act and the Privacy Act – Notices
In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and the Privacy Act of 1974 (5 U.S.C. 552a), please be advised that:
1.The gathering of information on fish and wildlife is authorized by:
a.Bald and Golden Eagle Protection Act (16 U.S.C. 668), Title 50 Part 22 of the Code of Federal Regulations (CFR);
b.Endangered Species Act of 1973 (16 U.S.C.
c.Migratory Bird Treaty Act (16 U.S.C.
d.Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), Title 50 CFR Part 18;
e.Wild Bird Conservation Act (16 U.S.C.
f.Lacey Act (18 U.S.C. 42); Injurious Wildlife, Title 50 CFR Part 16;
g.Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249); Title 50 CFR Part 23.
h.General Provisions, Title 50 CFR Part 10;
i.General Permit Procedures, Title 50 CFR Part 13; and
j.Wildlife (Import/export/transport), Title 50 CFR Part 14.
2.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 above laws. Failure to provide all requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. Response is not required unless a currently valid Office of Management and Budget (OMB) control number is displayed.
3.Certain applications for permits authorized under the Endangered Species Act of 1973 (16 U.S.C. 1539) and the Marine Mammal Protection Act of 1972 (16 U.S.C. 1374) will be published in the Federal Register as required by the two laws.
4.Routine use disclosures outside the Department of the Interior may be made without the consent of an individual if the disclosure is compatible with the purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003) Disclosures outside the DOI may be made under the routine uses listed below without the consent of the individual if the disclosure is compatible with the purposes for which the record was collected.
a.To subject matter experts, and State, Federal, local, and foreign agencies, for the purpose of obtaining advice relevant to making a decision on an application for a permit or when necessary to accomplish a FWS function related to this system of records.
b.To the public as a result of publishing Federal Register notices announcing the receipt of permit applications for public comment or notice of the decision on a permit application.
c.To Federal, State, local, or foreign wildlife and plant agencies for the exchange of information on permits granted or denied to assure compliance with all applicable permitting requirements.
d.To
e.To Federal, State, and local authorities who need to know who is permitted to receive and rehabilitate sick, orphaned, and injured birds under the Migratory Bird Treaty Act and the Bald and Golden Eagle Protection Act; federally permitted rehabilitators; individuals seeking a permitted rehabilitator with whom to place a sick, injured, or orphaned bird in need of care; and licensed veterinarians who receive, treat, or diagnose sick, orphaned, and injured birds.
f.To the Department of Justice (DOJ), or a court, adjudicative, or other administrative body or to a party in litigation before a court or adjudicative or administrative body, under certain circumstances;
g.To the appropriate Federal, State, tribal, local, or foreign governmental agency responsible for investigating, prosecuting, enforcing, or implementing statutes, rules, or licenses, when we become aware of a violation or potential violation of such statutes, rules, or licenses, or when we need to monitor activities associated with a permit or regulated use.
h.To a congressional office in response to an inquiry to the office by the individual to whom the record pertains.
i.To the General Accounting Office or Congress when the information is required for the evaluation of the permit programs.
j.To provide addresses obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a debtor to collect or compromise a Federal claim against the debtor, or to consumer reporting agencies to prepare a commercial credit report for use by the FWS.
5.For individuals, personal information such as home address and telephone number, financial data, and personal identifiers (social security number, birth date, etc.) will be removed prior to any release of the application.
6.The public reporting burden on the applicant for this information collection varies depending on the activity for which a permit is requested. The relevant burden for this permit application is 120 minutes. This burden estimate includes time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, Mail Stop 222, Arlington Square, U.S. Department of the Interior, 1849 C Street, NW, Washington D.C. 20240.
Freedom of Information Act – Notice
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request that you identify any information that should be considered privileged and confidential business information to allow the Service to meet its responsibilities under FOIA. Confidential business information must be clearly marked "Business Confidential" at the top of the letter or page and each succeeding page and must be accompanied by a
Application Processing Fee
The fee to process this application is $25. Checks should be made payable to "U.S. Fish and Wildlife Service." Fees for renewals and amendments may vary; see fee schedule at 50 CFR 13.11(d)(4)]. The processing fee will not be refunded regardless of whether a permit is issued, abandoned, or denied. The fee
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schedule does not apply to any Federal, State, or tribal government agency or individual or institution under contract to such agency for the proposed activities.
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