FWS Form 3-200-51 Federal Fish and Wildlife Permit Application Form - Approval of a Foreign Breeding Facility Under the Wild Bird Conservation Act (Wbca)

FWS Form 3-200-51 or the "Federal Fish And Wildlife Permit Application Form - Approval Of A Foreign Breeding Facility Under The Wild Bird Conservation Act (wbca)" is a form issued by the U.S. Department of the Interior - Fish and Wildlife Service.

Download a PDF version of the FWS Form 3-200-51 down below or find it on the U.S. Department of the Interior - Fish and Wildlife Service Forms website.

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Form 3-200-51
OMB Control No. 1018-0093
Expires 08/31/2020
Department of Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form
U.S. Fish and Wildlife Service
Type of Activity
Division of Management Authority
APPROVAL OF A FOREIGN BREEDING FACILITY under the
Branch of Permits, MS: IA
5275 Leesburg Pike
Wild Bird Conservation Act (WBCA)
Falls Church, VA 22041-3803
1-800-358-2104 or 703-358-2104
Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.
Instructions on how to make your application complete and help avoid unnecessary delays are attached.
Section A: Complete if applying as an individual
1.a. Last Name
1.b. First Name
1.c. Middle Name/Initial
1.d. Suffix
2. Date of Birth (mm/dd/yyyy)
3. Telephone Number
3.a. Alternate Telephone Number
4. E-mail address
Section B: Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution
1.b. Doing business as (DBA)
2. Tax identification no.
3. Description of business, agency, Tribe, or institution
4.a. Principal officer Last name
4.b. Principal officer First Name
4.c. Principal officer Middle name/initial
4.d. Suffix
5. Principal officer title
6. Primary contact name
7.a. Business telephone number
7.b. Alternate telephone number
7.c. Business fax number
7.d. Business e-mail address
Section C: All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City
1.c. State
1.d. Zip code/Postal code
1.e. County/Province
1.f. Country
2.a. Mailing address (include if different than physical address; include name of contact person if applicable)
2.b. City
2.c. State
2.d. Zip code/Postal code
2.e. County/Province
2.f.Country
Section D: All applicants MUST complete
Attach the nonrefundable application processing fee in the form of a check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the
1.
amount of $250. 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)].
2.
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 of applicant/Principal Officer for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)
Please continue to next page
Rev. 8/2017
Page 1 of 8
Form 3-200-51
OMB Control No. 1018-0093
Expires 08/31/2020
Department of Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form
U.S. Fish and Wildlife Service
Type of Activity
Division of Management Authority
APPROVAL OF A FOREIGN BREEDING FACILITY under the
Branch of Permits, MS: IA
5275 Leesburg Pike
Wild Bird Conservation Act (WBCA)
Falls Church, VA 22041-3803
1-800-358-2104 or 703-358-2104
Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.
Instructions on how to make your application complete and help avoid unnecessary delays are attached.
Section A: Complete if applying as an individual
1.a. Last Name
1.b. First Name
1.c. Middle Name/Initial
1.d. Suffix
2. Date of Birth (mm/dd/yyyy)
3. Telephone Number
3.a. Alternate Telephone Number
4. E-mail address
Section B: Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution
1.b. Doing business as (DBA)
2. Tax identification no.
3. Description of business, agency, Tribe, or institution
4.a. Principal officer Last name
4.b. Principal officer First Name
4.c. Principal officer Middle name/initial
4.d. Suffix
5. Principal officer title
6. Primary contact name
7.a. Business telephone number
7.b. Alternate telephone number
7.c. Business fax number
7.d. Business e-mail address
Section C: All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City
1.c. State
1.d. Zip code/Postal code
1.e. County/Province
1.f. Country
2.a. Mailing address (include if different than physical address; include name of contact person if applicable)
2.b. City
2.c. State
2.d. Zip code/Postal code
2.e. County/Province
2.f.Country
Section D: All applicants MUST complete
Attach the nonrefundable application processing fee in the form of a check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the
1.
amount of $250. 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)].
2.
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 of applicant/Principal Officer for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)
Please continue to next page
Rev. 8/2017
Page 1 of 8
Form 3-200-51
OMB Control No. 1018-0093
Expires 08/31/2020
E.
APPROVAL OF A FOREIGN BREEDING FACILITY UNDER WBCA
This application is to be completed by a non-US breeding facility currently breeding CITES-listed bird species that would
like to export live birds to the United States. All imports of live CITES-listed birds from non-approved facilities must be
accompanied by a U.S. Wild Bird Conservation Act (WBCA) import permit. Breeding facilities that have been approved by
the U.S. Fish and Wildlife Service can export birds into the United States with only the required CITES documents.
Complete all questions on the application. Mark questions that are not applicable with "N/A". Given the length of many of
your responses, please use separate sheets of paper. On all attachments or separate sheets you are submitting, indicate
the number of the application question you are addressing.
Electronic submission of inventories, photographs, and receipts: Some applications contain extensive inventories and /or
a large number of photographs or receipts. You may provide electronic versions of the documents. Such a submission will
assist in expediting the processing of your application since it may reduce data entry by the U.S. Fish and Wildlife Service.
If you wish to provide information electronically, once you have received an application number via the e-mailed
acknowledgment letter, e-mail your information to Permits@fws.gov. Be sure to include the application number provided in
the acknowledgment e-mail that will be sent to you when we receive your application.
_____ I will be submitting documents electronically.
1. Name and address where you wish the permit to be mailed, if different from page 1. If you would like expedited
shipping, please enclose a self-addressed, pre-paid, computer-generated, courier service airway bill. If
unspecified, all documents will be mailed via regular mail through the U.S. Postal Service.
2. Who should we contact if we have questions about the application (name, phone number, and e-mail)?
3. Have you or any of the owners of the business (if applying as a business, corporation, or institution), 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” to Question 3, 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.
BACKGROUND INFORMATION
4. List of bird species being bred at the breeding facility, including the common and scientific names of the species.
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Form 3-200-51
OMB Control No. 1018-0093
Expires 08/31/2020
5. The name and address of the foreign breeding facility.
6. A summary of the legislation implementing the Convention in the country in which the facility is located.
BREEDING FACILITY – Please provide the following:
7. A statement of the facility's capability of producing captive-bred birds of the species identified in question 1 and in
the numbers they anticipate exporting to the United States on an annual basis.
8. Relevant experience of persons involved in the operation of the facility.
9. Current stock of the facility, including total number, ages, sexes, and numbers of breeding pairs.
10. Production levels that have been achieved at the facility, at least for the past two complete calendar years,
including numbers of eggs produced, chicks hatched, and chicks reared to independence.
11. Anticipated future production.
12. A breeding protocol, including a genetic management plan and a description of breeding methods (attach on
separate page(s)). Breeding methods should include whether breeding is continuous or seasonal (including
descriptions of photoperiod manipulations used to stimulate or control breeding, if any) and whether breeding
birds are induced to produce multiple clutches by the removal of eggs for artificial incubation.
Rev. 8/2017
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Form 3-200-51
OMB Control No. 1018-0093
Expires 08/31/2020
13. Descriptions of incubation and rearing methods, as well as any other methods used to enhance production,
including artificial insemination when applicable.
14. A statement describing the facility and demonstrating that it is operated in a humane and healthful manner,
including:
a.
Diagrams and photographs of the facility;
b.
Descriptions of enclosures, including dimensions, construction materials, substrates, availability of water,
lighting, ventilation, the need for supplemental heat or cooling and how these are provided, and shading
(for outdoor enclosures);
c.
Densities of birds in enclosures;
d.
Internal features of enclosures, including perches, nest boxes, and plantings; and
e.
A description of any facility features designed to satisfy unique requirements of the particular species.
15. A description of the care and maintenance practices of the facility, including:
a.
Husbandry practices, feeding regimes (number of feedings per day), and diet;
b.
Hygienic practices, including methods and frequency of cleaning and disinfection of equipment and
facilities;
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Form 3-200-51
OMB Control No. 1018-0093
Expires 08/31/2020
c.
A statement as to the availability of routine professional veterinary care, including annual flock inspection
or examination, and medication/vaccination schedules;
d.
Records of mortality and disease outbreaks for both adults and chicks for at least the past two
years. Episodes of high mortality or disease should be explained, and measures taken to prevent similar
mortality or disease outbreaks in the future should be described; and
e.
Qualifications and experience of the personnel who will be responsible for the care of the exotic birds.
16. A statement that all birds exported or to be exported from the facility are bred at the facility and are marked with
closed leg bands or an electronic marking system.
17. Details on the system of record keeping and tracking of birds and their progeny hatched at the facility, including:
a.
Documentation that the facility maintains records of hatch dates and band numbers of all birds produced
at the facility;
b.
Documentation that the facility maintains records of all birds traded from the facility, including both within
the country in which the facility is located and internationally; and
c.
Copies of these production and trade data shall be included with the application for the past two calendar
years.
ADDITIONAL INFORMATION
18. A statement demonstrating that the facility is operated in a manner that is not detrimental to the survival of the
species in the wild, including:
a.
The number and origin of original breeding stock (founders);
b.
If any parental breeding stock was wild-caught, a statement as to the country of origin, date of acquisition,
Rev. 8/2017
Page 5 of 8

Download FWS Form 3-200-51 Federal Fish and Wildlife Permit Application Form - Approval of a Foreign Breeding Facility Under the Wild Bird Conservation Act (Wbca)

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