Application and VMS certification form

NWHI Monument Permit Application
OMB Control # 0648-0548
Page 1 of 16

Northwestern Hawaiian Islands Marine National Monument
Permit Application
NOTE: This Permit Application (and associated Instructions) are for activities to be
conducted in the Northwestern Hawaiian Islands Marine National Monument, including
Hawaiian Islands National Wildlife Refuge, the Midway Atoll National Wildlife Refuge, Battle
of Midway National Memorial, Northwestern Hawaiian Islands State Marine Refuge, Kure
Atoll Hawaii State Seabird Sanctuary, and the Northwestern Hawaiian Islands Coral Reef
Ecosystem Reserve. The Co-Trustees are required to determine that issuing the requested
permit is compatible with the findings of Presidential Proclamation 8031. Within this
Application, please provide all information that you believe will assist the Co-Trustees in
determining how your proposed activities are compatible with the conservation and
management of the natural, historical and cultural resources of the NWHI Marine National
Monument (Monument).

Summary Information
Applicant name:
Permit categories:
Research – Please fill out Sections A-D (as applicable) and Appendix A
Conservation and Management - Please fill out Sections A-D (as applicable) and Appendix A
Education - Please fill out Sections A-D (as applicable) and Appendix B
Native Hawaiian Practices - Please fill out Sections A-D (as applicable) and Appendix C
Recreation (Midway ONLY) - Please fill out Sections A-D (as applicable) and Appendix D
Special Ocean Use - Please fill out Sections A-D (as applicable) and Appendix E
Briefly describe permit activity:

This application is for a RENEWAL of an existing permitted project.
This application is for a NEW project.
When will the activity take place?
To:____________________
From:
NOTE: INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
Please Send Permit Applications to:
NWHI Marine National Monument Permit Coordinator
6600 Kalaniana'ole Hwy. # 300
Honolulu, HI 96825
[email protected]
PHONE: (808) 397-2660
FAX: (808) 397-2662
NOTE: SUBMITTAL VIA ELECTRONIC MAIL IS PREFERRED BUT NOT
REQUIRED. FOR ADDITIONAL SUBMITTAL INSTRUCTIONS, PLEASE SEE PG 7.

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OMB Control # 0648-0548
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Section A - Applicant Information
1. Applicant
Name (last, first, middle initial):
Title:

2. Mailing address (street/P.O. box, city, state, country, zip):
Phone:
Fax:
Email:
For students, major professor’s name, telephone and email address:

3. Affiliation (institution/agency/organization directly related to the proposed project):

4. Additional persons to be covered by permit:

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OMB Control # 0648-0548
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Section B: Project Information
5a. Project location(s):
Nihoa Island
Necker Island (Mokumanamana)
French Frigate Shoals
Gardner Pinnacles
Maro Reef
Laysan Island
Lisianski Island, Neva Shoal
Pearl and Hermes Atoll
Midway Atoll
Kure Atoll
Other

Land-based
Land-based
Land-based
Land-based

Ocean-based
Ocean-based
Ocean-based
Ocean-based

Land-based
Land-based
Land-based
Land-based
Land-based

Ocean-based
Ocean-based
Ocean-based
Ocean-based
Ocean-based

NOTE: Please note there is a fee schedule for people visiting Midway Atoll National Wildlife
Refuge via vessel and aircraft.
Location Description:

5b. Check all applicable regulated activities proposed to be conducted in the Monument:
Removing, moving, taking, harvesting, possessing, injuring, disturbing, or damaging any
living or nonliving monument resource
Drilling into, dredging, or otherwise altering the submerged lands other than by anchoring a
vessel; or constructing, placing, or abandoning any structure, material, or other matter on the
submerged lands
Anchoring a vessel
Deserting a vessel aground, at anchor, or adrift
Discharging or depositing any material or matter into the monument
Touching coral, living or dead
Possessing fishing gear except when stowed and not available for immediate use during
passage without interruption through the monument
Attracting any living monument resource
Sustenance fishing (Federal waters only, outside of Special Preservation Areas, Ecological
Reserves and Special Management Areas)
Subsistence fishing (State waters only)
Swimming, snorkeling, or closed or open circuit SCUBA diving within any Special
Preservation Area or Midway Atoll Special Management Area

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OMB Control # 0648-0548
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6. Purpose/Need/Scope State purpose of proposed activities:

7. As explained further in the instructions, please provide any information that you believe
will assist the Co-Trustees in determining how your proposed activities are compatible with
the conservation and management of the natural, historical and cultural resources of the
Monument:

8. Procedures:

Section C: Logistics
9. Other permits (list and attach documentation of all other related Federal or State
permits):

9a. For each of the permits listed, please identify any permit violations or any permit that
was suspended, amended, modified or revoked for cause. Please explain the circumstances
surrounding the violation or permit suspension, amendment, modification or revocation.

10. Funding sources (Please attach copies of your budget, specific to proposed activities
under this permit and include funding sources. Please see instructions for more
information):

11. Time frame:
Activity start:
Activity completion:

Dates actively inside the Monument:
From:
To:

Please describe any limiting factors in declaring specific dates of the proposed activity at the
time of application:

Personnel schedule in the Monument:

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OMB Control # 0648-0548
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12. Please indicate (with attached documentation) what insurance policies, bonding
coverage, and/or financial resources are in place to pay for or reimburse the Monument
trustees for the necessary search and rescue, evacuation, and/or removal of any or all
persons covered by the permit from the Monument:

13. Please check the appropriate box to indicate how personnel will enter the Monument:
Vessel
Aircraft
Provide Vessel and Aircraft information:

14. What certifications/inspections do you have scheduled for your vessel? Please fill in
scheduled date (attach documentation):
Rodent free, Date:
Tender vessel, Date:
Ballast water, Date:
Gear/equipment, Date:
Hull inspection, Date:

15. Vessel information (NOTE: if you are traveling aboard a National Oceanic and
Atmospheric Administration vessel, skip this question):
Vessel name:
Vessel owner:
Captain's name:
IMO#:
Vessel ID#:
Flag:
Vessel type:
Call sign:
Embarkation port:
Last port vessel will have been at prior to this embarkation:
Length:
Gross tonnage:
Total ballast water capacity volume (m3):
Total number of ballast water tanks on ship:
Total fuel capacity:
Total number of fuel tanks on ship:
Marine Sanitation Device:
Type :

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OMB Control # 0648-0548
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How will you comply with the 'No Discharge' regulations stipulated in Presidential Proclamation
8031? Describe in detail. If applicable, please attach schematics of the vessel's discharge and
treatment systems:
Other fuel/hazardous materials to be carried on board and amounts:
Please provide proof of a National Oceanic and Atmospheric Administration (NOAA) Office of
Law Enforcement-approved Vessel Monitoring System (VMS). Please provide the name and
contact information of the contractor responsible for installing the VMS system. Please also
describe unit name and type:
VMS Email:
Inmarsat ID#:

16. Tender information:
On what workboats (tenders) will personnel, gear and materials be transported within the
Monument? Please list the number of tenders/skiffs aboard and specific types of motors:

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OMB Control # 0648-0548
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Section D: Additional Information for Land Based Operations
17. Proposed movement of personnel, gear, materials, and, if applicable, samples:

18. Room and board requirements on island:

19. Work space needs:

With knowledge of the penalties for false or incomplete statements, as provided by 18 U.S.C.
1001, and for perjury, as provided by 18 U.S.C. 1621, I hereby certify to the best of my abilities
under penalty of perjury of that the information I have provided on this application form is true
and correct.
_____________________________________________________________________________
Signature
Date

PLEASE SEND ONE SIGNED APPLICATION VIA MAIL TO THE MONUMENT
OFFICE BELOW:
NWHI Marine National Monument Permit Coordinator
6600 Kalaniana'ole Hwy. # 300
Honolulu, HI 96825
FAX: (808) 397-2662

DID YOU INCLUDE THESE?
Applicant CV/Resume/Biography
Electronic and Hard Copy of Application with Signature
Map(s) or GPS point(s) of Project Location(s), if applicable
Funding Proposal(s)
Funding and Award Documentation, if already received
Documentation of Insurance, if already received
Documentation of Inspections
Documentation of all required Federal and State Permits or applications for permits
Statement of information you wish to be kept confidential

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OMB Control # 0648-0548
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Appendix A: Research OR Conservation and Management Application
NOTE: If land or marine archeological activities are involved, please contact the
Monument Permit Coordinator at the address on the general application form before
proceeding, as a customized application will be needed. For more information, please
contact the Monument office on the first page of this application.

1a. Collection of specimens - collecting activities (would apply to any activity): organisms
or objects (List of species, if applicable, attach additional sheets if necessary):
Common name:
Scientific name:
# & size of specimens:
Collection location:
Whole Organism

Partial Organism

1b. What will be done with the specimens after the project has ended?
1c. Will the organisms be kept alive after collection?

Yes

No

• Specific site/location:
• Is it an open or closed system?
• Is there an outfall?

Yes

Open

Closed

No

• Will these organisms be housed with other organisms? If so, what are the other organisms?
• Will organisms be released?
2. If applicable, how will the collected samples or specimens be transported out of the
Monument?
3. Describe collaborative activities to share samples, reduce duplicative sampling, or
duplicative research:
4a. Gear and materials:
4b. Please list all Hazardous Materials you propose to take to and use within the
Monument:

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5. Fixed installations and instrumentation:
6. Provide a time line for sample analysis, data analysis, write-up and publication of
information:
7. List all publications directly related to the proposed project:

DID YOU INCLUDE THESE?
Material Safety Data Sheets for Hazardous Materials

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Appendix B: Education Application
1. Are you collaborating with others in any way to reduce duplicative activities in the
Monument or elsewhere?
2. Gear and materials:
3. Fixed installations and instrumentation:
4. Is your proposed activity based on a State Department of Education Standards Based
Curriculum? If so, please describe:
5. What materials, products or deliverables will be developed as a result of your proposed
activity? Provide a time line for write-up and publication of information or production of
educational materials:
6. List all publications/references directly related to the proposed project:
7a. Collection of specimens - collecting activities (would apply to any activity): organisms
or objects (List of species, if applicable, attach additional sheets if necessary):
Common name:
Scientific name:
# & size of specimens:
Collection location:
Whole Organism

Partial Organism

7b. What will be done with the specimens after the project has ended?
7c. Will the organisms be kept alive after collection?

Yes

No

• Specific site/location:
• Is it an open or closed system?
• Is there an outfall?

Yes

Open

Closed

No

• Will these organisms be housed with other organisms? If so, what are the other organisms?
• Will organisms be released?

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OMB Control # 0648-0548
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8. If applicable, how will the collected samples be transported out of the Monument?

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OMB Control # 0648-0548
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Appendix C: Native Hawaiian Practices Application
1. Please state how the purpose and intent of the activity are appropriate and deemed
necessary by traditional standards in the Native Hawaiian culture (pono), and demonstrate
an understanding of, and background in, the traditional practice, and its associated values
and protocols:
2. Please state how the activity benefits the resources of the Northwestern Hawaiian
Islands and the Native Hawaiian community:
3. Please state how the activity supports or advances the perpetuation of traditional
knowledge and ancestral connections of Native Hawaiians to the Northwestern Hawaiian
Islands:
4. Will you be collecting any Monument resource?
If so, please provide the following information:

Yes

No

4a. Collection of specimens - collecting activities (would apply to any activity): organisms
or objects (List of species, if applicable, attach additional sheets if necessary):
Common name and/or Scientific name:
# & size of specimens:
Collection location:
Whole Organism

Partial Organism

4b. What will be done with the specimens after the Native Hawaiian cultural practice is
complete?
4c. Will organisms be kept alive after collection?

Yes

No

• Specific site/location:
Open

• Is it an open or closed system?
• Is there an outfall?

Yes

Closed

No

• Will these organisms be housed with other organisms? If so, what are the other organisms?
• Will organisms be released?
NOTE: Any Monument resource harvested from the Monument for the purpose of Native
Hawaiian practices will be consumed in the Monument.

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5. Are you collaborating with others in any way to reduce duplicative activities in the
Monument or elsewhere?
6. Gear and materials:
7. Will you erect any Native Hawaiian cultural structures or leave any offerings in the
Monument?
Yes
No
If so, please describe:
8. Will you produce any publications, educational materials or other deliverables?
Yes
No
Provide a time line for write-up and publication of information or production of materials:

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OMB Control # 0648-0548
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Appendix D: Recreation Application
For Activities in the Midway Atoll Special Management Area Only

1. Please explain how the activity is for the purpose of recreation as defined: An activity
conducted for personal enjoyment that does not result in the extraction of Monument
resources and that does not involve a fee-for-service transaction:
2. Other Associated Monument Permits:
3. Gear and materials:
4. Fixed installations and instrumentation:

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Appendix E: Special Ocean Use Application
NOTE: If this is a first time Special Ocean Use activity, it will be subject to a pilot project.
1. Please provide proof of general liability insurance, or indicate that you will be posting
an equivalent bond against claims arising out of activities conducted under the permit:
2. Are you collaborating with others in any way to reduce duplicative activities in the
Monument or elsewhere?
3. Gear and materials:
4. Fixed installations and instrumentation:
5. List all publications directly related to the proposed project:
For projects occurring with the Midway Atoll Special Management Area answer the following
questions:
6. Please explain how your activity has been found compatible with the purposes for which
the Midway Atoll National Wildlife Refuge was designated?
7. Please explain how your activity meets the requirement of furthering conservation and
management of the Monument:
For projects occurring outside of the Midway Atoll Special Management Area answer the
following questions:
8. Please explain how the proposed activity will directly benefit the conservation and
management of the Monument:
9. Please explain how the purpose of the proposed activity is for research and education
related to resources or qualities of the Monument:

NOTE: SPECIAL OCEAN USE PERMITS OUTSIDE THE MIDWAY ATOLL SPECIAL
MANAGEMENT AREA DO NOT ALLOW THE USE OF A COMMERCIAL PASSENGER
VESSEL. A commercial passenger vessel is defined by the monument regulations as a vessel
that carries individuals who have paid for such carriage.

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Northwestern Hawaiian Islands Marine National Monument
Joint Permit Application Instructions
January 2007
Introduction
On June 15, 2006, President Bush established the Northwestern Hawaiian Islands Marine
National Monument by issuing Presidential Proclamation 8031 (71 FR36443, June 26,
2006) under the authority of the Antiquities Act (Act)(16 U.S.C. 431). The Proclamation
reserves all lands and interests in lands owned or controlled by the Government of the
United States in the Northwestern Hawaiian Islands (NWHI), including emergent and
submerged lands and waters, out to a distance of approximately 50 nautical miles (nmi)
from the islands. The outer boundary of the Monument is approximately 950nmi long
(1200 miles) and 100nmi wide extending around coral islands, seamounts, banks, and
shoals. The area includes the Northwestern Hawaiian Islands Coral Reef Ecosystem
Reserve, the Midway Atoll National Wildlife Refuge/Battle of Midway National
Memorial, and the Hawaiian Islands National Wildlife Refuge.
The three principal entities with responsibility for managing lands and waters of the
Monument, the Department of Commerce, Department of Interior, and the State of
Hawaii (collectively the Co-Trustees), are working cooperatively to administer the
Monument. This relationship is further described in the Memorandum of Agreement
among the Co-Trustees signed on December 8, 2006.
Permit Application Deadlines
Permit applications must be postmarked by:
• February 1: For activities occurring between June 1 and Aug 31
• May 1: For activities occurring between September 1 and December 31
• October 1: For activities occurring between January 1 and May 31
Confidential Information
Applicants are requested to indicate any information that is considered proprietary
business information. Such information is typically exempt from disclosure to anyone
requesting information pursuant to the Freedom of Information Act (FOIA) and all
applicable State law. NOAA, the U.S. Fish and Wildlife Service and the State of Hawaii
attempt to protect such proprietary information, consistent with all application FOIA
exemptions in 5 U.S.C. 552(b) and applicable State law. Typically exempt information
includes trade secrets, commercial and financial information (5U.S.C. 552(b) (4)).
Personal information affecting an individual’s privacy will also be kept confidential
consistent with 5 U.S.C. 552(b) (6)) and applicable State law. Unless such information is
so identified, the application may be made available to the public in its entirety.

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Intellectual Property
The permittee retains ownership of any data, derivative analyses or other work product,
or any photographic or video material, or other copyrightable works, but the Federal
Government and the State of Hawaii retain a lifetime, non-exclusive, worldwide, royaltyfree license to use the same for government purposes, including copying and
redissemination, and making derivative works.
Indemnification
The permittee and any person participating in any activity authorized by this permit shall
release, indemnify, and hold harmless National Oceanic and Atmospheric
Administration, the Department of Commerce, the U.S. Fish and Wildlife Service, the
Department of the Interior, the United States Government, the State of Hawaii, and their
respective employees acting within the scope of their duties from and against any claims,
demands, actions, liens, rights, subrogated or contribution interests, debts, liabilities,
judgments, costs, and attorney's fees, arising out of, claimed on account of, or in any
manner predicated upon the issuance of this permit or the entry into or habitation upon
the NWHI Marine National Monument or as the result of any action of the permittee or
persons participating in the activity authorized by this permit.
Reporting Burden
Submittal of the information requested in these guidelines is required to obtain a permit
pursuant to Monument regulations (50 CFR Part 404). This data is to evaluate the
potential benefits of the activity, determine whether the proposed methods will achieve
the proposed results, evaluate any possible detrimental environmental impacts, and
determine if issuance of a permit is appropriate. It is through this evaluation that the Cotrustees are able to use permitting as one of the management tools to protect Monument
resources and qualities.
Public reporting burden for this collection of information, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information is estimated as:
A. Twenty-four (24) hours per response for Special Ocean Use permits;
B. Five (5) hours per response for General (Research, Conservation and
Management, and Education), Native Hawaiian Practices, and Recreation permits;
C. Four (4) hours per response for VMS installation and maintenance;
D. Five (5) minutes per response for entry and exit notices and VMS certification;
E. Five (5) seconds per response for hourly VMS reports.
Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to NWHI Marine National
Monument Permit Coordinator, 6600 Kalaniana'ole Hwy. # 300, Honolulu, HI 96825.

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Notwithstanding any other provision of the law, no person is required to respond to, nor
shall any person be subject to a penalty for failure to comply with, a collection of
information subject to the requirements of the Paperwork Reduction Act, unless that
collection of information displays a currently valid OMB Control Number.

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Northwestern Hawaiian Islands Marine National Monument
Permit Application Instructions
NOTE: This Permit Application (and associated Instructions) are for activities to be
conducted in the Northwestern Hawaiian Islands Marine National Monument,
including Hawaiian Islands National Wildlife Refuge, the Midway Atoll National
Wildlife Refuge, Battle of Midway National Memorial, Northwestern Hawaiian Islands
State Marine Refuge, Kure Atoll Hawaii State Seabird Sanctuary, and the
Northwestern Hawaiian Islands Coral Reef Ecosystem Reserve. The Co-Trustees are
required to determine that issuing the requested permit is compatible with the findings
of Presidential Proclamation 8031. Within this Application, please provide all
information that you believe will assist the Co-Trustees in determining how your
proposed activities are compatible with the conservation and management of the
natural, historical and cultural resources of the NWHI Marine National Monument
(Monument).

Summary Information
Applicant Name: Please enter the name of the person who is in charge of the proposed
activity and who will be responsible for all the personnel and actions under the authority
of the requested Monument Permit.
Permit categories: Please check the category of permit for which you wish to apply.
Below are the permit categories as defined by Presidential Proclamation 8031.
*Research: Research Permits may be issued for non-revenue generating scientific
research that is designed for further understanding of Monument resources and qualities,
and that are compatible with the purposes of Presidential Proclamation 8031. To apply
for a Research Permit, please fill out Sections A-C, D if applicable, and Appendix A.
*Conservation and Management: Conservation and Management Permits may be
issued for activities that assist in the conservation and management of the Monument and
are compatible with the purposes of Presidential Proclamation 8031. To apply for a
Conservation and Management Permit, please fill out Sections A-C, D if applicable, and
Appendix A.
*Education: Education Permits may be issued for non-revenue generating educational
activities that will further the educational value of the Monument and that are compatible
with the purposes of Presidential Proclamation 8031. To apply for an Education Permit,
please fill out Sections A-C, D if applicable, and Appendix B.
*Native Hawaiian Practices: Native Hawaiian Practice Permits may be issued for the
purpose of pursuing cultural activities. Cultural activities are activities conducted for the
purposes of perpetuating traditional knowledge, caring for and protecting the
environment, and strengthening cultural and spiritual connections to the Northwestern

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Hawaiian Islands and have demonstrable benefits to the Native Hawaiian community and
are compatible with the purposes of Presidential Proclamation 8031. To apply for a
Native Hawaiian Practices Permit, please fill out Sections A-C, D if applicable, and
Appendix C.
*Recreation (Midway Atoll Special Management Area ONLY): Recreation Permits
may be issued for activities conducted for personal enjoyment that do not result in the
extraction of Monument resources and that do not involve for-hire operations, and are
compatible with the purposes of Presidential Proclamation 8031. To apply for a
Recreation Permit, please fill out Sections A-C, D if applicable, and Appendix D.
*Special Ocean Use: Special Ocean Use Permits may be issued for an activity or use of
the Monument to generate revenue or profits for one or more of the persons associated
with the activity or use, and does not destroy, cause the loss of, or injure Monument
resources, and are compatible with the purposes of Presidential Proclamation 8031. To
apply for a Special Ocean Use Permit, please fill out Sections A-C, D if applicable, and
Appendix E.
*Please include a brief summary of the proposed activities.
* Please specify whether you are applying for a permit for a new project or for the
renewal of an existing permitted project.
* Please specify the dates that your activities will occur.

Section A: Applicant Information
1. Give the name and title of the Applicant. The Applicant is the individual who is in
charge of the proposed activity and therefore responsible for all the personnel and actions
undertaken under the authority of the requested Monument Permit. Attach his/her CV,
resume or biography if applicable.
2. Give the Applicant’s mailing address, phone number, fax number and email address.
If the Applicant is a student, give his/her Major Professor’s contact information in
addition to his/her own.
3. Specify the Applicant’s affiliation, if any, in relation to the proposed project.
4. List all personnel participating in the proposed activity. Please include first and last
name, affiliation, telephone number, and email address for each individual. The
Application Review Committee, on its own initiative, may request resumes, biographies,
or CVs for any of these personnel at a later date. Please attach additional information if
necessary. It is the Applicant’s responsibility to keep Monument staff apprised of any
personnel changes.

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Section B: Project Information
5a. Project Location: Check all applicable locations where the proposed activity will
occur. Please also indicate whether your project will occur on land, in the ocean, or both.
NOTE: Please include alternate locations if appropriate.
*Location Description: For each of the locations, if an activity is ocean-based, please
specify the exact GPS location, depth and habitats of the proposed activity. Instead of
listing locations here, you may have the option upload a list, Excel or Shape file which
contains this information. If the activity is land-based please describe the specific
island(s), and areas of the islands where the proposed activity is to occur.
5b. Check all applicable regulated activities proposed to be conducted in the Monument
by the Applicant at any of the locations mentioned in 5a.
*Removing, moving, taking, harvesting, possessing, injuring, disturbing, or damaging, or
attempting to remove, move, take, harvest, possess, injure, disturb, or damage any living
or nonliving Monument resource.
*Drilling into, dredging, or otherwise altering the submerged lands other than by
anchoring a vessel; or constructing, placing, or abandoning any structure, material, or
other matter on the submerged lands.
*Anchoring means dropping anything on to the ocean bottom with the intention of
holding something fast to the bottom. Generally an anchor secures a vessel, but it may
also be used for a mooring or any other item.
*Deserting a vessel aground, at anchor, or adrift.
*Discharging or depositing any material into Special Preservation Areas or the Midway
Atoll Special Management Area except vessel engine cooling water, weather deck runoff,
and vessel engine exhaust.
OR
*Discharging or depositing any material or other matter into the Monument, or
discharging or depositing any material or other matter outside of the Monument that
subsequently enters the Monument and injures any resources of the Monument, except
fish parts (i.e. chumming material or bait) used in and during authorized fishing
operations, or discharges incidental to vessel use such as deck wash, approved marine
sanitation device effluent, cooling water, and engine exhaust.
*Touching any coral, living or dead.
*Possessing fishing gear except when stowed and not available for immediate use during
passage without interruption through the Monument.

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*Attracting any living Monument resources.
*Sustenance Fishing means fishing for bottomfish or pelagic species within Federal
waters, but outside of Special Preservation Areas, Ecological Reserves and the Midway
Atoll Special Management Area, in which all catch is consumed within the Monument,
and that is incidental to another activity permitted under Presidential Proclamation 8031.
*Subsistence Fishing means fishing for bottomfish or pelagic species in State waters in
which all catch is for direct personal consumption within the Monument, and that is
incidental to another activity permitted under Presidential Proclamation 8031.
*Swimming means entering the water and propelling oneself by movements of the limbs,
without special equipment of any kind.
*Snorkeling means entering the water and swimming with the aid of a mask, snorkel, and
fins, or any combination of the aforementioned equipment.
*SCUBA Diving means entering the water and submerging oneself with the aid of selfcontained underwater breathing apparatus.
6. Please state the purpose of the proposed activities. Please also state the goals and
objectives of the activity.
7. The Co-Trustees are required to determine that issuing the requested permit is
compatible with the Findings of Presidential Proclamation 8031. Please provide any
information that you believe will assist the Co-Trustees in determining how your
proposed activities are compatible with the conservation and management of the natural,
historical and cultural resources of the Monument.
The Findings are as follows:
a. The activity can be conducted with adequate safeguards for the resources and
ecological integrity of the Monument;
b. The activity will be conducted in a manner compatible with the management direction
of this proclamation, considering the extent to which the conduct of the activity may
diminish or enhance Monument resources, qualities, and ecological integrity, any
indirect, secondary, or cumulative effects of the activity, and the duration of such effects;
c. There is no practicable alternative to conducting the activity within the Monument;
d. The end value of the activity outweighs its adverse impacts on Monument resources,
qualities, and ecological integrity;
e. The duration of the activity is no longer than necessary to achieve its stated purpose;

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f. The applicant is qualified to conduct and complete the activity and mitigate any
potential impacts resulting from its conduct;
g. The applicant has adequate financial resources available to conduct and complete the
activity and mitigate any potential impacts resulting from its conduct;
h. The methods and procedures proposed by the applicant are appropriate to achieve the
proposed activity's goals in relation to their impacts to Monument resources, qualities,
and ecological integrity;
i. The applicant's vessel has been outfitted with a mobile transceiver unit approved by
OLE and complies with the requirements of Presidential Proclamation 8031; and
j. There are no other factors that would make the issuance of a permit for the activity
inappropriate.
8. Please describe the procedures you will use in performing the proposed activity while
within the Monument. Please also address how the methods and procedures you will use
are appropriate to achieve the goals of the proposed activity in relation to their impacts to
Monument resources, qualities, and ecological integrity.
Please describe in detail how you will get to your work locations and specific sites
(walking, climbing, wading, swimming, snorkeling, diving, boating, etc.). Will you need
to enter a seabird colony? Will you need access to beaches? Will you work at night?
Will you request assistance from Monument staff to maintain the equipment or collect
data or samples in association with the proposed activity in your absence or presence? If
so, describe procedures for doing so including how often it is to occur and how long it
will take per maintenance/data/sample collection event. Describe how you plan to
compensate volunteers for the maintenance or data/sample collection work.

Section C: Logistics
9. Please list here and reference permit numbers for all other related Federal or State
Permits for which you have applied or received. These may include, but are not limited
to, a Bird Banding Lab Migratory Bird Banding Permit, State of Hawaii Department of
Land and Natural Resources Division of Forestry and Wildlife Permit, State Conservation
District Use Permit, Endangered Species Act consultations, Marine Mammal Protection
Act Permit, International Animal Care and Use Committee, or any University permits.
Please attach copies of permits already received. You will be required to provide copies
of all required permits to the Monument Permit coordination personnel prior to departure
for the Monument.
Please also list all permits which you have received on previous occasions for the same or
similar activities from any State or Federal entity.

8

9a. For each of the permits listed, please identify any permit violations or any permit that
was suspended, amended, modified or revoked for cause. Please explain the
circumstances surrounding the violation or permit suspension, amendment, modification
or revocation.
10. Please include a budget and funding sources specific to the proposed activities.
Salary information and detailed program budgets are not necessary. Please also list
any in-kind contributions awarded for the proposed activities.
NOTE: The Monument Permit Coordinators reserve the right to request additional
budget information.
11. The “Activity Start” and “Activity Completion” must reflect the entire time span of
the proposed activity. In other words, these dates must indicate if the proposed activity is
a multi-year activity and how many years the proposed activity is expected to be
conducted in the Monument. NOTE: Multi-year projects do NOT guarantee the issuance
of additional permits in subsequent years.
The “Dates Actively in the NWHI Marine National Monument” must reflect the dates
during the current calendar year in which this Permit Application is proposing work
within the Monument.
If specific dates cannot be determined at the time of application, please explain why the
dates are pending (e.g., ship schedules, flight schedules). At a minimum, you must
describe the intervals of time you wish to visit the Monument, e.g. during a specific
nesting season or quarterly, and you must describe how long you wish to stay.
In the text box allotted for Personnel Schedule, please list who will be located where in
the Monument and for what periods of time. Attach additional documentation if
necessary.
12. All persons covered under the permit are responsible for the cost of removing
themselves from the Monument at the conclusion of the term of the permit or upon
revocation of the permit. Additionally, persons covered under the permit are also
responsible for the cost of removing themselves from the Monument in the event of a
necessary medical evacuation, emergency evacuation, including weather, or for the cost
of any necessary search and rescue operation. Please demonstrate that all persons covered
under the permit have either appropriate insurance coverage, have been adequately
bonded, or have the independent financial resources to pay for or reimburse the
Monument Co-Trustees for the cost of their necessary search and rescue and/or removal
from the Monument.
NOTE: The State of Hawaii requires permittees to carry general liability insurance.

9

13. Please check the appropriate box to indicate how personnel will enter the Monument.
Note in the text box which vessel(s) or aircraft(s) will be used to transport personnel. If
entering by a vessel which is not already permitted to enter the Monument in support of
your proposed activity, you must include that respective vessel and its crew on this
permit application, or the vessel must apply separately for its own permit. If entering by
a vessel which is already permitted to enter the Monument in support of your proposed
activity, please note the vessel’s Monument Permit number here.
14. Please check the relevant inspections that you will conduct prior to departure for the
Monument. Include the dates of scheduled inspections. Upon completion of the
inspections and any required cleaning operations, you will be required to provide proof of
inspections and cleaning to Monument Permit coordination personnel.
All vessels must have at a minimum a Rodent Free Inspection, Hull Inspection, and
Ballast Water Record Inspection no more than 14 days prior to departure for the
Monument. If any small boat operations are proposed to occur within the Monument,
then a Tender Vessel Fouling Inspection must occur in this time frame as well. If any
gear will be placed or used in the water or on land, you must schedule an inspection of
these items before departing for the Monument. For more information on who to contact
to arrange these inspections please visit the Monument website at
http://hawaiireef.noaa.gov/
NOTE: Results of inspections may require cleaning operations such as rodent eradication,
hull cleaning, or ballast water maintenance at your own cost before departing for the
Monument. If proposed gear or materials are found to be contaminated with alien species
you may be required to conduct specific cleaning measures or complete replacement of
contaminated items at your own cost before departing for the Monument. Re-inspection
may be required.
15. Please list all vessel information: Vessel name, owner, captain’s name, vessel type,
length, gross tonnage and vessel identification number. Please also list vessel
International Maritime Organization Number (if applicable), flag of origin, Chief
Scientist, call sign, port of embarkation, total ballast water capacity volume (m3), total
number of fuel tanks on ship, total number of tanks on ship, total fuel capacity and last
port the vessel will have been prior to this embarkation.
Please also indicate if the vessel has a Marine Sanitation Device (MSD) and describe the
type of MSD on board the vessel. Please explain in detail how you will comply with the
‘No Discharge’ regulations stipulated in Presidential Proclamation 8031. If applicable,
please attach schematics of the vessel’s discharge and treatment systems.
Please list all other fuel and hazardous materials to be carried on board for vessel or
tender vessel use and their respective amounts.

10

Does the vessel have a NOAA Office of Law Enforcement (OLE)-approved Vessel
Monitoring System (VMS)? Please provide the name and contact information of the
contractor responsible for installing the VMS system. For more information on NOAA
OLE-approved VMS systems, please refer to Federal Register Notice 71 FR No. 135
Published July 14, 2006. http://hawaiireef.noaa.gov/PDFs/VMSfedreg.pdf
Please also describe the make and model of the VMS to be used while conducting
activities in the Monument.
NOTE: Per Presidential Proclamation 8031, all vessels entering the Monument MUST
have an NOAA OLE-approved VMS System installed PRIOR to entering the Monument,
“An owner or operator of a vessel that has been issued a permit for accessing the
Monument must ensure that such a vessel has an operating vessel monitoring system
(VMS) on board, approved by the OLE in the National Oceanic and Atmospheric
Administration in the Department of Commerce when voyaging within the Monument.”
Please include the following information in this section: VMS Email address and
Inmarsat ID #.
* NOTE: This question is not required if you are traveling aboard a NOAA vessel.*
16. Please list all workboats (tenders) which will be use to transport personnel, gear and
materials within the Monument. Please include information on the number of
tenders/skiffs aboard the vessel and the specific types of motors on each tender/skiff.

11

Section D: Additional Information for Land Based Operations
ANSWER QUESTIONS IN THIS SECTION IF YOU WISH TO CONDUCT
ACTIVITIES ON LAND
17. Please answer the following questions:
*If personnel, gear and materials are to be transported to the Monument by vessel, how
will personnel, gear and materials be transported between ship and shore?
*If applicable, how will personnel be transported between islands within any one atoll?
*Provide a time line of all significant transportation events for arrivals and departures.
18. Describe where personnel will sleep/eat/bathe while on the island(s). Note how many
personnel will be using U.S. Fish and Wildlife Service and/or State of Hawaii supplied
accommodations and for how long.
19. Describe office/desk/workbench/workshop/lab space you expect to use during the
proposed activity on the island(s). Describe all electrical and water needs you expect to
use during the proposed activity on the island(s). Describe what disposal route all of the
water and hazardous materials will take (e.g., laboratory sink, drains, flow-through
aquaria) and where these materials will ultimately end up.
NOTE: charging batteries, rinsing gear, cleaning tools, painting and maintaining
equipment, etc., all take space and resources. Requesting use of these resources should
be done in this section.

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Appendix A – Research OR Conservation and Management Application
Instructions
NOTE: If you do not intend to collect specimens, you may enter “N/A” for questions 1-3
and skip to question 4.
1a. Please list all specimens (organisms or objects) that you plan to collect. If applicable,
please list each species common name, scientific name, number to be collected,
maximum size of specimens to be collected, amount taken and the size of the organism
from which you will take any sample(s) and collection location corresponding to
coordinates requested in #5a (primary application). Please also indicate whether you will
be taking the whole organism or a subsample thereof.
1b. Please list what will be done with specimens upon completion of the project. Also
state what will be done with the parts of samples that are not used in your initial analysis?
1c. Please check the appropriate box to indicate if the organisms will be kept alive after
collection. If the organisms are to be kept alive, where will they be housed? Provide the
specific site and/or location. Also check the appropriate box to indicate if there is an
open or closed system for maintaining living organisms and if there is an outfall or
discharge. If applicable, please note whether the organisms will be kept with other
species and if so, the species names of the other organisms. Will any organisms be
released? If so, where?
2. How will the collected samples be transported out of the Monument? Will they be
transported by vessel or aircraft? Will they be transported frozen, in formalin, in alcohol,
or other media?
3. Please describe if you are collaborating with others to reduce duplicative activities in
the Monument or elsewhere in the State of Hawaii or other Pacific Remote Island
National Wildlife Refuges. If you are collecting samples for someone else, stipulate to
whom the samples will be provided and give their Monument permit number. Please also
list State of Hawaii and United States Fish and Wildlife Service permit numbers for any
relevant collaborations or research related to this project, including projects in the main
Hawaiian Islands and Pacific Remote Island National Wildlife Refuges. If any permit
applications for related research are under review at any of the above agencies, please
provide us with that information.
4a. Provide a complete itemized list of work related gear/equipment/supplies, including
collecting equipment, radio isotopes, dive equipment, etc., that will be taken into and
removed from the Monument. If you wish to store any items on any island between field
seasons, please request so here. Please indicate how and where you propose the stored
items be kept. If you are proposing to take any work or personal items ashore that will
require use of resources (electrical power or water supplies) also describe that in this
section.

13

4b. For any Hazardous Materials also include the following information:
*List all hazardous materials by common name, proper shipping name, hazard class, and
amount to be taken into the Monument. Provide a Material Safety Data Sheet for each
hazardous material.
*Describe how each hazardous material will be contained and stored while in the
Monument.
*Describe how each hazardous material will be used for the proposed activity. Describe
how and when each hazardous material will be removed from the Monument.
NOTE: The Co-Trustees will not be responsible for disposal of, storage, or unauthorized
use of any left-over hazardous materials from any permitted activity.
5. If applicable, please indicate the types of permanent or semi-permanent installments
you would like to install in the Monument, and answer the following questions:
*What is it made of?
*What will be installed?
*How will it be installed?
*Where will it be installed?
*How long will it be installed?
*Will the installation require maintenance? If so, who will conduct the maintenance and
how often?
*How and when will the installation be removed?
6. In addition to reports required by all Monument Permits, please provide information
regarding the projected completion dates of the following: sample analysis, write-up and
publication of information gathered within the Monument.
7. List all publications directly related to the proposed project:

14

Appendix B - Education Permit Instructions
1. Please describe if you are collaborating with others to reduce duplicative activities in
the Monument or elsewhere in the State of Hawaii or other Pacific Remote Island
National Wildlife Refuges. Please also list State of Hawaii and U.S. Fish and Wildlife
Service permit numbers for any relevant collaborations or education activities related to
this project, including projects in the main Hawaiian Islands and Pacific Remote Island
National Wildlife Refuges. If any permit applications for related education activities are
under review at any of the above agencies, please provide us with that information.
2. Provide a complete itemized list of work related gear/equipment/supplies, including
collecting equipment, radio isotopes, dive equipment, etc., that will be taken into and
removed from the Monument. If you wish to store any items on any island between field
seasons, please request so here. Please indicate how and where you propose the stored
items be kept. If you are proposing to take any work or personal items ashore that will
require use of resources (electrical power or water supplies) also describe that in this
section.
3. If applicable, please indicate the types of permanent or semi-permanent installments
you would like to install in the Monument, and answer the following questions:
*What is it made of?
*What will be installed?
*How will it be installed?
*Where will it be installed?
*How long will it be installed?
*Will the installation require maintenance? If so, who will conduct the maintenance and
how often?
*How and when will the installation be removed?
4. Is your proposed activity based on a State Department of Education Standards Based
Curriculum? If so, please describe.
5. What materials, products or deliverables will be developed as a result of your
proposed activity? Provide a time line for write-up and publication of information or
production of educational materials
6. List all publications directly related to the proposed project:
NOTE: If you do not intend to collect specimens, you may enter “N/A” for questions 7a7c.
7a. Please list all specimens (organisms or objects) that you plan to collect. If applicable,
please list each species common name, scientific name, number to be collected,
maximum size of specimen(s) to be collected, amount taken and the size off the organism
from which you will take any sample(s), and collection location(s) corresponding to

15

coordinates requested in #5a (primary application). Please also indicate whether you will
be taking the whole organism or a subsample thereof.
7b. Please list what will be done with specimens upon completion of the project. Also
state what will be done with the parts of samples that are not used in the proposed
education activity?
7c. Please check the appropriate box to indicate if the organisms will be kept alive after
collection. If the organisms are to be kept alive, where will they be housed? Provide the
specific site and/or location. Also check the appropriate box to indicate if there is an
open or closed system for maintaining living organisms and if there is an outfall or
discharge. If applicable, please note whether the organisms will be kept with other
species and if so, the species names of the other organisms. Will any organisms be
released? If so, where?
8. How will the collected samples be transported out of the Monument? Will they be
transported by vessel or aircraft? Will they be transported frozen, in formalin, in alcohol,
or other media?

16

Appendix C – Native Hawaiian Practices Application Instructions
1. Please state how the purpose and intent of the activity are appropriate and deemed
necessary by traditional standards in the Native Hawaiian culture (pono), and
demonstrate an understanding of, and background in, the traditional practice, and its
associated values and protocols.
2. Please state how the activity benefits the resources of the Northwestern Hawaiian
Islands and the Native Hawaiian community.
3. Please state how the activity supports or advances the perpetuation of traditional
knowledge and ancestral connections of Native Hawaiians to the Northwestern Hawaiian
Islands.
4. Please indicate whether or not you will be collecting any Monument resource for use
in any Native Hawaiian cultural practice in the course of your proposed activity.
NOTE: If you do not intend to collect specimens, you may enter “N/A” for questions 4a
– 4c, and skip to question 5.
4a. Please list all resources (organisms or objects) that you plan to collect. If applicable,
please list each species common name and/or scientific name, number to be collected,
maximum size to be collected, and collection location(s) corresponding to coordinates
requested in #5a (primary application form). Please also indicate whether you will be
taking the whole organism or a subsample thereof. What will be done with the parts of
samples that are not used?
4b. Please list what will be done with specimens upon completion of the native Hawaiian
cultural practice is complete.
4c. Please check the appropriate box to indicate if the organisms will be kept alive after
collection. If the organisms are to be kept alive, where will they be housed? Provide the
specific site and/or location. Also check the appropriate box to indicate if there is an
open or closed system for maintaining living organisms and if there is an outfall or
discharge. If applicable, please note whether the organisms will be kept with other
species and if so, the species names of the other organisms. Will any organisms be
released? If so, where?
NOTE: Any Monument resource harvested from the Monument for the purpose of
Native Hawaiian practices will be consumed in the Monument.
5. If you are collaborating with any other groups or individuals permitted to conduct
Native Hawaiian practices in the Monument, please describe how your efforts are being
collaborated. Please also list State of Hawaii and Monument permit numbers for any
relevant collaboration related to this project, including projects in the main Hawaiian

17

Islands. If any permit applications for related Native Hawaiian practices are under
review, please provide us with that information.
6. Provide a complete itemized list of work related gear/equipment/supplies, including
collecting equipment, radio isotopes, dive equipment, etc., that will be taken into and
removed from the Monument. If you wish to store any items on any island between field
seasons, please request so here. Please indicate how and where you propose the stored
items be kept. If you are proposing to take any work or personal items ashore that will
require use of resources (electrical power or water supplies) also describe that in this
section.
7. If applicable, please indicate the types of permanent or semi-permanent installments
(such as ahu or other stone structure) you would like to install in the Monument, and
answer the following questions:
*What is it made of?
*What will be installed?
*How will it be installed?
*Where will it be installed?
*How long will it be installed?
*Will the installment require maintenance? If so, who will conduct the maintenance and
how often?
*How and when will the installation be removed?
*Will you be making any offerings in the Monument? If so, please describe.
8. Will you be producing any publications, educational materials, or other deliverables?
Please provide a time line for write-up and publication of the information or production
of materials.

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Appendix D – Recreation Application Permit Instructions
For Activities in the Midway Atoll Special Management Area Only
NOTE: If you are visiting the Midway Atoll Special Management Area and entering the
Monument via aircraft for the purpose of conducting recreational activities, you are not
required to complete this application form.
1. Please explain how the activity is for the purpose of recreation as defined: “An
activity conducted for personal enjoyment that does not result in the extraction of
Monument resources and that does not involve a fee-for-service transaction. This
includes, but is not limited to, wildlife viewing, SCUBA diving, snorkeling, and boating.”
2. Please also list Monument permit numbers for any associated activities related to the
proposed activity. This should include any Research Permits, Conservation and
Management Permits, Education Permits, Native Hawaiian Practices Permits, Recreation
Permits or Special Ocean Use Permits that may be related to the proposed Recreation
activities. If any Monument permit applications for related activities are under review,
please provide that information.
3. Provide a complete itemized list of work related gear/equipment/supplies, including
collecting equipment, radio isotopes, dive equipment, etc., that will be taken into and
removed from the Monument. If you wish to store any items on any island between field
seasons, please request so here. Please indicate how and where you propose the stored
items be kept. If you are proposing to take any work or personal items ashore that will
require use of resources (electrical power or water supplies) also describe that in this
section.
4. If applicable, please indicate the types of permanent or semi-permanent installments
you would like to install in the Monument, and answer the following questions:
*What is it made of?
*What will be installed?
*How will it be installed?
*Where will it be installed?
*How long will it be installed?
*Will the installation require maintenance? If so, who will conduct the maintenance and
how often?
*How and when will the installation be removed?

19

Appendix E – Special Ocean Use Application Instructions
NOTE: If this is a first time Special Ocean Use activity, it will be considered a pilot
project.
1. Please provide proof of general liability insurance, or indicate that you will be posting
an equivalent bond against claims arising out of activities conducted under the permit.
2. Please describe if you are collaborating with others to reduce duplicative activities in
the Monument or elsewhere in the State of Hawaii or other Pacific Remote Island
National Wildlife Refuges. Please also list State of Hawaii and U.S. Fish and Wildlife
Service permit numbers for any relevant collaboration related to this project, including
projects in the main Hawaiian Islands and Pacific Remote Islands National Wildlife
Refuges. If any permit applications for related education activities are under review at
any of the above agencies, please provide us with that information.
3. Provide a complete itemized list of work related gear/equipment/supplies, including
collecting equipment, radio isotopes, dive equipment, etc., that will be taken into and
removed from the Monument. If you wish to store any items on any island between field
seasons, please request so here. Please indicate how and where you propose the stored
items be kept. If you are proposing to take any work or personal items ashore that will
require use of resources (electrical power or water supplies) also describe that in this
section.
4. If applicable, please indicate the types of permanent or semi-permanent installments
you would like to install in the Monument, and answer the following questions:
*What is it made of?
*What will be installed?
*How will it be installed?
*Where will it be installed?
*How long will it be installed?
*Will the installation require maintenance? If so, who will conduct the maintenance and
how often?
*How and when will the installation be removed?
5. List all publications directly related to the proposed project.
For projects occurring with the Midway Atoll Special Management Area, answer
the following questions:
6. Please explain how your activity has been found compatible with the purposes for
which the Midway Atoll National Wildlife Refuge was designated.
7. Please explain how your activity meets the requirement of furthering conservation and
management of the Monument.

20

For projects occurring outside of the Midway Atoll Special Management Area,
answer the following questions:
8. Please explain how the proposed activity will directly benefit the conservation and
management of the Monument.
9. Please explain how the purpose of the proposed activity is for research and education
related to resources or qualities of the Monument.
NOTE: SPECIAL OCEAN USE PERMITS OUTSIDE THE MIDWAY ATOLL
SPECIAL MANAGEMENT AREA DO NOT ALLOW THE USE OF A
COMMERCIAL PASSENGER VESSEL. A commercial passenger vessel is defined by
the monument regulations as a vessel that carries individuals who have paid for such
carriage.

21