Application to Transfer QS/IFQ by Self Sweep-up

Revised: 5/7/07

OMB No. 0648-0272; Expires 04/30/2008

APPLICATION FOR
TRANSFER OF QS/IFQ BY
SELF SWEEP-UP

U.S. Dept. of Commerce/NOAA
National Marine Fisheries Service
Restricted Access Management
P.O. Box 21668
Juneau, AK 99802-1668
(800) 304-4846 toll free / 586-7202 in Juneau Fax (907) 586-7354

BLOCK A - INSTRUCTIONS
To complete a "Self Sweep-Up" (i.e., to combine two blocks
that you currently hold), use this form instead of the standard
Application for Transfer of QS/IFQ form. In the space
provided, identify yourself and the blocks of QS you wish to
combine; sign and date the application in the presence of a
Notary Public; attach both original QS certificates; and
submit all to RAM at the address above. NOTE: To be
combined, QS must be in the same Vessel Category, and the
resulting block size must not exceed the Sweep Up Limits (see
block B).

BLOCK B - SWEEP UP LIMITS
Halibut
Area
2C
3A
3B
4A
4B
4C
4D

Quota Share
Units
19,992
27,912
44,193
22,947
15,087
30,930
26,082

Sablefish
Area
SE
WY
CG
WG
AI
BS

BLOCK C - APPLICANT INFORMATION (Type or Print legibly)
1. Name(full name):

2. NMFS Person ID:

3. Date of Birth:

4. SSN (required) or Tax ID:

5. Permanent Business Mailing Address:

6. Temporary Business Mailing Address:

7. Home Phone:

8. Business Phone:

9. Business Fax:

BLOCK D - FIRST QUOTA SHARE BLOCK
1. Halibut

[ ]

or

Sablefish

[ ]

2. IFQ Regulatory Area:

3. Vessel Category:

4. Number of QS Units to be Swept up:

5. Numbered From:

6. Numbered To:

BLOCK E - SECOND QUOTA SHARE BLOCK
1. Halibut

[ ]

or

Sablefish

[ ]

2. IFQ Regulatory Area:

3. Vessel Category:

4. Number of QS Units to be Swept up:

5. Numbered From:

6. Numbered To:

Quota Share
Units
33,270
43,390
46,055
48,410
99,210
91,275

BLOCK F - CERTIFICATION OF NOTARY AND APPLICANT
Under penalty of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, the
information presented hereon is true, correct, and complete.
1. Signature of QS holder or Authorized Agent:

2. Date:

3. Printed Name of QS Holder or Authorized Agent: Note: If this is completed by an agent, attach authorization:

4. Notary Public (Signature):

ATTEST

6. Affix Notary Stamp or Seal Here:

5. Commission Expires:

Please mail completed application to NMFS Alaska Region, Restricted Access Management, P.O. Box 21668, Juneau, AK
99802-1668. If you need additional information, call RAM at (800) 304-4846 (#2) or (907) 586-7202 (#2). Please allow at least ten
working days for your application to be processed. Items will be sent by first class mail, unless you provide alternate instructions
and include a prepaid mailer with appropriate postage or corporate account number for express delivery. Note: RAM will not
process faxed applications.
Privacy Act Statement: The Debt Collection Improvement Act, in Section 7701 of title 31, United States Code requires collection of
this information from each person doing business with a federal agency. This information is used for purposes of collecting and
reporting any delinquent amounts arising out of such person’s relationship with the government. This information is also used to
verify the identity of the applicant(s) and to accurately retrieve confidential records related to federal commercial fishery permits
issued under 50 CFR Part 679.

PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 0.2 hours per response, including the time for
reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to Assistant Regional Administrator, Sustainable Fisheries Division,
NOAA National Marine Fisheries Service, P.O. Box 21668, Juneau, AK 99801.

ADDITIONAL INFORMATION
Before completing this form please note the following: 1) Notwithstanding any other provision of 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; 2) This information is mandatory and is required to manage commercial fishing efforts under 50 CFR part 679 and
under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.); 3) Responses to this information request are
confidential under section 402(b) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.). They are also confidential under
NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.

Application for Transfer of QS/IFQ by Self Sweep-Up – Page 2 of 2