Application to replace certificate, permit or card

Revised March 2006

OMB 0648-0272 Expires 04/30/2008

APPLICATION FOR
REPLACEMENT OF
CERTIFICATES, PERMITS,
OR CARDS

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

BLOCK A—IDENTIFICATION OF APPLICANT
1. Name:

2. NMFS Person ID:

3. Date of Birth:
5. Business Mailing Address:

4. SSN* or Tax ID:
[ ] Permanent

[ ] Temporary

6. Business Telephone Number:

7. Business Fax Number:

*Privacy Act Statement: Where the requested information is a Social Security Number, disclosure is voluntary; in the event it is not provided, NMFS will
assign a unique code that will identify the records.

BLOCK B—REPLACEMENT REQUEST
(check only those items that apply)
Part I—BSAI Crab Permits and Scallop Permits
[

] Crab QS Report: Units __________________________________________________
Is this QS Report requested for a pending QS/IFQ transfer?
[ ] Yes

Select fishery
Fishery ______________
[ ] No

[

] Crab PQS Report: Units __________________________________________________
Is this QS Report requested for a pending QS/IFQ transfer?
[ ] Yes

Select fishery
Fishery ______________
[ ] No

[

] Crab Annual IFQ Fishing Permit: Permit Number ____________________

[

] Crab Annual IPQ Fishing Permit: Permit Number ____________________

[

] Registered Crab Receiver: Permit Number ____________________

[

] Crab Federal Vessel Permit: Permit Number ____________________

[

] Crab IFQ Hired Master Permit: Permit Number ___________________ Skipper Name _______________________
Skipper NMFS ______________________________ (Application to be completed and signed by permit holder)

[

] Crab QS or PQS Transfer Eligibility Certificate

[

] Crab License Limitation License (LLP): License Number ____________________

[

] Scallop License Limitation License (SLLP): License Number ____________________

Vessel ADF&G Number ______________

Application for Replacement of Certificates, Permits, or Cards
Page 1 of 4

Revised March 2006

OMB 0648-0272 Expires 2/28/2008

PART II—Pacific Halibut and Sablefish IFQ Program Permits
[

] Halibut/Sablefish QS Certificate:

Units ___________________________________________________________
Select area
Area _______________
Species _______________
Select species
Is this QS Certificate requested for pending QS/IFQ transfer? [ ] Yes [ ] No

[

] Halibut/Sablefish IFQ Fishing Permit: Permit Number _______________

[

] Halibut/Sablefish IFQ/CDQ Landing Card for individual permit holder:
Permit Number _______________

Select species
Species _______________

Select species
Species _______________

[

] Halibut/Sablefish Transfer Eligibility Certificate (TEC): NMFS Person ID __________________________

[

] Registered Buyer Permit: Permit Number ______________________

PART III—Federal Groundfish Permits
[

] Federal Fisheries Permit (FFP): Permit Number ____________________

[

] Federal Processor Permit (FPP):

[

] Groundfish License Limitation License (LLP): Groundfish License Number ____________________

[

] American Fisheries Act (AFA) Inshore Cooperative: Permit Number ____________________

[

] American Fisheries Act (AFA) Catcher Vessel Permit: Permit Number ____________________
Vessel Name ______________________________ USCG No. _____________ ADF&G No. _____________

[

] American Fisheries Act (AFA) Catcher Processor Permit: Permit Number ____________________
Vessel Name ______________________________ USCG No. _____________ ADF&G No. _____________

[

] American Fisheries Act (AFA) Inshore Processor: Permit Number ____________________

[

] American Fisheries Act (AFA) Mothership: Permit Number ____________________
Vessel Name ______________________________ USCG No. _____________ ADF&G No. _____________

Permit Number ____________________
Vessel ADF&G Number (if stationary floating processor) ______________

PART IV—Halibut Subsistence
[

] Subsistence Halibut Registration Certificate (SHARC):

Tribal SHARC Number _______________
Rural Resident SHARC Number _______________

[

] Subsistence Halibut Ceremonial Permit: Permit Number ____________________

BLOCK C—REASON FOR REPLACEMENT REQUEST
[

] Lost

[

] Destroyed

[

] Stolen

[

] Other (explain)

BLOCK D—SIGNATURE OF APPLICANT
Under penalties of perjury, I declare that I have examined this application and, to the best of my knowledge and belief, the
information is true, correct, and complete.
1.

Signature of Applicant or Authorized Agent:

2.

Date:

3.

Printed Name of Applicant or Authorized Agent (Note: If this is completed by an agent, attach authorization):

Application for Replacement of Certificates, Permits, or Cards
Page 2 of 4

Revised March 2006

OMB 0648-0272 Expires 2/28/2008

INSTRUCTIONS
Application for Replacement of Certificates, Permits, or Cards

Please type or print legibly in ink and retain a copy of the completed application for your records.
Allow at least 10 business days for your application to be processed. Items will be sent by U.S.
First-Class Mail, unless alternative mailing instructions are provided with RAM’s receipt of the
application and include a prepaid mailer with the appropriate postage or a corporate account number for
express delivery.
If you have any questions about this application or need additional information, call Restricted Access
Management (RAM) at (800) 304-4846 (#2) or (907) 586-7202 (#2).
Mail completed applications to:
NMFS Alaska Region
Restricted Access Management
P.O. Box 21668
Juneau, Alaska 99802-1668

BLOCK A—IDENTIFICATION OF APPLICANT
Provide the information requested below regarding the replacement of the item(s) requested.
1. Name:
The name of the individual, corporation, or partnership that is the holder of the permit, card, certificate,
and/or license being replaced.
Note: If a landing card is being replaced for a hired skipper, the applicant completing and signing the
application must be the CDQ/IFQ permit holder.
2. NMFS Person ID:
The identification number assigned to the applicant by National Marine Fisheries Service, RAM.
3. Date of Birth:
If the applicant is an individual person, enter that person’s date of birth.

Application for Replacement of Certificates, Permits, or Cards
Page 3 of 4

Revised March 2006

OMB 0648-0272 Expires 2/28/2008

4. SSN or Tax ID:
Privacy Act Statement: Federal Regulations (50 CFR § 679) authorize but do not require collection of
this information. The information is used to verify the identity of applicants and to accurately retrieve
confidential records related to federal commercial fishery permits. Where the requested information is a
Social Security Number, disclosure is voluntary; in the event it is not provided NMFS will assign a
unique code that will identify the records.
5. Business Mailing Address:
Enter the business mailing address, including street or P.O. Box number, state, and zip code, where the
item(s) should be sent. Check whether the address provided is a permanent or temporary address. If
you check “Permanent Address,” we will update the official RAM database. If you choose “Temporary
Address,” we will use it for this one application only and we will not change the RAM database.
6-7.

Business Telephone and Fax Numbers:

Include applicant’s business telephone and fax numbers including the area codes.
Note: It is important to provide a number where a message can be left to avoid delay in processing the
application if any questions arise.
BLOCK B - REPLACEMENT REQUEST
Check the block for each of the items you are requesting to be replaced. Fill out only the information
that pertains to the items that have been checked.
BLOCK C - REASON FOR REPLACEMENT REQUEST
Indicate the reason(s) for replacement of the items checked in Block B.
BLOCK D – SIGNATURE OF APPLICANT
1-2.

Signature of Applicant or Authorized Agent:

The applicant or authorized agent must sign and date the application certifying all information set forth
in the application is true, correct, and complete to the best of the applicant's knowledge and belief. The
application will not be considered without the applicant’s or authorized agent’s signature.
Note: If a representative is acting on behalf of the applicant, written authorization signed by the
applicant must be submitted with the application.

Application for Replacement of Certificates, Permits, or Cards
Page 4 of 4