Subsistence Halibut Community Harvest Permit Log

Revised: 04/28/2005

OMB Control No.: 0648-0460; Expiration Date: 02/29/2008

Subsistence Halibut Community Harvest Permit (CHP) Log
National Marine Fisheries Service

Community Harvest Permit Coordinator

Subsistence Fisher Identification
Name (First, Middle, Last)

Date of Birth

Community of Residence

Tribal Affiliation

SHARC No.

Did you subsistence fish for halibut during the period indicated on the permit? (Circle Yes or No)
If Yes, complete the following harvest information.
Halibut
Local Water
Type of
No. of No. of
Date of
IPHC
Body, Bay or
Gear
Hooks Lingcod
Harvest
Reg. Area Number
Pounds
Sound
Used
Set

Subsistence Fisher Identification
Name (First, Middle, Last)

Date of Birth

Community of Residence

Tribal Affiliation

SHARC No.

Did you subsistence fish for halibut during the period indicated on the permit? (Circle Yes or No)
If Yes, complete the following harvest information.
Halibut
Local Water
Type of
No. of No. of
Date of
IPHC
Body, Bay or
Gear
Hooks Lingcod
Harvest
Reg. Area Number
Pounds
Sound
Used
Set

Subsistence Fisher Identification
Name (First, Middle, Last)

Date of Birth

No. of
Rockfish

No. of
Rockfish

Community of Residence

Tribal Affiliation

SHARC No.

Did you subsistence fish for halibut during the period indicated on the permit? (Circle Yes or No)
If Yes, complete the following harvest information.
Halibut
Type of
No. of No. of
Local Water
Date of
IPHC
Gear
Hooks Lingcod
Body, Bay or
Harvest
Reg. Area Number Pounds
Used
Set
Sound

No. of
Rockfish

Thank you! Please mail the completed log to:
Restricted Access Management
NMFS, Alaska Region
P.O. Box 21668
Juneau, AK 99802-1668

Questions?
Call 1-800-304-4846
Fax 907-586-7354

PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 30 minutes 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 Sue Salveson, Assistant
Regional Administrator, Sustainable Fisheries Division, Alaska Region, NMFS, P.O. Box 21668, Juneau, AK 99802-1668 (Attn: Lori Durall).
ADDITIONAL INFORMATION
Before completing this form please note the following: 1) The NMFS may not conduct or sponsor this information request, and you are not required to
respond to this information request, unless the form displays a currently valid OMB control number; 2) This information is being used to implement the
Alaska Subsistence Halibut Program; 3) Federal law and regulations require and authorize NMFS to manage subsistence halibut programs in Alaska; 4)
Submission of this information is mandatory for any tribe or community participating in directed fishing for Pacific halibut under the Community Harvest
Permit Program; 5) This information is used to monitor the subsistence halibut program under the Northern Pacific Halibut Act of 1982; 6) Responses to this
information request are not confidential.