Form 88-166 Fishermen's Contingency Fund 150Day Report

NOAA FORM 88-166
(12-82)

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION

FISHERMEN’S CONTINGENCY FUND 15-DAY REPORT

OMB Control No.: 0648-0082
Expiration Date: 05/31/2008

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NOTE: No compensation may be awarded unless a completed application form has been received (Title IV – The Fishermen’s
Contingency Fund -- of the Outer Continental Shelf Lands Act Amendment of 1978.
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INSTRUCTIONS
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1. In order to gain a presumption that the damage or loss for which
you will file a FCF claim was caused by an item related to OCS
oil and gas activities, you must submit the information required by
this form to the National Marine Fisheries Service within 15 days
after the date your vessel first returned to port after discovering
such damage or loss. You may report your damage or loss while at
sea by contacting the National Marine Fisheries Service Regional
Office by radiotelephone and providing the required information.
2. If you radiotelephone the information to meet the 15-day deadline, you should also confirm the radiotelephone report by sending a
completed copy of this form as soon as possible after you return to
port to National Marine Fisheries Service, Financial Services Division
F/MB5, 1315 East-West Hwy.. Rm. 13301, Silver Spring, MD 20910,
Phone: (301) 713-2396.
3. Please remember that in addition to this 15-day report,
you must also send a completed claim to the Financial Services Division,
NMFS, at the above address within 90 days after the damage was first
discovered. Please call or write that office or your regional office
if you need advice on how to submit a complete claim.

Privacy Act Statement
Section 3701 © of title 31, United States Code, authorizes collection
of this information. This information is part of an application
for benefits and is required to obtain those benefits. The primary use
of social security numbers or taxpayer identification numbers is to
verify the identity of the applicant(s) and to allow preparation of IRS
Form 1099s for claim payments as required pursuant to Section 6109
of the Internal Revenue code.
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewinstructions, searching exiting 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 suggestions for reducing this burden to National Marine
Fisheries Service, Financial Services Division, F/MB5, 1315 East
West Hwy.,Rm. 13301, Silver Spring, MD 20910.

Confidential name and address information will be released via a
NOAA Fisheries website for informational purposes. All other data
submitted will be handled as confidential material in accordance
with NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. Notwithstanding any other provisions of the
law, no person is required to respond to, nor shall any person be
subjected 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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CORPORATE NAME

TAX IDENTIFICATION NUMBER

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NAME

SOCIAL SECURITY NUMBER

DATE

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ADDRESS

PHONE NO.

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VESSEL’S NAME

VESSEL NUMBER

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LOCATION OF OBSTRUCTION (Use Loran C or the next best available method of position fixing.)

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DESCRIPTION OF THE NATURE OF DAMAGE OR LOSS

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DATE AND TIME OF DISCOVERY OF DAMAGE OR LOSS

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DATE VESSEL FIRST RETURNED TO PORT (Unless 15-Day Report was made before vessel returned)

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REMARKS