AFA Pollock Buyback Loan Fee Collection Settlement Sheet

OMB Control No.: 0648-0376; Expiration Date: 08/31/2008

AFA POLLOCK BUYBACK LOAN
FEE COLLECTION SETTLEMENT SHEET
Fee Collector's Name
Mailing Address
City
State
Zip
Phone Number
Fee Collector's Permit or Buyer Code
Settlement Sheet Date
Month of Landings
FOR ALL INSHORE COMPONENT POLLOCK LANDED 1
Vessel Permit Number

Delivery Date Fish Ticket Number

Totals

Pounds Landed

Fee Collected ($)

0

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

$

-

1

Fee collector must separately record each vessel landing. The totals must equal the amount that the fee collector disburses
to NMFS.
Instructions:
1. Complete the fee collector's name, address, telephone number, fee collector's permit number, date of this fee
collection settlement sheet, and month of landings.
2. Record the vessel permit number, delivery date, fish ticket number, pounds landed and fee collected for each
vessel. The fee collected equals the the pounds of pollock landed for each vessel trip multiplied by $0.006.
3. Note that deliveries must occur within the same month. Use a separate report for a different month.
4. Use Pay.gov to remit fee due or mail a check payable to: "NOAA Inshore Component Pollock
Loan Subaccount" in the amount of the total fee collected to: P O Box 979002, St. Louis, MO 63197-9000.
Paperwork Reduction Act Statement:
Public reporting burden for this collection of information is estimated to average one hour per response,
including the time for reviewing 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 suggestions for reducing this burden to Leo Erwin, Chief, Financial
Services Division, NMFS, MB5, 1315 East West Highway, Silver Spring, MD 20910.
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.