Application to Participate in the Rockfish Pilot Program

Revised: 10/06/06 OMB Control No. 0648-0545

Expiration Date: 7/31/2009

Application to Participate in the Rockfish Pilot Program		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 (907) 586-7354 fax
Each person who is eligible to participate in the Rockfish Pilot Program must submit this application to receive an assignment of catch history or halibut Prohibited Species Catch (PSC) history for any License Limitation Program (LLP) licenses held by that person or to be eligible to receive fish from the Rockfish Pilot Program. Please indicate the type of eligibility to participate for which you are applying: [ ] Eligible Rockfish Harvester (catcher-vessel or catcher-processor sectors). Applicants must complete Blocks A and B and sign in Block F. Note: If you disagree with the Rockfish Program Official Record Summary, you must also complete Block C. [ ] Eligible Rockfish Processor (shoreside and stationary floating processors only). Applicants must complete Blocks A, B, and E and sign in Block F. Note: If you disagree with the Rockfish Program Official Record Summary, you must also complete Block D. NOTE: In addition to this application, each year an Eligible Rockfish Harvester must submit an application for the Rockfish Cooperative Fishery, the Limited Access Rockfish Fishery, or Opt-out (catcher-processors only) of the Rockfish fishery.
This completed application must be received by NMFS no later than January 2, 2007.
BLOCK A -- APPLICANT INFORMATION
1. Applicant name		2. NMFS person ID (if applicable)
		3. Tax ID number or social security number* (required)
4. Permanent business mailing address
5. Business telephone number	6. Business FAX number		7. e-mail address (if available)

*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.

Note: The Applicant must be a U.S. citizen or U.S. corporation, partnership, or other business entity to obtain a catch history or halibut PSC history assignment.

8. Are you a U.S. citizen? [ ] YES [ ] NO If YES, enter Date of Birth _____________

9. Are you a U.S. corporation, partnership, association or other business Entity? [ ] YES [ ] NO

If YES, enter Date of Incorporation _______________________

10. Is the applicant a successor-in-interest to a deceased individual or to a non-individual no longer in existence?

[ ] YES [ ] NO

If YES, attach death certificate or evidence of dissolution to the application.

BLOCK B -- AGREEMENT WITH ROCKFISH PROGRAM OFFICIAL RECORD

[ ] I AGREE with the Rockfish Program Official Record Summary sent to me by NMFS. If you check this box, you are accepting the Rockfish Program Official Record.

If you are an eligible rockfish harvester, proceed to Block F, sign the application, and return the application to NMFS.

If you are an eligible rockfish processor, complete Block E, proceed to Block F, sign the application, and return the application to NMFS.

[ ] I DO NOT AGREE with the Rockfish Program Official Record Summary sent to me by NMFS. I have indicated the areas of disagreement in Block C or D of this form or attached a separate page explaining my disagreement and providing evidence to support my claims.

[ ] I DID NOT RECEIVE a Rockfish Program Official Record Summary from NMFS. I believe that I am qualified as an eligible rockfish harvester or processor. I have indicated in Block C or Blocks D and E of this form or attached a separate page explaining the basis for my eligibility as an eligible rockfish harvester or processor.

BLOCK C – HARVESTER LEGAL ROCKFISH LANDINGS

If you are applying as an Eligible Rockfish Harvester and you do not agree with the Official Rockfish Program Record, enter the following information for the original qualifying vessel and other vessels used under authority of each LLP license.

LLP license number

Name of original qualifying vessel (OQV)

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

Other vessels used under authority of this LLP license

Name of Vessel

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

Name of Vessel

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

Name of Vessel

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

LLP license number

Name of original qualifying vessel (OQV)

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

Other vessels used under authority of this LLP license

Name of Vessel

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

Name of Vessel

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

Name of Vessel

ADF&G No.

USCG No.

Date Landings Made in 2000 and 2001

BLOCK D – LEGAL ROCKFISH LANDINGS IN CATCHER/PROCESSOR SECTOR

If you are claiming Legal Rockfish Landings in the Catcher/Processor Sector and you do not agree with the Official Rockfish Program Record, enter the following information for the catcher/processor on which legal rockfish landings were caught and processed.

LLP license number

Vessel Name

ADF&G No.

USCG No.

LLP license number

Vessel Name

ADF&G No.

USCG No.

BLOCK E -- PROCESSOR ELIGIBILITY

If you are applying as an Eligible Rockfish Processor, you must provide the following information to establish your eligibility:

1. Did the applicant receive at least 250 metric tons in round weight equivalent of aggregate legal rockfish landings of primary rockfish species each calendar year in any four of the five calendar years beginning 1996 through 2000 during the season dates for that primary rockfish species as established in Table 28 to part 679?

[__] YES [__] NO

2. If YES, enter the following information for each processor where legal rockfish landings were received.

Facility Name

ADF&G Processor Code

Qualifying years or seasons

Community Name* In Which Primary Rockfish Species Were Received

*The community is either:

o The city, if the community is incorporated as a city within the State of Alaska or

o The borough, if the community is not a city incorporated within the State of Alaska, but the community is in a borough incorporated

within the State of Alaska.

3. Enter the four calendar years from 1996 through 2000 that applicant wishes NMFS to use when determining an association with a Rockfish Cooperative.
4. Attach a copy of the contract to the application that demonstrates that the legal processing history and rights to apply for and receive processor eligibility based on that legal processing history have been transferred or retained (if applicable).

BLOCK F -- APPLICANT CERTIFICATION
The applicant must sign and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. If the application is completed by an authorized representative, attach authorization to application.
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, the information presented here is true, correct, and complete.
1. Signature of Applicant (or Authorized Representative)	2. Date Signed
3. Printed Name of Applicant (or Authorized Representative); if representative, attach authorization

_____________________________________________________________________________________

PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing the instructions, searching the existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the 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 99802-1668.

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. They are also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.

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Instructions for

Application to Participate

in the Rockfish Pilot Program

This completed application must be received by NMFS no later than January 2, 2007.

NOTE: Participant must be a U.S. Citizen or U.S. Corporation, partnership or other business.

A person who wishes to participate in the Rockfish Program as an Eligible Rockfish Harvester or Eligible Rockfish Processor must submit this application to NMFS. Use this application to apply to receive an assignment of catch history or halibut PSC history for any LLPs held by the applicant or to be eligible to receive fish from the Rockfish Pilot Program.

Type or print legibly in ink; retain a copy of completed application for your records. Completed forms should be mailed or faxed to:

NMFS Alaska Region

Restricted Access Management

P.O. Box 21668

Juneau, AK 99802-1668

FAX: (907) 586-7354

If you need additional information, contact Restricted Access Management at (800) 304-4846 (#2) or

(907) 586-7202 (#2).

Please allow at least 10 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.

Please indicate which type of eligibility to participate for which you are applying:

• Eligible Rockfish Harvester (catcher-vessel or catcher-processor sectors). Complete Blocks A and B, sign in Block F. Note: If you disagree with the Rockfish Program Official Record Summary, you must also complete Block C.

• Eligible Rockfish Processor (shoreside and stationary floating processors only). Complete Blocks A, B, and E, sign in Block F. Note: If you disagree with the Rockfish Program Official Record Summary, you must also complete block D.

NOTE: The person who holds the processing history of a shoreside processor or stationary floating processor is the person who owns the shoreside processor or stationary floating processor at the time of Application to Participate in the Rockfish Pilot Program, unless that processing history has been transferred to another person by the express terms of a written contract that clearly and unambiguously provides that such processing history has been transferred.

If the applicant did not own one or more of the processing facilities through which claiming processor eligibility, attach a copy of that contract to the application.

BLOCK A – APPLICANT INFORMATION

Enter Applicant Name, NMFS ID (if known), Tax ID or Social Security Number* (SSN), Permanent Business Mailing Address, Business Telephone, Business Facsimile, Business e-mail (if available).

*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.

Indicate (YES or NO) if the applicant is a U.S. citizen; if YES, enter his or her date of birth;

Indicate (YES or NO) if the applicant is a U.S. corporation, partnership, association, or other business entity;

if YES, enter the date of incorporation;

Indicate (YES or NO) if the applicant is a successor-in-interest to a deceased individual or to a non-individual no longer in existence, attach death certificate or evidence of dissolution to the application.

BLOCK B - AGREEMENT WITH ROCKFISH PROGRAM OFFICIAL RECORD

All Applicants must mark the box that applies to them:

♦ Agree with the Rockfish Program Official Record Summary. If you check this box, you are accepting the Rockfish Program Official Record. Proceed to Block F, sign the application and return the completed application to NMFS. Note: All applicants must complete Block E to become an Eligible Rockfish Processor.

♦ Do not agree with the Rockfish Program Official Record Summary. If you check this box, you disagree with the rockfish Program Official Records. Indicate areas of disagreement in Block C or D or attach a separate page explaining your disagreement and provide evidence to support your claims.

♦ Did not receive a Rockfish Program Official Record Summary. If you check this box, even though you did not receive an official record from NMFS, you believe that you are qualified as an eligible rockfish harvester or processor. Indicate your information in Block C or Blocks D and E or attach a separate page explaining the basis for your eligibility as an eligible rockfish harvester or processor.

BLOCK C – HARVESTER LEGAL ROCKFISH LANDINGS

If you are applying as an Eligible Rockfish Harvester and you do not agree with the Official Rockfish Program Record, enter the following information for each LLP license.

LLP license number

Original Qualifying Vessel (OQV)

Name of the OQV vessel that gave rise to the LLP license

Alaska Department of Fish and Game (ADF&G) vessel registration number

United States Coast Guard (USCG) documentation number

Dates landings made on vessel which gave rise to that LLP license

Other Vessels Used under the Authority of this LLP license

Name(s) of vessel

ADF&G vessel registration numbers

USCG documentation numbers

Dates landings made for each vessel

BLOCK D – LEGAL ROCKFISH LANDINGS IN CATCHER/PROCESSOR SECTOR

If you are applying as an Eligible Rockfish Processor in the Catcher/Processor Sector, and you do not agree with the Official Rockfish Program Record, enter the following information for each LLP license.

LLP license number

Vessel(s) name, ADF&G vessel registration number, and USCG documentation number

BLOCK E -- PROCESSOR ELIGIBILITY

If you are applying as an Eligible Rockfish Processor, you must provide the following information to establish your eligibility:

1. Indicate (YES or NO) whether applicant received at least 250 metric tons in round weight equivalent of aggregate legal rockfish landings of primary rockfish species each calendar year in any four of the five calendar years beginning 1996 through 2000 during the season dates for that primary rockfish species as established in Table 28 to part 679.

2. If YES, enter the following information for each processor where legal rockfish landings were received.

Facility Name

ADF&G Processor Code

Qualifying years or seasons

Community Name* In Which Primary Rockfish Species Were Received

*The community is either the city if the community is incorporated as a city within the State of Alaska; or the borough if the community is not in a city incorporated within the State of Alaska and the city is in a borough as incorporated within the State of Alaska

3. Enter the four calendar years from 1996 through 2000 that applicant wishes NMFS to use when determining an association with a Rockfish Cooperative.

4. Attach a copy of the contract to the application that demonstrates that the legal processing history and rights to apply for and receive processor eligibility based on that legal processing history have been transferred or retained (if applicable).

BLOCK F – APPLICANT CERTIFICATION

The applicant must print name, sign, and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. If the application is completed by an authorized representative, then authorization must accompany the application.

Application to Participate in the Rockfish Pilot Program

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