Application to Opt Out of Rockfish Fishery

Revised: 9/29/06 OMB Control No. 0648-0545

Expiration Date: 7-31-2009

Application to Opt Out of Rockfish Fishery		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
This application must be submitted annually and received by NMFS no later than 1700 hours A.l.t. on March 1 of the year for which the applicant wishes to opt-out of a rockfish fishery, or if sent by U.S. mail, the application must be postmarked by that time.
BLOCK A -- APPLICANT INFORMATION
1. Applicant name				2. NMFS person ID
				3. Tax ID or social security number* (required)
4. Permanent business mailing address
5. Business telephone number	6. Business FAX number		7. e-mail address (if available)
8. Is the applicant a U.S. citizen? [_] YES [_] NO If YES, enter date of birth ___________ 9. Is the applicant a U.S. corporation, partnership, association, or other business entity? [__] YES [__] NO If YES, enter date of incorporation: ___________________________
10. Is the applicant an Eligible Rockfish Harvester? [__] YES [__] NO 11. Is the applicant opting-out of the Rockfish Pilot Program? [__] YES [__] NO 12. Does the applicant hold an LLP license with Rockfish QS assigned to the catcher/processor sector? [__] YES [__] NO

*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.

BLOCK B -- VESSEL INFORMATION
1. Name of vessel	2. ADF&G No.
	3. USCG No.
	4. LLP license number(s)

BLOCK C -- LLP HOLDERSHIP DOCUMENTATION
Enter the names of all persons, to the individual level, holding an ownership interest in the LLP license and the percentage ownership each person and individual holds in the LLP license.
Name	% Ownership in LLP License

BLOCK D -- APPLICANT CERTIFICATION
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 Representative)	2. Date
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.

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Instructions

Application to Opt Out of Rockfish Fishery

An Eligible Rockfish Harvester who wishes to Opt-out of the Rockfish Program for a calendar year with an License Limitation Program (LLP) license assigned a Catch History Allocation in the Catcher/Processor Sector must submit an Application to Opt-out. This application must be submitted annually and received by NMFS no later than 1700 hours A.l.t. on March 1 of the year for which the applicant wishes to opt-out of a rockfish fishery, or if sent by U.S. mail, the application must be postmarked by that time.

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.

BLOCK A. APPLICANT INFORMATION

Name and NMFS person ID

Tax ID or social security number* (required)

*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

Permanent business mailing address

Business telephone number, fax number, and e-mail address (if available).

Indicate (YES or NO) whether applicant is a U.S. citizen; if YES, provide date of birth.

Indicate (YES or NO) whether applicant is a U.S. corporation; if YES, provide date of incorporation

Indicate (YES or NO) whether the applicant is an Eligible Rockfish Harvester.

Indicate (YES or NO) whether the applicant is opting-out of the Rockfish Pilot Program.

Indicate (YES or NO) whether the applicant holds an LLP license with Rockfish QS assigned

to the catcher/processor sector.

BLOCK B. VESSEL INFORMATION

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

United States Coast Guard (USCG) documentation number of the vessel

LLP license number(s) held by the applicant and used on that vessel.

BLOCK C. LLP HOLDERSHIP DOCUMENTATION

Names of all persons, to the individual level, holding an ownership interest in the LLP license

Percentage ownership each person and individual holds in the LLP license.

BLOCK D. APPLICANT CERTIFICATION

Signature of applicant (or authorized representative) and date signed

Printed name of applicant (or authorized representative); if representative, attach authorization

Application to Opt Out of Rockfish Fishery

Page 4 of 4