Marine Mammal Authorization Program Registration Form

MARINE MAMMAL AUTHORIZATION PROGRAM
Registration Form
Regulations implementing section 118 of the Marine Mammal Protection Act (50 CFR 229.4) requires the owner
of a commercial fishing vessel engaged in a Category I or II fishery to obtain an authorization for the incidental take of marine
mammals. Failure to obtain an authorization, or to maintain a current and valid authorization, shall subject vessel owners to the
penalties of the Marine Mammal Protection Act. If you will be participating in one of the Category I or II fisheries listed on the insert of
this application, complete the following:
Please PRINT LEGIBLY and in CAPITAL LETTERS, all responses in the blocks provided. See page 6 for complete instructions.
VESSEL NAME

VESSEL STATE REG. NO. / COAST GUARD DOC. NO.

HOME PORT OF VESSEL - CITY
NO.

STATE

LAST NAME OF PRIMARY VESSEL OWNER

COMM. VESSEL LIC.

FIRST NAME OF PRIMARY VESSEL OWNER

LAST NAME OF SECONDARY VESSEL OWNER (if applicable)
M.I.

LENGTH (Ft)

M.I.

FIRST NAME OF SECONDARY VESSEL OWNER

CORPORATE NAME (if applicable)

MAILING ADDRESS (for business correspondence)

CITY

STATE

ZIP CODE
-

TELEPHONE NUMBER (including area code)
-

Fax Number (including area code)

-

-

LAST NAME OF OPERATOR (if different than owner)

-

FIRST NAME OF OPERATOR

M.I.

MAILING ADDRESS (for business correspondence)

CITY

STATE

ZIP CODE
-

TELEPHONE NUMBER (including area code)

Fax Number (including area code)

For Administrative Use Only:
M.O.

Check

No. ____________

Received By: ___________________

Date: _________________

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Certificate Issued By:

_________

Date:

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OMB Control No. 0648-0293 (expires 12/31/2008)

MARINE MAMMAL AUTHORIZATION PROGRAM
Certification
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT I AM THE OWNER OF THE ABOVE NAMED VESSEL (OR
NON-VESSEL FISHING GEAR), OR THAT I AM AUTHORIZED TO REGISTER FOR THIS AUTHORIZATION ON BEHALF
OF THE OWNER, THAT I HAVE REVIEWED ALL INFORMATION CONTAINED IN THIS DOCUMENT, AND THAT IT IS
TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

____________________________________________________
Signature

_________________________________________
Date

IF THIS REGISTRATION IS SIGNED BY A PERSON OTHER THAN THE OWNER OR AUTHORIZED REPRESENTATIVE OF THE ABOVE-NAMED
VESSEL, PLEASE COMPLETE THE FOLLOWING:
LAST NAME OF REPRESENTATIVE

FIRST NAME OF REPRESENTATIVE

M.I.

ADDRESS

CITY

STATE

ZIP CODE
-

Mail this completed registration form,
along with a check in the amount of $25.00, payable to the National Marine Fisheries Service,
to the nearest NMFS regional office listed below.
(Please allow 30 days for processing):
Lyle Enriquez
NMFS Southwest Region
501 West Ocean Blvd, Suite 4200
Long Beach, CA 90802
562 / 980-4024
e-mail: [email protected]

This collection of information is mandated by the Marine Mammal Protection Act (16 U.S.C. 1387) and by implementing regulations contained at 50 CFR
229.4. The information supplied on this form will be used by the National Marine Fisheries Service to approximate fishing effort in various fisheries
which impact marine mammal populations in U.S. waters and to alert vessel owners of applicable rules and regulations regarding the incidental take
of marine mammals in commercial fishing operations. Certain information supplied on this form may be considered proprietary and therefore subject
to data confidentiality restrictions of 50 CFR Part 229.11.
Public reporting burden for this collection of information is estimated to average 15 minutes per response for new applications and 9 minutes per
response for renewals, 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 aspect of this collection of
information, including suggestions for reducing this burden, to Director, Office of Protected Resources, National Marine Fisheries Service, 1315 EastWest Highway, Silver Spring, MD 20910, (301) 713-2332.

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MARINE MAMMAL AUTHORIZATION PROGRAM
Registration Form Instructions
VESSEL NAME: Enter the name of the vessel as it is identified for commercial fishing operations. For non-vessel fisheries,
leave this blank. A SEPARATE REGISTRATION FORM IS REQUIRED FOR EACH VESSEL, OR EACH FIXED GEAR SITE
FOR A NON-VESSEL FISHERY.
LENGTH (FT): Enter the overall length of the vessel, in feet.
HOME PORT OF VESSEL - CITY, STATE: Enter the city and state where the vessel is registered.
VESSEL STATE REGISTRATION NO./COAST GUARD DOCUMENTATION NO.: Enter either the vessel’s state registration
number OR Coast Guard Documentation number. One of these numbers must be provided or an authorization cannot be
granted. In the case of non-vessel fisheries, enter the site permit or set-net license number.
STATE COMMERCIAL VESSEL LICENSE NO.: Enter the vessel’s state commercial fishery vessel license number, if
applicable. In Alaska, this is the ADFG commercial fishery vessel license number. In California, this is the CDFG
commercial fishery vessel license number.
PRIMARY VESSEL OWNER: Enter the vessel owner’s last name, first name, and middle initial.
SECONDARY VESSEL OWNER: If the vessel is jointly owned, enter the secondary vessel owner’s last name, first name,
and middle initial.
CORPORATE NAME: If the vessel is owned by a corporation, enter the full legal name of that corporation.
MAILING ADDRESS, CITY, STATE, ZIP CODE, TELEPHONE NUMBER: Enter the address that the vessel owner or
corporate owner uses for business correspondence. Enter the vessel owner’s phone number, including area code.
SOCIAL SECURITY NUMBER: If the vessel owner participates in an Alaska Fishery, enter the vessel owner’s social security
number. THIS INFORMATION IS OPTIONAL.
OPERATOR: If the operator of the vessel is different than the owner, enter the operator’s last name, first name, and middle
initial.
MAILING ADDRESS, CITY, STATE, ZIP CODE, and TELEPHONE NUMBER: Enter the address that the operator of the
vessel uses for business correspondence. Enter the vessel owner’s phone number and fax number, including area code.
FISHERIES CHECKLIST: Check the circle corresponding to the fishery or fisheries in which you will participate during the
next year. Registration for fisheries marked with an asterisk (*) has been integrated with existing state and Federal permitting
and licensing programs. If you have a valid permit to participate in any of the fisheries marked with an asterisk (*), you are
not required to submit an MMAP registration form and processing fee in order to receive a Marine Mammal Authorization
Certificate. However, if you participate in any of the fisheries not marked with an asterisk (*), you must complete this form
and mail it to NMFS, along with the $25 processing fee. If you will not be participating in any of the fisheries identified on the
checklist, you do not need to fill out this registration form.
CERTIFICATION: The vessel owner or operator must sign and date the registration form. If someone filled out the form other
than the vessel owner or operator, enter the representative’s full name and address.
MAILING INSTRUCTIONS: After completing the registration form, mail it, along with a check in the amount of $25, payable
to the National Marine Fisheries Service, to the nearest NMFS regional office address listed on page 7. A Marine Mammal
Authorization Program certificate and decal will be sent to you in the mail. The decal must be displayed on the port side of
the vessel’s cabin or hull, and the certificate must be in the possession of the vessel operator while engaged in commercial
fishing operations.
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OMB Control No. 0648-0293 (expires 12/31/2008)