Western Pacific Federal Fisheries Permit Application For

FEDERAL FISHERIES PERMIT APPLICATION FORM
U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NATIONAL MARINE FISHERIES SERVICE
PACIFIC ISLANDS REGION

OMB Control No: 0648-0490
Expires: 10/31/2011

For Office Use:
GC __________
Issued _________
Transmit _________

Mail or deliver this application to:
NOAA Fisheries Pacific Islands Regional Office
ATTN: Permits
1601 Kapiolani Blvd., Suite 1110
Honolulu, Hawaii 96814-4700
Tel: (808) 944-2200; FAX: (808) 973-2940

2009-2010

(Check U one or more appropriate boxes for types of permit application)
1. PELAGIC:
± Hawaii Longline Limited Entry Permit - Renewal, Transfer, or Vessel Registration
(Non-refundable Application Processing Fee: $41.00. Make checks or money orders payable to: Dept. Of Commerce, NOAA)
± Hawaii Closed Area Exemption (see reverse side of this page, must meet all conditions to qualify)
± Western Pacific General Longline Permit (Guam, Northern Mariana Islands, Pacific Remote Island Areas)
± Western Pacific Receiving Vessel Permit (all areas)
± Pacific Remote Island Areas Troll & Handline
LOBSTER and DEEPWATER SHRIMP (Use the Western Pacific Crustacean Permit application form, OMB Control No. 0648-0586)
2. BOTTOMFISH: ± Northwestern Hawaiian Islands (NWHI) Limited Entry: Hoomalu Zone – Renewal (No fee)
± NWHI Limited Entry: Mau Zone – Renewal (Non-refundable Application Processing Fee: $33.00)
(Submit supplementary info sheet for Hoomalu and Mau Zone applications)

± Guam Large Vessel
± Pacific Remote Island Areas
(CNMI: Use the Northern Mariana Islands Bottomfish Permit application form, OMB Control No. 0648-0584)
3. PRECIOUS CORAL: ±
Permit Area (write in):

Deleted:
Deleted: x
Deleted:

Formatted: Border: Top: (No border)
Deleted: 2. LOBSTER: ± Main Hawaiian
Islands
± American Samoa
± Guam ¶
± Northern Mariana Islands
±
Pacific Remote Island Areas

Formatted: Border: Top: (No border),
Bottom: (No border)
Deleted: ¶

VESSEL NAME: _____________________________________ VESSEL OFFICIAL NO: _______________ CALL SIGN:___________

Deleted: 3

VESSEL OWNER: ____________________________________________________________

Deleted: 4

First, Middle, & Last Name or Business Name

_______________________
Taxpayer Identification Number (business)

DATE OF BIRTH (individual) OR INCORPORATION (business): _______________________________
Privacy Act Statement: Federal Regulations (at 50 CFR Part 665) authorize collection of this information. This information is used to verify the identity of the applicant(s) and to
accurately retrieve confidential records related to federal commercial fishery permits. The primary purpose for requesting the Taxpayer Identification Number is for the collection
and reporting on any delinquent amounts arising of such person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104134). Personal information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be disclosed to the public.

BUSINESS CONTACT: ___________________________________________________________/TITLE: ______________________
(First, Middle, & Last Name, if not same as vessel owner)

(corporate officer, business owner, partner)

BUSINESS MAILING ADDRESS: ________________________________________
Street/PO Box

_________________
City

______
State

____________
ZIP Code

HOME ADDRESS: _________________________________________________
Street/PO Box

_________________
City

______
State

____________
ZIP Code

BUSINESS PHONE (_____)_____________; HOME PHONE (_____)_____________; CELL PHONE (_____)______________
FAX (_____)______________ EMAIL: ______________________________________________
APPLICANT: ______________________________________________________________________

DATE: ________________

Printed Name and Signature of Vessel Owner/Permit Holder, Corporate Officer, Partner, or Designated Agent
APPLICANT TITLE: ± Vessel owner, ± Permit holder, ± Corporate officer or partner, ± Designated agent, or ± Other _____________________
(Check only one)
For Permit Transfer: to be completed and signed by originating permit holder

PERMIT TRANSFEROR: _________________________________________________________________ DATE: ________________
Printed Name & Signature of Permit Holder Transferring Permit

Permit Number of Transferred Permit:
NOTE: You must submit 1) a copy of the vessel's current U.S. Coast Guard Certificate of Documentation (documented vessel) or registration
certificate from a state/territorial agency (undocumented vessel) showing current vessel owner, 2) payment for the processing fee, if required,
with this application form, and 3) if the applicant is an agent, attach a signed letter from the permit holder authorizing the applicant as the agent.
Revised 7/1/2009
It is prohibited to file false information on any application for a fishing permit (50 CFR ' 665.15(b)).

(side two)

OMB Control No: 0648-0490
Expires: 10/31/2011

Federal Fisheries Application Form - Pacific Islands Region

SUPPLEMENTAL INFORMATION FOR:
** MAIN HAWAIIAN ISLANDS LONGLINE FISHING PROHIBITED AREA EXEMPTION**
ELIGIBLE VESSEL: __________________________________ OFFICIAL NUMBER:________________
Basis for Exemption Eligibility (all boxes must be checked and supporting documents attached to be eligible):
~ Applicant currently holds a Hawaii longline limited entry permit
~ Applicant was the owner or operator of a vessel that made landings of pelagic management unit species taken on
longline gear prior to 1970 from waters now closed to longline fishing.
~ Applicant was the owner or operator of a vessel that made landings of pelagic management unit species taken on
longline gear in at least five (5) years since (and including) 1970 from waters now closed to longline fishing.
~ Applicant was the owner or operator of a vessel that made at least 80 percent of its landings of longline-caught pelagic
management unit species in any calendar year in waters now closed to longline fishing.
Legible copies of document(s) demonstrating exemption eligibility attached (check as many boxes as may apply):
~ State of Hawaii Catch Reports ~ Vessel fishing logs
~ Auction receipts
~ Signed affidavits (original) ~ Other (specify): ____________________________________________
SIGNATURE OF APPLICANT:____________________________________________________

SUPPLEMENTARY INFORMATION FOR:
Northwestern Hawaiian Islands Bottomfish Fishery:
Hoomalu Zone Limited Access Permit Application
Mau Zone Limited Access Permit Application
VESSEL OWNER NAME:_________________________________
VESSEL NAME:________________________________________

VESSEL NO. __________________

If this permit application is filed by a partnership or corporation, indicate the names of all the owners and their respective
percentage of ownership of the partnership or corporation.
Name of Owner (Shareholder):

______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________

Percent (%) of Ownership:

________
________
________
________
________

Signature of Vessel Owner or Agent: ________________________________________
If the applicant is an agent, attach a signed letter from the vessel owner/permit holder authorizing the applicant as the
agent. It is prohibited to file false information on any application for a fishing permit (50 CFR ' 665.15(b)).

OMB Control No: 0648-0490
Expires: 10/31/2011

PAPERWORK REDUCTION ACT INFORMATION
Public reporting burden for this collection is estimated as follows: 30 minutes for Hawaii longline limited access permit renewal/transfer, longline
general permit initial issuance/renewal, and receiving vessel permit initial issuance/renewal; 2 hours for main Hawaiian Islands longline fishing
prohibited area exemption; 1 hour for permit renewals and landing waiver requests for the Hoomalu and Mau Zones limited access permits; 30
minutes for Guam bottomfish large vessel permits; 30 minutes for main Hawaiian Islands, American Samoa, Guam, and NMI crustacean permits; 30
minutes for precious coral permit initial/re-issuance (established, conditional, refugia, exploratory areas), Pacific remote island areas (PRIA) troll and
handline, bottomfish, and crustacean permits; and 2 hours for all permit denial appeals. Each burden includes 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 aspects of this collection of information, including suggestions for reducing this burden, to
NOAA Fisheries Pacific Islands Regional Administrator, 1601 Kapiolani Blvd. Suite 1110, Honolulu, Hawaii 96814-4700.
This information is being collected to ensure accurate and timely records about the persons licensed to participate in fisheries under Federal
regulations in the Western Pacific Region. This will enable NOAA Fisheries and the Western Pacific Fishery Management Council to (a) determine
who would be affected by changes in management; (b) inform license holders of changes in fishery regulations; and (c) determine whether the
objectives of the fishery program are being achieved by monitoring entry and exit patterns and other aspects of the fisheries. The information is used
in analyzing and evaluating the potential impacts of regulatory changes on persons in the regulated fisheries as well as in related fisheries. Responses
to the collection are required to obtain the benefit of a license for the fishery involved (ref. 50 CFR 665.13). Data provided concerning the vessel
and/or business of the respondents are handled as confidential under the Magnuson-Stevens Fishery Conservation and Management Act (Sec. 402(b)).
Notwithstanding any other provision of the 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.