QS/IFQ designated beneficiary form

Individual Fishing Quotas for Pacific Halibut and Sablefish in the Alaska Fisheries

0272 renewal beneficiary form

QS/IFQ Designated Beneficiary Form

OMB: 0648-0272

Document [pdf]
Download: pdf | pdf
Revised 01/24/2008

OMB Control No.: 0648-0272
Expiration Date: 04/30/2008

QS/IFQ BENEFICIARY
DESIGNATION
FORM

U.S. Dept. of Commerce/NOAA
National Marine Fisheries Service
Restricted Access Management Program
P.O. Box 21668
Juneau, AK 99802-1668
(800) 304-4846 toll free / 586-7202 in Juneau
(907) 586-7354 fax

BLOCK A - INSTRUCTIONS
•
•
•
•
•

QS holders may provide NMFS with the name of a designated beneficiary to receive survivorship transfer
privileges in the event of the QS holder’s death.
If the QS holder does not leave a surviving spouse, he/she may name an immediate family member to be
the beneficiary.
NMFS will allow the transfer of IFQ only (lease) of any QS/IFQ transferred to the beneficiary by right of
survivorship, for a period of 3 years following the death of the original QS holder.
Use this form to designate the surviving spouse, or in the absence of a surviving spouse, an immediate family
member to be the beneficiary for these purposes.
QS/IFQ can only be held by a U.S. citizen.
BLOCK B - IDENTIFICATION OF QS HOLDER
2. NMFS Person ID:

1. Name:
3. Business Mailing Address:

4. Business Telephone Number:

5. Business Fax Number:

6. Business E-mail Address:

BLOCK C - NAME OF BENEFICIARY
1. Name:

2. NMFS Person ID:

3. Business Mailing Address:

4. Business Telephone Number:

5. Business Fax Number:

6. Business E-mail Address:

BLOCK D - RELATIONSHIP OF BENEFICIARY TO QS HOLDER
Is the beneficiary named on this form the spouse of the QS holder?

YES [ ] NO [ ]

If NO, what is the immediate relationship of the beneficiary to the QS holder:
BLOCK E -- SIGNATURE
QS/IFQ Beneficiary Designation Form – Page 1of 2

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.
Signature of QS holder:

Date:

Printed Name of QS Holder (Note: If this is completed by an agent, attach agent authorization):

Notary Public:

ATTEST

Affix Notary Stamp or Seal Here:

Commission Expires:

________________________________________________________________________________________________________________________
PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 0.5 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 estimate or any other aspect of this collection of information, 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 (16 U.S.C. 1801, et seq.). They are also confidential
under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.
________________________________________________________________________________________________________________________

QS/IFQ Beneficiary Designation Form – Page 2of 2


File Typeapplication/pdf
File TitleMicrosoft Word - 0272 renewal beneficiary form.doc
Authorjlocks
File Modified2008-04-10
File Created2008-04-10

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