Conservation and Management permit instructions and appl

OMB Control# 0648-0548

Papahānaumokuākea Marine National Monument
Conservation and Management Permit Application Instructions
January 2008
Introduction
On June 15, 2006, President Bush established the Papahānaumokuākea Marine National
Monument (Presidential Proclamation 8031, 71 FR36443, June 26, 2006) under the authority of
the Antiquities Act (Act) (16 U.S.C. 431). The Proclamation reserves all lands and interests in
lands owned or controlled by the Government of the United States in the Northwestern Hawaiian
Islands (NWHI), including emergent lands and submerged lands and waters, out to a distance of
approximately 50 nautical miles (nmi) from the islands. The outer boundary of the Monument is
approximately 1040 nmi long by 100nmi wide, extending around coral islands, seamounts,
banks, and shoals. The area includes the Northwestern Hawaiian Islands Coral Reef Ecosystem
Reserve, the Midway Atoll National Wildlife Refuge/Battle of Midway National Memorial, and
the Hawaiian Islands National Wildlife Refuge and the Northwestern Hawaiian Islands State
Marine Refuge.
The three principals with responsibility for managing lands and waters of the Monument, the
Department of Commerce, Department of Interior, and the State of Hawaii (collectively the CoTrustees), work cooperatively to administer the Monument. This relationship is further
described in the Memorandum of Agreement among the Co-Trustees signed on December 8,
2006.
Permit Application Deadlines
Permit applications must be received by:
• February 1: For activities occurring between June 1 and Aug 31
• May 1: For activities occurring between September 1 and December 31
• September 1: For activities occurring between January 1 and May 31
NOTE: Issuance of a Monument permit is dependent upon the completion and review of the
application and Compliance Information Sheet.
Confidential Information
The Co-Trustees intend to post completed permit applications on the Internet for public review.
Applicants are requested to indicate any information that is considered proprietary business
information. Such information is typically exempt from disclosure to anyone requesting
information pursuant to the Freedom of Information Act (FOIA) and all applicable State law.
NOAA, the U.S. Fish and Wildlife Service and the State of Hawaii attempt to protect such
proprietary information, consistent with all application FOIA exemptions in 5 U.S.C. 552(b) and
applicable State law. Typically exempt information includes trade secrets, commercial and
financial information (5U.S.C. 552(b) (4)). Personal information affecting an individual’s
privacy will also be kept confidential consistent with 5 U.S.C. 552(b) (6) and applicable State
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law. Unless such information is so identified, the application may be made available to the
public in its entirety.
Intellectual Property
The permittee retains ownership of any data, derivative analyses or other work product, or any
photographic or video material, or other copyrightable works, but the Federal Government and
the State of Hawaii retain a lifetime, non-exclusive, worldwide, royalty-free license to use the
same for government purposes, including copying and redissemination, and making derivative
works.
Indemnification
The permittee and any person participating in any activity authorized by this permit shall release,
indemnify, and hold harmless National Oceanic and Atmospheric Administration, the
Department of Commerce, the U.S. Fish and Wildlife Service, the Department of the Interior, the
United States Government, the State of Hawaii, and their respective employees acting within the
scope of their duties from and against any claims, demands, actions, liens, rights, subrogated or
contribution interests, debts, liabilities, judgments, costs, and attorney's fees, arising out of,
claimed on account of, or in any manner predicated upon the issuance of this permit or the entry
into or habitation upon the Papahānaumokuākea Marine National Monument or as the result of
any action of the permittee or persons participating in the activity authorized by this permit.
Reporting Burden
Submittal of the information requested in these guidelines is required to obtain a permit pursuant
to Monument regulations (50 CFR Part 404). This data is to evaluate the potential benefits of the
activity, determine whether the proposed methods will achieve the proposed results, evaluate any
possible detrimental environmental impacts, and determine if issuance of a permit is appropriate.
It is through this evaluation that the Co-trustees are able to use permitting as one of the
management tools to protect Monument resources and qualities.
Public reporting burden for this collection of information, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information is estimated as:
A. Twenty-four (24) hours per response for Special Ocean Use permits;
B. Five (5) hours per response for General (Research, Conservation and Management, and
Education), Native Hawaiian Practices, and Recreation permits;
C. Four (4) hours per response for VMS installation and maintenance;
D. Five (5) minutes per response for entry and exit notices and VMS certification;
E. Five (5) seconds per response for hourly VMS reports.
Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Papahānaumokuākea Marine
National Monument Permit Coordinator, 6600 Kalaniana'ole Hwy. # 300, Honolulu, HI 96825.
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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.

Directions for filling out the Monument Permit Application
1. Download the Conservation and Management permit application form. If you are unsure
of the category for your proposed project, contact the Monument Permit Coordinator
(contact information below).
2. Click on the document to open.
3. You will now be able to type in all the gray text field boxes and check boxes.
4. You will not be able to alter, copy, delete or modify the permit application questions and
cover page in any way.
If you have difficulty filling out the application, contact the PMNM Permit Coordinator at (808)
397-2660 or [email protected].

Send Permit Applications to:
Papahānaumokuākea Marine National Monument Permit Coordinator
6600 Kalaniana'ole Hwy. # 300
Honolulu, HI 96825
[email protected]
PHONE: (808) 397-2660
FAX: (808) 397-2662
NOTE: SUBMITTAL VIA ELECTRONIC MAIL IS PREFERRED BUT NOT
REQUIRED. YOU ARE ALSO REQUIRED TO SEND ONE SIGNED ORIGINAL
APPLICATION VIA MAIL TO THE MONUMENT OFFICE ABOVE:

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Papahānaumokuākea Marine National Monument
CONSERVATION AND MANAGEMENT Permit Application Instructions
NOTE: This Permit Application (and associated Instructions) are to propose activities to be
conducted in the Papahānaumokuākea Marine National Monument. The Co-Trustees are
required to determine that issuing the requested permit is compatible with the findings of
Presidential Proclamation 8031. Within this Application, provide all information that you
believe will assist the Co-Trustees in determining how your proposed activities are compatible
with the conservation and management of the natural, historic and cultural resources of the
Papahānaumokuākea Marine National Monument (Monument).

Permit Application Cover Sheet Summary Information
NOTE: The permit application cover sheet is intended to provide summary information on
permit applications for activities proposed to occur in the Papahānaumokuākea Marine National
Monument. Information submitted in this section will be posted on the Monument website to
inform the public regarding projects proposed to occur in the Monument.
Applicant Name: Enter the name of the person who is in charge of the proposed activity and
who will be responsible for all the personnel and actions under the authority of the requested
Monument permit.
Affiliation: Specify the Applicant’s affiliation, if any, in relation to the proposed project.
Proposed Activity Dates: Specify the dates of your activities.
Proposed Method of Entry: Specify whether you will enter the Monument via vessel or
aircraft.
Proposed Locations: Provide a brief summary of the location(s) for proposed activities (e.g.
French Frigate Shoals, or 300-1500 meters depth east of Twin Banks, etc.). NOTE: Specific
GPS and other location information are requested in the Monument Compliance Information
Sheet.
Estimated number of individuals to be covered under this permit: Provide an ESTIMATE
of the number of individuals (including Applicant) to be covered under this permit.
Estimated number of days in the Monument: Provide the ESTIMATED number of days in
the Monument.

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Description of proposed activities: Include a brief description of the proposed activities,
including the following:
•
Define the objective of the proposed activity (The proposed activity would. . .)
•
Identify what the action would entail (To accomplish this activity we would. . .)
•
Explain the benefit of the activity to the Monument (This activity would help the
Monument by. . .)
Other information or Background: Include any other information relevant to your proposed
activity summary.

Section A: Applicant Information
1. State the name and title of the Applicant. The Applicant is the individual who is in charge of
the proposed activity and, therefore, responsible for all the personnel and actions undertaken
under the authority of the any Monument Permit issued pursuant to this application. Attach the
Applicant’s CV, resume or biography if applicable.
1a. If the Applicant will not be present in the Monument for the proposed activities in the
application, provide the full name(s), affiliation(s) and contact information of the person or
persons responsible for ensuring the permit conditions are followed in the Monument. Attach
their respective CV, resume, or biography if applicable.
2. State the Applicant’s mailing address, phone number, fax number, and email address. If the
Applicant is a student, state the Major Professor’s contact information in addition to his/her own.
3. Specify the Applicant’s affiliation, if any, in relation to the proposed project.
4. List all personnel roles and/or names. Include first and last name, position (Research Diver,
Field Technician, Medical Assistant, etc.), affiliation, telephone number, and email address for
each individual. If specific names of all participants are not known at the time this form is
submitted, then specific roles must be provided as placeholders for numbers of persons requested
to enter the Monument. The Application Review Committee may request resumes, biographies,
or CVs for any personnel listed, at a later date. Attach additional information if necessary.
It is the Applicant’s responsibility to keep Monument staff apprised of any proposed personnel
changes. Full names of personnel and roles will be required in the Monument Compliance
Information Sheet prior to issuance of a permit.

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Section B: Project Information
5a. Project Location: Check the boxes of all applicable locations where the proposed activities
will occur. Indicate whether your project will occur on land, in the ocean, or both. Also indicate
whether your project will occur in deep water or shallow water, or both. Shallow water is
defined by water less than 100 meters in depth. NOTE: Include alternate locations if
appropriate.
* Location Description: Provide a description of the location of the proposed activity that
includes sufficient detail. Refer to the Monument Compliance Information Sheet for information
on including specific site and collection location(s).
5b. Check all applicable regulated activities proposed to be conducted in the Monument by the
Applicant at any of the locations mentioned in 5a.
*Removing, moving, taking, harvesting, possessing, injuring, disturbing, or damaging, or
attempting to remove, move, take, harvest, possess, injure, disturb, or damage any living or
nonliving Monument resource.
*Drilling into, dredging, or otherwise altering the submerged lands other than by anchoring a
vessel; or constructing, placing, or abandoning any structure, material, or other matter on the
submerged lands.
*Anchoring means dropping anything on to the ocean bottom with the intention of holding
something fast to the bottom. Generally an anchor secures a vessel, but it may also be used for a
mooring or any other item.
*Deserting a vessel aground, at anchor, or adrift.
*Discharging or depositing any material into Special Preservation Areas or the Midway Atoll
Special Management Area except vessel engine cooling water, weather deck runoff, and vessel
engine exhaust.
OR
*Discharging or depositing any material or other matter into the Monument, or discharging or
depositing any material or other matter outside of the Monument that subsequently enters the
Monument and injures any resources of the Monument, except fish parts (i.e. chumming material
or bait) used in and during authorized fishing operations, or discharges incidental to vessel use
such as deck wash, approved marine sanitation device effluent, cooling water, and engine
exhaust.
*Touching any coral, living or dead.
*Possessing fishing gear except when stowed and not available for immediate use during passage
without interruption through the Monument.
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*Attracting any living Monument resources.
*Sustenance Fishing means fishing for bottomfish or pelagic species within Federal waters, but
outside of Special Preservation Areas, Ecological Reserves and the Midway Atoll Special
Management Area, in which all catch is consumed within the Monument, and that is incidental to
another activity permitted under Presidential Proclamation 8031.
*Subsistence Fishing means fishing for bottomfish or pelagic species in State waters in which all
catch is for direct personal consumption within the Monument, and that is incidental to another
activity permitted under Presidential Proclamation 8031.
*Swimming means entering the water and propelling oneself by movements of the limbs,
without special equipment of any kind.
*Snorkeling means entering the water and swimming with the aid of a mask, snorkel, and fins, or
any combination of the aforementioned equipment.
*SCUBA Diving means entering the water and submerging oneself with the aid of self-contained
underwater breathing apparatus.
6. State the purpose of the proposed activities, including the goals and objectives of the activities.
7. The Secretaries of Commerce and Interior are required to determine that issuing the requested
permit is compatible with the Findings of Presidential Proclamation 8031. Answer the
Monument findings below and provide information that you believe will assist the Co-Trustees
in determining your proposed activities are compatible with the conservation and management of
the natural, historic and cultural resources of the Monument:
The Findings are as follows:
a. How can the activity be conducted with adequate safeguards for the cultural, natural and
historic resources and ecological integrity of the Monument?
b. How will the activity be conducted in a manner compatible with the management direction of
the proclamation, considering the extent to which the conduct of the activity may diminish or
enhance Monument cultural, natural and historic resources, qualities, and ecological integrity,
any indirect, secondary, or cumulative effects of the activity, and the duration of such effects?
c. Is there a practicable alternative to conducting the activity within the Monument? If not,
explain why your activities must be conducted in the Monument.
d. How does the end value of the activity outweigh its adverse impacts on Monument cultural,
natural and historic resources, qualities, and ecological integrity?
e. Explain how the duration of the activity is no longer than necessary to achieve its stated
purpose.
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f. Provide information demonstrating that you are qualified to conduct and complete the activity
and mitigate any potential impacts resulting from its conduct.
g. Provide information demonstrating that you have adequate financial resources available to
conduct and complete the activity and mitigate any potential impacts resulting from its conduct.
h. Explain how the methods and procedures proposed by the applicant are appropriate to achieve
the proposed activity's goals in relation to their impacts to Monument cultural, natural and
historic resources, qualities, and ecological integrity.
i. Has your vessel has been outfitted with a mobile transceiver unit approved by OLE and
complies with the requirements of Presidential Proclamation 8031?
j. Demonstrate that there are no other factors that would make the issuance of a permit for the
activity inappropriate.
8. Describe the procedures and methods you will use in performing the proposed activity while
within the Monument.
Describe in detail how you will get to your work locations and specific sites (walking, climbing,
wading, swimming, snorkeling, diving, boating, etc.). Will you need to enter a seabird colony?
Will you need access to beaches? Will you work at night?
Will you request assistance from Monument staff to maintain the equipment or collect data or
samples in association with the proposed activity in your absence or presence? If so, describe
procedures for doing so including how often it is to occur and how long it will take per
maintenance/data/sample collection event. Describe how you plan to compensate volunteers for
the maintenance or data/sample collection work.
NOTE: If you will not collect specimens, you may enter “N/A” for questions 9-10 and skip to
question 11.
9a. List all specimens (organisms or objects) you plan to collect. If applicable, list each species
common name, scientific name, number to be collected, maximum size of specimens to be
collected, amount taken and the size of the organism from which you will take any sample(s),
and general collection location requested in #5a. Also indicate whether you will take the whole
organism or a subsample thereof.
9b. List the post project disposition of specimens. What will be done with the parts of samples
that are not used in your initial analysis?
9c. Check the appropriate box to indicate if the organisms will be kept alive after collection. If
the organisms are to be kept alive, state where will they be housed. (Provide the general site
and/or location.) Also check the appropriate box to indicate if there is an open or closed-system
for maintaining living organisms and if there is an outfall or discharge. If applicable, note
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whether the organisms will be kept with other species and if so, the species names of the other
organisms. Will any organisms be released? If so, where?
10. How will the collected samples be transported out of the Monument? Will samples be
transported by vessel or aircraft? Will samples be transported frozen, in formalin, in alcohol, or
other media?
11. Describe whether you are collaborating with others to reduce duplicative activities in the
Monument or elsewhere in the State of Hawaii or other Pacific Remote Island National Wildlife
Refuges. If you are collecting samples for someone else, stipulate to whom the samples will be
provided and give their Monument permit number. Also, list State of Hawaii and United States
Fish and Wildlife Service permit numbers for any relevant collaborations or research related to
this project, including projects in the main Hawaiian Islands and Pacific Remote Island National
Wildlife Refuges. Provide information on permit applications for related conservation and
management activities or research that are under review at any of the above agencies.
12. Provide a complete itemized list of work related gear/equipment/supplies, including
collecting equipment, radio isotopes, dive equipment, etc. that will be taken into and removed
from the Monument. If you wish to store any items on any island between field seasons, request
so here. Indicate how and where you propose the stored items be kept. If you propose to take
any work or personal items ashore that will require use of resources (electrical, power, water, or
other resources) also describe that in this section.
13. For any Hazardous Materials also include the following information:
*List all hazardous materials by common name, proper shipping name, hazard class, and amount
to be taken into the Monument. Provide a Material Safety Data Sheet for each hazardous
material.
*Describe how each hazardous material will be contained and stored while in the Monument.
*Describe how each hazardous material will be used for the proposed activity. Describe how
and when each hazardous material will be removed from the Monument.
NOTE: The Principal Investigator (Applicant) is responsible for disposal of, storage or
unauthorized use of any left-over hazardous materials from any permitted activity.
14. If applicable, indicate the types of permanent or semi-permanent installments you would like
to install in the Monument, and answer the following questions:
*What is it made of?
*What will be installed?
*How will it be installed?
*Where will it be installed?
*How long will it be installed?
*Will the installation require maintenance? If so, who will conduct the maintenance and how
often?
*How and when will the installation be removed?

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15. Provide information regarding the projected completion dates of the following: sample
analysis, write-up and publication of information gathered within the Monument.
16. List all Applicant’s publications directly related to the proposed project.

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Permit Application – Conservation and Management
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Papahānaumokuākea Marine National Monument
CONSERVATION AND MANAGEMENT Permit Application
NOTE: This Permit Application (and associated Instructions) are to propose activities to be
conducted in the Papahānaumokuākea Marine National Monument. The Co-Trustees are
required to determine that issuing the requested permit is compatible with the findings of
Presidential Proclamation 8031. Within this Application, provide all information that you
believe will assist the Co-Trustees in determining how your proposed activities are compatible
with the conservation and management of the natural, historic, and cultural resources of the
Papahānaumokuākea Marine National Monument (Monument).
ADDITIONAL IMPORTANT INFORMATION:
•

Any or all of the information within this application may be posted to the
Monument website informing the public on projects proposed to occur in the
Monument.

•

In addition to the permit application, the Applicant must either download the
Monument Compliance Information Sheet from the Monument website OR request
a hard copy from the Monument Permit Coordinator (contact information below).
The Monument Compliance Information Sheet must be submitted to the Monument
Permit Coordinator after initial application consultation.

•

Issuance of a Monument permit is dependent upon the completion and review of the
application and Compliance Information Sheet.

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
Send Permit Applications to:
Papahānaumokuākea Marine National Monument Permit Coordinator
6600 Kalaniana'ole Hwy. # 300
Honolulu, HI 96825
[email protected]
PHONE: (808) 397-2660
FAX: (808) 397-2662
SUBMITTAL VIA ELECTRONIC MAIL IS PREFERRED BUT NOT REQUIRED. FOR
ADDITIONAL SUBMITTAL INSTRUCTIONS, SEE THE LAST PAGE.

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Papahānaumokuākea Marine National Monument
Permit Application Cover Sheet
This Permit Application Cover Sheet is intended to provide summary information and status to
the public on permit applications for activities proposed to be conducted in the
Papahānaumokuākea Marine National Monument. While a permit application has been received,
it has not been fully reviewed nor approved by the Monument Management Board to date. The
Monument permit process also ensures that all environmental reviews are conducted prior to the
issuance of a Monument permit.

Summary Information
Applicant Name:
Affiliation:
Permit Category: Conservation and Management
Proposed Activity Dates:
Proposed Method of Entry (Vessel/Plane):
Proposed Locations:

Estimated number of individuals (including Applicant) to be covered under this permit:
Estimated number of days in the Monument:
Description of proposed activities: (complete these sentences):
a.) The proposed activity would…

b.) To accomplish this activity we would ….

c.) This activity would help the Monument by …

Other information or background:

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Section A - Applicant Information
1. Applicant
Name (last, first, middle initial):
Title:

1a. Intended field Principal Investigator (See instructions for more information):

2. Mailing address (street/P.O. box, city, state, country, zip):
Phone:
Fax:
Email:
For students, major professor’s name, telephone and email address:

3. Affiliation (institution/agency/organization directly related to the proposed project):

4. Additional persons to be covered by permit. List all personnel roles and names (if
known at time of application) here (e.g. John Doe, Research Diver; Jane Doe, Field
Technician):

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Section B: Project Information
5a. Project location(s):
Nihoa Island
Necker Island (Mokumanamana)
French Frigate Shoals
Gardner Pinnacles
Maro Reef
Laysan Island
Lisianski Island, Neva Shoal
Pearl and Hermes Atoll
Midway Atoll
Kure Atoll
Other

Land-based
Land-based
Land-based
Land-based

Ocean Based
Shallow water
Shallow water
Shallow water
Shallow water

Deep water
Deep water
Deep water
Deep water

Land-based
Land-based
Land-based
Land-based
Land-based

Shallow water
Shallow water
Shallow water
Shallow water
Shallow water

Deep water
Deep water
Deep water
Deep water
Deep water

NOTE: There is a fee schedule for people visiting Midway Atoll National Wildlife Refuge via
vessel and aircraft.
Location Description:

5b. Check all applicable regulated activities proposed to be conducted in the Monument:
Removing, moving, taking, harvesting, possessing, injuring, disturbing, or damaging any
living or nonliving Monument resource
Drilling into, dredging, or otherwise altering the submerged lands other than by anchoring a
vessel; or constructing, placing, or abandoning any structure, material, or other matter on the
submerged lands
Anchoring a vessel
Deserting a vessel aground, at anchor, or adrift
Discharging or depositing any material or matter into the Monument
Touching coral, living or dead
Possessing fishing gear except when stowed and not available for immediate use during
passage without interruption through the Monument
Attracting any living Monument resource
Sustenance fishing (Federal waters only, outside of Special Preservation Areas, Ecological
Reserves and Special Management Areas)
Subsistence fishing (State waters only)
Swimming, snorkeling, or closed or open circuit SCUBA diving within any Special
Preservation Area or Midway Atoll Special Management Area

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6 Purpose/Need/Scope State purpose of proposed activities:

7. Answer the Findings below by providing information that you believe will assist the CoTrustees in determining how your proposed activities are compatible with the conservation
and management of the natural, historic, and cultural resources of the Monument:
The Findings are as follows:
a. How can the activity be conducted with adequate safeguards for the cultural, natural and
historic resources and ecological integrity of the Monument?

b. How will the activity be conducted in a manner compatible with the management direction of
this proclamation, considering the extent to which the conduct of the activity may diminish or
enhance Monument cultural, natural and historic resources, qualities, and ecological integrity,
any indirect, secondary, or cumulative effects of the activity, and the duration of such effects?

c. Is there a practicable alternative to conducting the activity within the Monument? If not,
explain why your activities must be conducted in the Monument.

d. How does the end value of the activity outweigh its adverse impacts on Monument cultural,
natural and historic resources, qualities, and ecological integrity?

e. Explain how the duration of the activity is no longer than necessary to achieve its stated
purpose.

f. Provide information demonstrating that you are qualified to conduct and complete the activity
and mitigate any potential impacts resulting from its conduct.

g. Provide information demonstrating that you have adequate financial resources available to
conduct and complete the activity and mitigate any potential impacts resulting from its conduct.

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h. Explain how your methods and procedures are appropriate to achieve the proposed activity's
goals in relation to their impacts to Monument cultural, natural and historic resources, qualities,
and ecological integrity.

i. Has your vessel has been outfitted with a mobile transceiver unit approved by OLE and
complies with the requirements of Presidential Proclamation 8031?

j. Demonstrate that there are no other factors that would make the issuance of a permit for the
activity inappropriate.

8. Procedures/Methods:

NOTE: If land or marine archeological activities are involved, contact the Monument
Permit Coordinator at the address on the general application form before proceeding, as a
customized application will be needed. For more information, contact the Monument office
on the first page of this application.

9a. Collection of specimens - collecting activities (would apply to any activity): organisms
or objects (List of species, if applicable, attach additional sheets if necessary):
Common name:

Scientific name:

# & size of specimens:

Collection location:

Whole Organism

Partial Organism

9b. What will be done with the specimens after the project has ended?

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9c. Will the organisms be kept alive after collection?

Yes

No

• General site/location for collections:

• Is it an open or closed system?

• Is there an outfall?

Yes

Open

Closed

No

• Will these organisms be housed with other organisms? If so, what are the other organisms?

• Will organisms be released?

10. If applicable, how will the collected samples or specimens be transported out of the
Monument?

11. Describe collaborative activities to share samples, reduce duplicative sampling, or
duplicative research:

12. List all specialized gear and materials to be used in this activity:

13. List all Hazardous Materials you propose to take to and use within the Monument:

14. Describe any fixed installations and instrumentation proposed to be set in the
Monument:

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15. Provide a time line for sample analysis, data analysis, write-up and publication of
information:

16. List all Applicant’s publications directly related to the proposed project:

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Papahānaumokuākea Marine National Monument
Permit Application – Conservation and Management
OMB Control # 0648-0548
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With knowledge of the penalties for false or incomplete statements, as provided by 18 U.S.C.
1001, and for perjury, as provided by 18 U.S.C. 1621, I hereby certify to the best of my abilities
under penalty of perjury of that the information I have provided on this application form is true
and correct. I agree that the Co-Trustees may post this application in its entirety on the Internet.
I understand that the Co-Trustees will consider deleting all information that I have identified as
“confidential” prior to posting the application.
_________________________________________________________________
Signature
Date

SEND ONE SIGNED APPLICATION VIA MAIL TO THE MONUMENT OFFICE
BELOW:
Papahānaumokuākea Marine National Monument Permit Coordinator
6600 Kalaniana'ole Hwy. # 300
Honolulu, HI 96825
FAX: (808) 397-2662

DID YOU INCLUDE THESE?
Applicant CV/Resume/Biography
Intended field Principal Investigator CV/Resume/Biography
Electronic and Hard Copy of Application with Signature
Statement of information you wish to be kept confidential
Material Safety Data Sheets for Hazardous Materials

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