Compliance Information Sheet (VMS certification under Qu

Papahānaumokuākea Marine National Monument
Compliance Information Sheet
OMB Control # 0648-0548
Page 1 of 4

Papahānaumokuākea Marine National Monument
Compliance Information Sheet
1. Updated list of personnel to be covered by permit. List all personnel names and
their roles here (e.g. John Doe, Diver; Jane Doe, Field Technician, Jerry Doe,
Medical Assistant):

2. Specific Site Location(s): (Attach copies of specific collection locations):

3. Other permits (list and attach documentation of all other related Federal or State
permits):

3a. For each of the permits listed, identify any permit violations or any permit that
was suspended, amended, modified or revoked for cause. Explain the circumstances
surrounding the violation or permit suspension, amendment, modification or
revocation.

4. Funding sources (Attach copies of your budget, specific to proposed activities
under this permit and include funding sources. See instructions for more
information):

5. Time frame:
Activity start:
Activity completion:

Dates actively inside the Monument:
From:
To:

Describe any limiting factors in declaring specific dates of the proposed activity at the
time of application:

Personnel schedule in the Monument:

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Papahānaumokuākea Marine National Monument
Compliance Information Sheet
OMB Control # 0648-0548
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6. Indicate (with attached documentation) what insurance policies, bonding
coverage, and/or financial resources are in place to pay for or reimburse the
Monument trustees for the necessary search and rescue, evacuation, and/or removal
of any or all persons covered by the permit from the Monument:

7. Check the appropriate box to indicate how personnel will enter the Monument:
Vessel
Aircraft
Provide Vessel and Aircraft information:

8. The certifications/inspections (below) must be completed prior to departure for
vessels (and associated tenders) entering the Monument. Fill in scheduled date
(attach documentation):
Rodent free, Date:
Tender vessel, Date:
Ballast water, Date:
Gear/equipment, Date:
Hull inspection, Date:
9. Vessel information (NOTE: if you are traveling aboard a National Oceanic and
Atmospheric Administration vessel, skip this question):
Vessel name:
Vessel owner:
Captain's name:
IMO#:
Vessel ID#:
Flag:
Vessel type:
Call sign:
Embarkation port:
Last port vessel will have been at prior to this embarkation:
Length:
Gross tonnage:
Total ballast water capacity volume (m3):
Total number of ballast water tanks on ship:
Total fuel capacity:
Total number of fuel tanks on ship:
Marine Sanitation Device:
Type:

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Papahānaumokuākea Marine National Monument
Compliance Information Sheet
OMB Control # 0648-0548
Page 3 of 4

Explain in detail how you will comply with the regulations regarding discharge in the
Monument. Describe in detail. If applicable, attach schematics of the vessel's discharge
and treatment systems:
Other fuel/hazardous materials to be carried on board and amounts:
Provide proof of a National Oceanic and Atmospheric Administration (NOAA) Office of
Law Enforcement-approved Vessel Monitoring System (VMS). Provide the name and
contact information of the contractor responsible for installing the VMS system. Also
describe VMS unit name and type:
VMS Email:
Inmarsat ID#:
* Individuals MUST ENSURE that a type-approved VMS unit is installed and that its
automatic position reports are being properly received by the NOAA OLE system prior to
the issuance of a permit. To make sure your VMS is properly configured for the NOAA
OLE system, please contact NOAA OLE at (808) 203-2503 or (808) 203-2500.
* PERMITS WILL NOT BE ISSUED TO INDIVIDUALS ENTERING THE
MONUMENT VIA VESSEL UNTIL NOAA OLE HAS CONTACTED THE
MONUMENT PERMIT COORDINATOR WITH A ‘POSITIVE CHECK’ READING.

10. Tender information:
On what workboats (tenders) will personnel, gear and materials be transported within the
Monument? List the number of tenders/skiffs aboard and specific types of motors:

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Papahānaumokuākea Marine National Monument
Compliance Information Sheet
OMB Control # 0648-0548
Page 4 of 4

Additional Information for Land Based Operations
11. Proposed movement of personnel, gear, materials, and, if applicable, samples:

12. Room and board requirements on island:

13. Work space needs:

DID YOU INCLUDE THESE?
Map(s) or GPS point(s) of Project Location(s), if applicable
Funding Proposal(s)
Funding and Award Documentation, if already received
Documentation of Insurance, if already received
Documentation of Inspections
Documentation of all required Federal and State Permits or applications for permits

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