Application for approval as an entity to receive transfe

Revised: 06//22/2010

OMB Control No. 0648-0393, Expiration Date: 10/31/2012
U.S. Dept. of Commerce/NOAA
National Marine Fisheries Service (NMFS)
Sustainable Fisheries Division
P.O. Box 21668
Juneau, AK 99802-1668
Fax: 907-586-7131
Telephone: 907-586-7228

APPLICATION FOR APPROVAL AS AN
ENTITY TO RECEIVE TRANSFERABLE
CHINOOK SALMON PSC ALLOCATION

REQUIRED AUTHORIZATION CONTRACT ATTACHMENT
An authorization contract containing the following information must be attached:
♦

Information that documents that all vessel owners party to the contract agree that the entity, the entity’s
representative, and the entity’s agent for service of process named in this application represent them for purposes
of receiving transferable allocations of Chinook salmon Prohibited Species Catch (PSC).

♦

A statement that the entity’s representative and agent for service of process are authorized to act on behalf of the
vessel owners party to the contract and are responsible to comply with all applicable requirements of this part.

BLOCK A – CONTACT INFORMATION
1. Name of Entity:

2. NMFS Person ID:

3. Name of Entity’s Representative

4. Name of Agent for Service of Process, if different
from representative

5. Permanent Business Mailing Address:

6. Temporary Business Mailing Address (if
applicable):

7. Business Telephone No.:

8. Business Fax No.:

9. Business E-mail address:

BLOCK B – CERTIFICATION
Under penalty of perjury, I certify by my signature below that I have examined the information and the claims
provided on this application and, to the best of my knowledge and belief, the information presented here is true,
correct, and complete.
1. Printed Name of Representative:
2. Signature of Representative:
3. Date Signed:

4. Printed Name of Agent for Service
of Process (if different from
Representative):

5. Signature of Agent:

6. Date Signed:

Application for Approval as an Entity to Receive Transferable Chinook PSC Allocation
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BLOCK C – VESSEL IDENTIFICATION
For each AFA permitted vessel that the entity will represent, provide the following information. Attach additional
sheet if necessary.
Federal Fisheries
Name of vessel
ADF&G No.
Permit No.

Application for Approval as an Entity to Receive Transferable Chinook PSC Allocation
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Instructions

APPLICATION FOR APPROVAL AS AN ENTITY
TO RECEIVE TRANSFERABLE CHINOOK SALMON PSC ALLOCATION
GENERAL INFORMATION
An authorization contract containing the following information must be attached:
♦

Information that documents that all vessel owners party to the contract agree that the entity, the entity’s representative,
and the entity’s agent for service of process named in this application represent them for purposes of receiving
transferable allocations of Chinook salmon Prohibited Species Catch (PSC).

♦

A statement that the entity’s representative and agent for service of process are authorized to act on behalf of the vessel
owners party to the contract and are responsible to comply with all applicable requirements of this part.

Once submitted, the contract attached to this application is valid until amended or revoked by the parties to the contract.
Deadlines.
♦

The initial application and contract must be received by October 1.

♦

Additions or deletions to the vessel owners party to the contract or the list of vessels represented by the entity must
be received by December 1.

Additionally
♦

Retain a copy of completed application for your records.

♦

Submit the completed application online at:
Website: http://www.alaskafisheries.noaa.gov/

♦

If you have any questions, or if you need any assistance in completing the application, please call NMFS
Sustainable Fisheries at 907-586-7228.

COMPLETING THE FORM
BLOCK A – CONTACT INFORMATION
1. Name of Entity: Legibly print or type the name of the entity requesting transfer.
2. NMFS Person ID. NMFS will assign this number, if necessary.
3. Name of Entity’s Representative. Name of representative of entity.
4. Name of Agent for Service of Process, if different from representative.
5. Permanent Business Mailing Address: number, street, city, state, and zip code or post office box number

Application for Approval as an Entity to Receive Transferable Chinook PSC Allocation
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6. Temporary Business Mailing Address (if applicable): If appropriate, enter the temporary business mailing address
(the address to which the transfer documentation should be sent, if different from the permanent address).
7. Business Telephone Number, including area code.
8. Business Fax Number, including area code.
9. Business E-mail address.
BLOCK B – CERTIFICATION
1. Enter printed name and signature of the Representative, and date signed.
2. Enter printed name and signature of Agent for Service of Process (if different from the Representative),
and date signed.
BLOCK C – VESSEL INFORMATION
For each AFA permitted vessel that the entity will represent, provide the following information. Attach additional
sheet if necessary.
1. Vessel Name
2. Alaska Department of Fish and Game (ADF&G) Vessel Registration Number of vessel
3. Federal Fisheries Permit (FFP) Number of vessel
__________________________________________________________________________________________________________
PUBLIC REPORTING BURDEN STATEMENT
Public reporting for this collection of information is estimated to average 8 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to
Assistant Regional Administrator, Sustainable Fisheries Division, NOAA National Marine Fisheries Service, P.O. Box 21668, Juneau, AK 998021668.
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.) as
amended in 2006; 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act. They are also
confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.
______________________________________________________________________________________________________________________

Application for Approval as an Entity to Receive Transferable Chinook PSC Allocation
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