Fishermen's Data Request Form

NOAA National Marine Fisheries Service At-sea Hake Observer Program

DATA RELEASE FOR COPIES OF OBSERVER DATA
_______________________
(Date of Request)
Dear ASHOP Coordinator:
I, _______________________________, request and authorize the release to myself observer
data collected on the vessel __________________, USCG or state registration # ____________.

I: (circle one and fill in permit/license # if applicable)
Own permit/license #: _______________
Hold permit/license #: _______________
Do not own or hold a permit or license but am the captain of the above vessel
Do not own or hold a permit or license but am the vessel owner of the above vessel
I am requesting all observer data collected from _____________ to _______________.
I am making this request as the permit holder or the authorized representative of the owner(s), of
the said permit/license/vessel. I understand that I am responsible for these data upon release to
me by NOAA Fisheries. I further understand that the data I receive may be preliminary, and not
yet completely reviewed by the At-sea Hake Observer Program.
____________________________________
(SIGNED NAME)
Address to which data should be sent:
____________________________________
Name
____________________________________
Street/ PO Box
____________________________________
City, State, Zip

OMB Control No. 0648‐xxxx Expires xx/xx/2012        

PAPERWORK REDUCTION ACT STATEMENT: The information provided on this form will
be used to ensure that the data for a specific trip is not provided to a person who does not have
authority to obtain that data under the confidentiality requirements of the Magnuson-Stevens
Fishery Conservation and Management Act (MSA). Meeting those confidentiality requirements
is critical for collecting information that is used in analyses that support the conservation and
management of living marine resources and that are required under the MSA, the Endangered
Species Act (ESA), the MMPA, the National Environmental Policy Act (NEPA), the Regulatory
Flexibility Act (RFA), Executive Order 12866 (EO 12866), and other applicable law. The public
reporting burden for this form is estimated to average 5 minutes per response, including the time
for completing, reviewing, and transmitting the information on the form. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden to: At-sea Hake Observer Program, 2725 Montlake Blvd.
East, Seattle, WA 98112. Providing the requested information is required to obtain the observer
data you have requested. The information on this form will be kept confidential as required
under Section 402(b) of the MSA (18 U.S.C. 1881a(b)) and regulations at 50 C.F.R. Part 600,
Subpart E. 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.

OMB Control No. 0648‐xxxx Expires xx/xx/2012