Application to Opt Out of Rockfish Fishery

OMB Control No. 0648-0545
Expiration Date: 07/31/2009

Revised: 04/13/2009
U.S. Dept. of Commerce/
NOAA National Marine Fisheries Service (NMFS)
Restricted Access Management (RAM)
P.O. Box 21668
Juneau, AK 99802-1668
(800) 304-4846 toll free / (907) 586-7202 in Juneau
(907) 586-7354 fax

Application to Opt Out of
Rockfish Fishery

This application must be submitted annually and received by NMFS no later than 1700 hours A.l.t. on March 1
of the year for which the applicant wishes to opt-out of a rockfish fishery, or if sent by U.S. mail, the application
must be postmarked by that time.
BLOCK A -- APPLICANT INFORMATION
2. NMFS person ID

1. Applicant name

3. Permanent business mailing address

4. Business telephone number

7. Is the applicant a U.S. citizen?

5. Business Fax number

[_] YES

[_] NO

6. e-mail address (if available)

If YES, enter date of birth ___________

8. Is the applicant a U.S. corporation, partnership, association, or other non-individual business entity?
[__] YES

[__] NO

If YES, enter date of incorporation: ___________________________

9. Is the applicant an Eligible Rockfish Harvester?
[__] YES
[__] NO
10. Is the applicant opting-out of the Rockfish Pilot Program?
[__] YES
[__] NO
11. Does the applicant hold an LLP license with Rockfish quota share (QS) assigned to the
catcher/processor sector?
[__] YES
[__] NO

1. Name of vessel

BLOCK B -- VESSEL INFORMATION
2. ADF&G No.
3. USCG No.
4. LLP license No(s)

Application to Opt Out of Rockfish Fishery
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OMB Control No. 0648-0545
Expiration Date: 07/31/2009

BLOCK C -- LLP HOLDERSHIP DOCUMENTATION
If the LLP License Holder (Applicant) is not an individual (i.e. is a corporation, partnership, association, or
some other non-individual entity), the name(s) of all owners of the Applicant must be provided, together with
the percent of ownership. In the space below, enter all of the names of all of the owners of the Applicant, and
indicate the percent of ownership. If a listed owner is not an individual, provide the same information for each
such owner until all owners, and their percent of ownership, is revealed to the individual level.
Name
% Ownership in LLP License

BLOCK D -- APPLICANT CERTIFICATION
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and
belief, the information is true, correct, and complete.
1. Signature of Applicant (or Authorized Representative)
2. Date

3. Printed Name of Applicant (or Authorized Representative); if representative, attach authorization

__________________________________________________________________________________
PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 2 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, 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 as amended in 2006. They are also
confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery
statistics.
___________________________________________________________________________________________________

Application to Opt Out of Rockfish Fishery
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OMB Control No. 0648-0545
Expiration Date: 07/31/2009

INSTRUCTIONS
Application to Opt Out of Rockfish Fishery
Issuance of a permit in response to this application may be delayed or denied if it is
determined that the applicant(s) owes any delinquent non-tax debts to any agency or
department of the United States federal government.
GENERAL INFORMATION
An Eligible Rockfish Harvester who wishes to Opt-out of the Rockfish Program for a calendar year with a
License Limitation Program (LLP) license assigned a catch history allocation in the Catcher/Processor Sector
must submit an Application to Opt-out. This application must be submitted annually and received by NMFS no
later than 1700 hours A.l.t. on March 1 of the year for which the applicant wishes to opt-out of a rockfish
fishery, or if sent by U.S. mail, the application must be postmarked by that time.
Type or print legibly in ink; retain a copy of completed application for your records.
When complete, mail application to:
NMFS Alaska Region
Restricted Access Management (RAM)
P.O. Box 21668
Juneau, AK 99802-1668
Or fax to:
FAX: (907) 586-7354
If you need additional information, contact RAM at (800) 304-4846 (#2) or (907) 586-7202 (#2).
Please allow at least 10 working days for your application to be processed. Items will be sent by first class
mail, unless you provide alternate instructions and include a prepaid mailer with appropriate postage or
corporate account number for express delivery.
COMPLETING THE APPLICATION
BLOCK A. APPLICANT INFORMATION
1. Name
2. NMFS person ID
3. Permanent business mailing address
4. Business telephone number, fax number, and e-mail address (if available).
5. Indicate whether applicant is a U.S. citizen; if YES, provide date of birth.
6. Indicate whether applicant is a U.S. corporation; if YES, provide date of incorporation
7. Indicate whether the applicant is an Eligible Rockfish Harvester.
8. Indicate whether the applicant is opting-out of the Rockfish Pilot Program.
9. Indicate whether the applicant holds an LLP license with Rockfish quota share (QS) assigned to the
catcher/processor sector.
BLOCK B. VESSEL INFORMATION
1. Name of vessel and Alaska Department of Fish and Game (ADF&G) vessel registration number
2. United States Coast Guard (USCG) documentation number
3. LLP license number(s) held by the applicant and used on that vessel.
Application to Opt Out of Rockfish Fishery
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OMB Control No. 0648-0545
Expiration Date: 07/31/2009

BLOCK C. LLP HOLDERSHIP DOCUMENTATION
Names of all persons, to the individual level, holding an ownership interest in the LLP license and the
percent of ownership each person and individual holds in the LLP license.
BLOCK D. APPLICANT CERTIFICATION
Signature of applicant (or authorized representative) and date signed
Printed name of applicant (or authorized representative); if representative, attach authorization

Application to Opt Out of Rockfish Fishery
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