Federal Fisheries Permit Application - Pacific Islands R

FEDERAL FISHERIES PERMIT APPLICATION FORM

OMB Control No: 0648-0490
Expires: xx/xx/xxxx

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NATIONAL MARINE FISHERIES SERVICE
PACIFIC ISLANDS REGION

Mail or deliver this application to:
NOAA Fisheries Pacific Islands Regional Office
ATTN: Permits
1601 Kapiolani Blvd., Suite 1110
Honolulu, Hawaii 96814-4700
Tel: (808) 944-2200; FAX: (808) 973-2940

201x
Please Print Legibly

(Check U one or more appropriate boxes for types of permit application)
1. PELAGIC:
± Hawaii Longline Limited Entry Permit - Renewal, Transfer, or Vessel Registration
(Non-refundable Application Processing Fee: $xx.xx. Make checks or money orders payable to: Dept. of Commerce, NOAA)
± Hawaii Closed Area Exemption (contact Pacific Islands Region for form)
± Western Pacific General Longline Permit (Guam, Northern Mariana Islands, Pacific Remote Island Areas)
± Western Pacific Receiving Vessel Permit (all areas)
± Pacific Remote Island Areas Troll & Handline
LOBSTER and DEEPWATER SHRIMP (Use the Western Pacific Crustacean Permit application form, OMB Control No. 0648-0586)
2. BOTTOMFISH: ± Guam Large Vessel
± Pacific Remote Island Areas
(CNMI: Use the Northern Mariana Islands Bottomfish Permit application form, OMB Control No. 0648-0584)
3. PRECIOUS CORAL: ±
Permit Area (write in):
VESSEL NAME: _____________________________________ VESSEL OFFICIAL NO: _______________ CALL SIGN:___________
VESSEL OWNER: __________________________________________________________________________________________
First, Middle, & Last Name or Business Name

PERMIT HOLDER: ____________________________________________________________
First, Middle, & Last Name or Business Name

___________________________
Taxpayer Identification Number (business)

DATE OF BIRTH (if individual) OR INCORPORATION (if business) OF PERMIT HOLDER: _______________________________
Privacy Act Statement: Federal Regulations (at 50 CFR Part 665) authorize collection of this information. This information is used to verify the identity of the applicant(s) and to
accurately retrieve confidential records related to federal commercial fishery permits. The primary purpose for requesting the Taxpayer Identification Number is for the collection
and reporting on any delinquent amounts arising of such person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104134). Personal information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be disclosed to the public.

BUSINESS CONTACT: ___________________________________________________________/TITLE: ______________________
(First, Middle, & Last Name, if not same as permit holder)

BUSINESS MAILING ADDRESS: ________________________________________
Street/PO Box
BUSINESS PHONE (_____)_______________;

(corporate officer, business owner, partner)

_________________
City

CELL PHONE (_____)________________ ;

______
State

____________
ZIP Code

FAX (_____)__________________

EMAIL: ________________________________________________________
APPLICANT: ______________________________________________________________________

DATE: ________________

Printed Name and Signature of Permit Holder, Corporate Officer, Partner, or Designated Agent
APPLICANT TITLE: ± Permit holder, ± Corporate officer or partner, ± Designated agent, or ± Other _____________________
(Check only one)
For Permit Transfer: to be completed and signed by originating permit holder

PERMIT TRANSFEROR: _________________________________________________________________ DATE: ________________
Printed Name & Signature of Permit Holder Transferring Permit

Permit Number of Transferred Permit:
REQUIRED DOCUMENTS: You must submit: 1) a copy of the vessel's current U.S. Coast Guard Certificate of Documentation (documented
vessel) or registration certificate from a state/territorial agency (undocumented vessel) showing current vessel owner, 2) payment for the
processing fee, if required, with this application form, and 3) if the applicant is an agent, attach a signed letter from the permit holder
authorizing the applicant as the agent. It is prohibited to file false information on any application for a fishing permit (50 CFR '
665.15(b)).
Revised xx/xx/xxxx

(side two)

OMB Control No: 0648-0490
Expires: xx/xx/xxxx

PAPERWORK REDUCTION ACT INFORMATION
Public reporting burden for this collection is estimated as follows: 30 minutes for Hawaii longline limited access permit renewal/transfer, WP general
longline permits and receiving vessel permits; 30 minutes for Guam bottomfish large vessel permits; 30 minutes for precious coral permits
(established, conditional, refugia, exploratory areas), Pacific remote island areas (PRIA) troll and handline and bottomfish permits; and 2 hours for all
permit denial appeals. Each burden includes time for reviewing instructions, searching 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 aspects of this
collection of information, including suggestions for reducing this burden, to Pacific Islands Regional Administrator, NOAA Fisheries Service, 1601
Kapiolani Blvd. Suite 1110, Honolulu, Hawaii 96814-4700.
This information is being collected to ensure accurate and timely records about the persons licensed to participate in fisheries under Federal
regulations in the Pacific Islands Region. This will enable NOAA Fisheries Service and the Western Pacific Fishery Management Council to (a)
determine who would be affected by changes in management; (b) inform license holders of changes in fishery regulations; and (c) determine whether
the objectives of the fishery program are being achieved by monitoring entry and exit patterns and other aspects of the fisheries. The information is
used in analyzing and evaluating the potential impacts of regulatory changes on persons in the regulated fisheries as well as in related fisheries.
Responses to the collection are required to obtain the benefit of a permit for the fishery involved (ref. 50 CFR 665.13). Data provided concerning the
proprietary business of the respondents are handled as confidential under the Magnuson-Stevens Fishery Conservation and Management Act (Sec.
402(b)). 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: 0648-0490
Expires: xx/xx/xxxx

Federal Fisheries Application Form - Pacific Islands Region

SUPPLEMENTAL INFORMATION FOR:
** MAIN HAWAIIAN ISLANDS LONGLINE FISHING PROHIBITED AREA EXEMPTION**
ELIGIBLE VESSEL: __________________________________ OFFICIAL NUMBER:________________
Basis for Exemption Eligibility (all boxes must be checked and supporting documents attached to be eligible):
~ Applicant currently holds a Hawaii longline limited entry permit
~ Applicant was the owner or operator of a vessel that made landings of pelagic management unit species taken on
longline gear prior to 1970 from waters now closed to longline fishing.
~ Applicant was the owner or operator of a vessel that made landings of pelagic management unit species taken on
longline gear in at least five (5) years since (and including) 1970 from waters now closed to longline fishing.
~ Applicant was the owner or operator of a vessel that made at least 80 percent of its landings of longline-caught pelagic
management unit species in any calendar year in waters now closed to longline fishing.
Legible copies of supporting document(s) for exemption eligibility attached (check as many boxes as may apply):
~ State of Hawaii Catch Reports ~ Vessel fishing logs
~ Auction receipts
~ Signed affidavits (original) ~ Other (specify): ____________________________________________
SIGNATURE OF APPLICANT:____________________________________________________
Privacy Act Statement: Federal Regulations (at 50 CFR Part 665) authorize collection of this information. This information is used to verify the identity of the
applicant(s) and to accurately retrieve confidential records related to federal commercial fishery permits. The primary purpose for requesting the Taxpayer Identification
Number is for the collection and reporting on any delinquent amounts arising of such person’s relationship with the government pursuant to the Debt Collection
Improvement Act of 1996 (Public Law 104-134). Personal information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be
disclosed to the public.

PAPERWORK REDUCTION ACT INFORMATION
Public reporting burden for this collection is estimated as follows: 2 hours for main Hawaiian Islands longline fishing prohibited area exemption and 2
hours for all permit denial appeals. Each burden includes time for reviewing instructions, searching 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 aspects of
this collection of information, including suggestions for reducing this burden, to Pacific Islands Regional Administrator, NOAA Fisheries Service,
1601 Kapiolani Blvd. Suite 1110, Honolulu, Hawaii 96814-4700.
This information is being collected to ensure accurate and timely records about the persons licensed to participate in fisheries under Federal
regulations in the Western Pacific Region. This will enable NOAA Fisheries and the Western Pacific Fishery Management Council to (a) determine
who would be affected by changes in management; (b) inform license holders of changes in fishery regulations; and (c) determine whether the
objectives of the fishery program are being achieved by monitoring entry and exit patterns and other aspects of the fisheries. The information is used
in analyzing and evaluating the potential impacts of regulatory changes on persons in the regulated fisheries as well as in related fisheries. Responses
to the collection are required to obtain the benefit of a permit for the fishery involved (ref. 50 CFR 665.13). Data provided concerning the vessel
and/or business of the respondents are handled as confidential under the Magnuson-Stevens Fishery Conservation and Management Act (Sec. 402(b)).
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.