First Receive Site License Application

OMB Control No. 0648-0620; Expiration Date: 11/30/2014

FIRST RECEIVER SITE
LICENSE
PACIFIC COAST
GROUNDFISH

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service, Northwest Region
Fisheries Permits Office
7600 Sand Point Way NE, Bldg. 1
Seattle, WA 98115-0070
Phone (206) 526-4353

Fax (206) 526-4461

www.nwr.noaa.gov

INSTRUCTIONS
This form must be completed and submitted to the National Marine Fisheries Service (NMFS) at the address
given above to apply for a first receiver site license. A first receiver site license authorizes a buyer to receive,
purchase, or take custody or control of an IFQ landing at the physical location of the facility given on the license.
This license is effective upon approval by NMFS.
Section A – First Receiver Information
The applicant must provide the name of the first receiver as given on the state buyer’s license, the state in which
the buyer’s license was issued and the buyer license number. The buyer’s license must be issued by the state in
which the receiving facility is located as given in Section B. A copy of the state buyer’s license must be included
with the application. Provide the tax identification number if the first receiver is a business entity or date of birth if
an individual. The applicant must provide the first receiver’s business address, phone number, fax number
(optional) and email address. Please provide the name of contact person if the first receiver is a business entity
and phone number if different from that given for the first receiver business entity.
Section B – Physical Location of Receiving Facility
The applicant must provide the name of the legal owner of the landing facility where the IFQ landings will occur,
the owner’s tax identification number or date of birth (if individual), the physical location of the receiving facility
(street address only), city, state and zip code. The applicant must provide a phone number, fax number and
email address (optional) and the name of the receiving facility’s manager. If the first receiver given in Section A
intends to receive IFQ landings at multiple sites, please append the application and provide all information
requested in Section B for each of these receiving facilities. A separate catch monitor plan must be provided for
each unique receiving facility.
Section C – Small Business Certification
Read the criteria to determine if you are a small business according to the criteria listed. Check the appropriate
box, yes or no.
Section D - Certification of Applicant and Notary:
The applicant or authorized representative must sign and date the form in the presence of a notary to certify that
the individual(s) signing the form have satisfactorily identified themselves. By signing and dating the form, the
applicant or authorized representative certifies that all information set forth in the form is true, correct, and
complete to the best of the applicant's knowledge and belief. The form will not be considered without the
authorized representative’s signature. The notary must sign and date this section, and affix notary stamp or seal.
Supplemental Documentation
The applicant must provide a catch monitor plan for the site given in Section B, and must request in
writing a site inspection. The applicant must provide a copy of their state buyer’s license in the state where the
receiving facility is located. The applicant must include a check or money order for the application fee in the
amount of $50.00,made payable to: U.S Department of Commerce/NOAA.

First Receiver Site License Application Page 1 of 3

OMB Control No. 0648-0620; Expiration Date: 11/30/2014

FIRST RECEIVER SITE
LICENSE APPLICATION

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service, Northwest Region
Fisheries Permits Office
7600 Sand Point Way NE, Bldg. 1
Seattle, WA 98115-0070

PACIFIC COAST GROUNDFISH

Phone (206) 526-4353

Fax (206) 526-4461

www.nwr.noaa.gov

SECTION A – Applicant/First Receiver Information
1. State of Buyer License

2. Buyer License #

3. First Receiver Name

4. TIN or DOB

5. If business entity, state registered in:

6. Business Mailing Address

7. Business Phone

(
Street or PO BoxNumber

)

8. Business Fax (optional)

(
City

State

Zip Code

)

9. Business Email (optional)

11. Contact Business Phone (if different from
above)

10. First Receiver Contact Person/Name:

(

)

SECTION B – Receiving Facility Information (Physical Location of IFQ Landing)
1. Name of Owner of the Receiving Facility

2. TIN or DOB

3. Street Address (No P.O. Box numbers)

City

State

Zip Code

4. Business Phone

5.Business Fax

(

(

)

6. Business E-mail Address

)

7. Plant Manager name/Point of Contact at receiving facility

First Receiver Site License Application Page 2 of 4

SECTION C – SMALL BUSINESS CERTIFICATION
Are you a small business according to the standards outlined below?

“ YES

“ NO

Small businesses. The Small Business Administration has established size criteria for all major
industry sectors in the US, including fish harvesting and fish processing businesses. A business
involved in fish harvesting is a small business if it is independently owned and operated and not
dominant in its field of operation (including its affiliates) and if it has combined annual receipts not in
excess of $4.0 million for all its affiliated operations worldwide. A seafood processor is a small
business if it is independently owned and operated, not dominant in its field of operation, and employs
500 or fewer persons on a full time, part time, temporary, or other basis, at all its affiliated operations
worldwide. A business involved in both the harvesting and processing of seafood products is a small
business if it meets the $4.0 million criterion for fish harvesting operations. A wholesale business
servicing the fishing industry is a small business if it employs 100 or fewer persons on a full time, part
time, temporary, or other basis, at all its affiliated operations worldwide. For marinas and charter/party
boats, a small business is one with annual receipts not in excess of $7.0 million.
Small organizations. The Regulatory Flexibility Act defines “small organizations” as any nonprofit
enterprise that is independently owned and operated and is not dominant in its field.
Small governmental jurisdictions. The Regulatory Flexibility Act defines small governmental
jurisdictions as governments of cities, counties, towns, townships, villages, school districts, or special
districts with populations of less than 50,000.

SECTION D - CERTIFICATION OF APPLICANT AND NOTARY
This section must be completed by a notary to certify that the individual(s) have satisfactorily identified themselves.

Under penalties of perjury, I hereby declare that I, the undersigned, am authorized to certify this application on behalf of the applicant and completed
this form, and the information contained herein is true, correct, and complete to the best of my knowledge and belief.
Signature of Authorized Representative

Date

Printed Name of Authorized Representative (NOTE: attach authorization, if needed)

Notary Public Signature

“ ATTEST

Affix Notary Stamp or Seal Here

Date Commission Expires

WARNING STATEMENT: A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under 15 CFR 904, a civil
penalty of up to $140,000 under 16 USC 1858, and/or criminal penalties including, but not limited to, fines or imprisonment or both under 18 USC 1001.
PRIVACY ACT STATEMENT: Your DOB and/or TIN are confidential and protected under the Privacy Act. Provision of your DOB or TIN is mandatory as part of
this collection. The primary purpose for requiring the DOB and/or TIN is to verify the identity of individuals/entities doing business with the government to provide a
unique identification for assistance to comply with the Debt Collection Improvement Act of 1996 (Public Law 104-134) and for enforcement activities. The
information collected is part of a Privacy Act System of Records, COMMERCE/NOAA #19, Permits and Registration for United States Federally Regulated
Fisheries. A notice was published in the Federal Register on April 17, 2008 (73 FR 20914) and became effective on June 11, 2008 (73 FR 33065).

First Receiver Site License Application Page 3 of 4

PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 1.0 hours per response, including the time for reviewing the
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 aspect of this collection of information, including suggestions for reducing the burden, to NOAA/National
Marine Fisheries Service, Northwest Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115.
Some of the information collection described above is confidential under section 402(b) of the Magnuson-Stevens Act and under NOAA Administrative Order 216100, Protection of Confidential Fisheries Statistics. Phone number, fax, email, TIN, and DOB are not released to the public. The names of individuals who have
an ownership interest in an entity that owns a permit, vessel or processing plant and the actual percentage of ownership are considered business confidential and
are not released to the public.