Vessel Account Activation Form

OMB Control Number 0648-0620; Expires 11/30/14

VESSEL ACCOUNT
REGISTRATION REQUEST

PACIFIC COAST GROUNDFISH
SHOREBASED IFQ PROGRAM

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

In order to apply for a vessel account, this form must be completed and submitted to the National Marine Fisheries
Service (NMFS) at the address given above. Also, the vessel must be currently register to a trawl endorsed
limited entry permit and the applicant must submit a complete trawl ownership interest form. A vessel account
is effective upon approval by NMFS. NMFS will mail a user ID and password upon establishing the vessel account.
Please note that any change in vessel ownership requires the new owner to request another vessel account in the
name of the new owners. New vessel owners cannot use the prior owner’s vessel account to cover the vessel’s
catch.
1. Permit Number

2. Vessel Name

3. USCG or State Registered Vessel Number

GF
4. Legal Name of Vessel Owner

5. Business Mailing Address

6. Business Phone

(

Street or PO Box

)

7. Business Fax (optional)

(
City

State

Zip Code

)

8. Business Email (optional)

______________________________________________________________________________________________
Signature of Authorized Representative
Title (If corporate officer)
Date
____________________________________
Printed Name of Authorized Representative

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: 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).
PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 0.25 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.