BSAI Non-Pollock Groundfish Fee Collection Report

OMB Control # 0648-0376 Expires X/XX/20XX

BSAI Non-Pollock Buyback Loan Fee Collection Report
Company Name
Mailing Address
City
State
Zip
Phone Number
LLP License Number
Vessel Name
ADFG Vessel Number
Month and Year of Landings
Check this box if payment is for an
adjustment to previous fees paid
Contact Person

FOR LANDINGS OF

Sub-account

Fee Rate per
Pound

BSAI Pacific Cod

BBNA-001A

$0.0145
Prior Year Adjustment

Gross Catch (lbs.)

Fee Due ($)

Amount Due

Prior Year Adjustment

Credit

Only enter late charges for which you have received a Bill of Collection.

Late Charges ($)
Total Fees ($)

Instructions:
1. Complete the company name, address, phone number, LLP license number, vessel name, ADFG vessel number,
month and year of landings, and check adjustment box if applicable.
2. Record the gross catch in round weight pounds and fee collected for the fishery. The fee due equals the fee rate
multiplied by the gross catch of Pcod landed for each vessel trip.
3. Use a separate report for catch in a different month.
4. Payment of late charges for which you have received a Bill of Collection can be included with the fee payment.
Do not pay late charges in advance of receiving a Bill of Collection.
5. Use Pay.gov to remit fee due or mail a check payable to "NMFS BSAI Non-Pollock Buyback Loan"
in the amount of the total fee due to: P.O. Box 979028, St. Louis, MO 63197–9000.
Paperwork Reduction Act Statement:
Public reporting burden for this collection of information is estimated to average one hour per response,
including the 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 suggestions for reducing this burden to Paul Marx, Chief, Financial
Services Division, NMFS, MB5, 1315 East West Highway, Silver Spring, MD 20910.
Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be
subjected 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.