Federal Fisheries Vessel Permit Application - Initial

National Marine Fisheries Service
Northeast Regional Office / Fisheries Statistics Office

Initial Application for a Northeast
Commercial Vessel Operator Permit
Please complete all sections of this application. Incomplete applications will
be returned and will be not be processed. Submission of all application information
is required. Application information is not confidential and may be released to the
public. You must sign and date this application in Section 2 on back.
Return completed applications to:

Permits Operations
55 Great Republic Drive
Gloucester, MA 01930-2276
Telephone: (978) 281-9370 Ext. 6437
0B

1B

2B

Section 1
Last Name__________________ First Name______________________ MI_________
Mailing Address_______________________________________________________
City / ST / Zip Code___________________/_____/____________________________
Phone Number______-______-_______ Date of Birth____/_____/_____ (MO/DAY/YR)
Eye Color________________ Hair Color______________________________________
Weight (lbs)_____________ Height (ft/in)______/____________________________

Please enclose ONE color passport sized photo of yourself, which is
recent (taken no more than 1 year prior to the date of this
application).
U

U

SAMPLE

Recommended
Picture Size
1½“high
1 ¼ inches wide
X
1 ½ inches high

1 ¼ “ wide

You must sign and date this application in Section 2 on back.
Revised 11/07/2008

OMB# 0648-0202 - Expires 11/30/2009

United States Coast Guard Requirements
Any vessel of at least five net tons which engages in the fisheries on the navigable
waters of the United States or in the Exclusive Economic Zone (EEZ), Great Lakes trade,
or coastwise trade, unless exempt under 46 CFR § 67.9(c), must have a Certificate of
Documentation bearing a valid endorsement appropriate for the activity in which
engaged [46 CFR § 67.7]. The EEZ extends up to 200 nautical miles (370 km) from the
U.S. coastline. Only a citizen of the United States may serve as master, chief engineer,
radio officer, or officer in charge of a deck watch or engineering watch on a United
States documented fishing vessel [46 USC 8103 (a)].
Section 2
I affirm that all information I have given on this application is true and correct. Making
a false statement on this application is punishable by law [18 USC 1001]. I
understand that violations of Federal fisheries laws and regulations may subject me to
criminal and civil penalties including fine and/or revocation of license. Further, as a
condition of this operator's permit, I agree that if this permit is suspended or revoked
pursuant to 15 CFR part 904, I will not be on board a Federally permitted fishing vessel
in any capacity while the vessel is at sea or engaged in offloading.
I also understand, in obtaining this operator's permit, that I must comply with current
law, which includes a requirement that I be a U.S. citizen to serve as master or officer
in charge of a deck watch on a U.S. documented fishing vessel fishing (see USCG
regulations above).

Signature of Applicant

Date

Public reporting burden for this collection of information is estimated to average 1 hour per
response, including time for reviewing instructions, searching existing data sources, gathering and
maintaining data needed, and completing and reviewing the information. Send comments
regarding this burden estimate or suggestions for reducing this burden to: NMFS, 55 Great
Republic Drive, Gloucester, MA 01930-2276. The purpose and use of these permits are to (1)
register industry participants and fishing vessels, (2) exercise influence over compliance, (3)
provide a mailing list for the dissemination of important information to the industry, (4) register
participants to be considered for limited entry, and (5) provide a universe for data collection
samples. Both the MSFCMA and Executive Orders 12866 et al, require the determination of this
information. 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.
Any information submitted by any person to obtain a permit is not confidential, and may be
disclosed upon request.
Revised 11/07/2O08

OMB# 0648-0202

Expires 11/30/2009