SHARC certificate application for an individual rural re

Revised 7/9/2012 OMB Control No. 0648-0460 Expiration Date: 11/31/2012

SUBSISTENCE HALIBUT REGISTRATION CERTIFICATE (SHARC) APPLICATION FOR A RURAL RESIDENT			U .S. Dept of Commerce/NOAA National Marine Fisheries Service Restricted Access Management P.O. Box 21668 Juneau, Alaska 99802-1668
Are you applying for a new SHARC or a renewal of an existing SHARC? [ ] New [ ] Renewal: enter current SHARC number: ___________ NOTE: Applicants must complete Blocks A, B & C, and sign and date Block D on page 2. Incomplete applications will result in delayed processing. Unsigned applications will not be processed.
BLOCK A - ALASKA RURAL SUBSISTENCE REGISTRANT INFORMATION
1. Name of Fisherman (First, Middle, Last)	2. Birth Date (mm/dd/yyyy)			3. Daytime Telephone Number
4. Mailing Address (P.O. Box, Street, City, State, Zip Code)
If you use a P.O. Box for mailing you must provide a street address or a description of the physical location of your domicile:
5. Rural Community or Rural Area of Residence		6. Dates of residence in this community or area ___ ___ ___ to ___ ___ ___
BLOCK B - TYPE OF SUBSISTENCE HALIBUT REGISTRATION
Only persons who are rural residents as defined in 50 CFR 300.65 may be issued a rural SHARC. A Rural Resident means, for purposes of the subsistence fishery for Pacific halibut in waters in and off Alaska, an individual domiciled in a rural community, as listed in 50 CFR Part 300.65(g)(1), OR a rural area as described at 50 CFR Part 300.65(g)(3), who has maintained a domicile in listed rural communities or described rural areas for 12 consecutive months immediately preceding the time when the assertion of residence is made and who is not claiming residency in another state, territory, or country. A rural SHARC may not be issued to anyone who has not maintained a domicile within the municipal or census boundaries for an eligible rural community or within a described rural area, or has not maintained a domicile within those boundaries or rural areas for 12 consecutive months. Please select one option from the following list to indicate the basis for your eligibility to harvest subsistence halibut. In Block A you must provide the name of the rural community and/or a description of the physical location of your domicile that coincides with the box you check below: [ ] An individual domiciled in a rural community, as listed in 50 CFR Part 300.65(g)(1). [ ] An individual domiciled in Southeast Alaska east of 141° W long., except for the land areas of the Ketchikan Gateway Borough on May 18, 2008, the land areas of the City and Borough of Juneau, and the Ketchikan and Juneau non-subsistence marine waters areas (see Figures 2 and 3 to subpart E of 50 CFR Part 300). [ ] An individual domiciled on the Alaska Peninsula, Aleutian Islands, or Kodiak Island Archipelago, or in the area south of the northern boundary of the Bristol Bay Borough and south of 58°39.2’ N lat. (see Figures 5, 6, and 7 to subpart E of 50 CFR Part 300). [ ] An individual domiciled on Nelson, Nunivak, or Saint Lawrence Islands (see Figure 6 to subpart E of 50 CFR Part 300). [ ] An individual domiciled in any other area of Alaska within 10 statute miles of mean high water on the Bering Sea and Pacific Ocean coasts, south of Cape Espenberg, including along the Kuskokwim River to Bethel, and that is not specified as a non-rural land or water area as defined in 50 CFR Part 300.65(g)(4) (see Figures 4, 5, 6, and 7 to subpart E of 50 CFR Part 300).

BLOCK C – VERIFIER INFORMATION The verifying person MAY NOT be your wife, husband, parent, or child. The verifying person MAY NOT be living at the rural residence listed by you.
1. Name of an Adult Verifier (First, Middle, Last)	2. Verifier’s Daytime Telephone Number
3. Verifier’s Mailing Address (P.O. Box, Street, City, State, Zip Code).

BLOCK D – CERTIFICATION OF ELIGIBILITY
I certify, under penalties of perjury, that I am a Rural Resident as defined at 50 CFR 300.65(g)(1) or (g)(3) and that to the best of my knowledge and belief all information contained on this application is true, correct and complete.
Signature of Rural Applicant	Date:

PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average 10 minutes 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 Assistant Regional Administrator, Sustainable Fisheries Division, Alaska Region, NMFS, P.O. Box 21668, Juneau, AK 99802-1668.

ADDITIONAL INFORMATION

Before completing this form please note the following: 1) NMFS may not conduct or sponsor this information request, and you are not required to respond to this information request, unless the form displays a currently valid OMB control number; 2) This information is being used to monitor the Alaska Subsistence Halibut Program; 3) Federal law and regulations require and authorize NMFS to manage the subsistence halibut program in Alaska; 4) Submission of this information is required of all persons seeking to participate in directed fishing for Pacific halibut under the subsistence halibut program; 5) This information is mandatory and is required to monitor the subsistence halibut program under the Northern Pacific Halibut Act of 1982; 6) The birthdate is confidential under the Privacy Act.

INSTRUCTIONS

SHARC APPLICATION FOR RURAL RESIDENT

GENERAL INFORMATION

A rural SHARC may not be issued to anyone who has not maintained a domicile within the municipal or census boundaries for an eligible rural community or within a described rural area for 12 consecutive months prior to the date of application.

A rural SHARC may not be issued to anyone who is claiming residency in another state, territory, or country.

Applicants must complete Blocks A, B & C, and sign and date Block D on page 2.

Incomplete applications will result in delayed processing.

Unsigned applications will not be processed.

If you have questions when completing the application, please

• call RAM at (800) 304-4846 (select option 2) or (907) 586-7202 (select option 2),

• check our web site at www.alaskafisheries.noaa.gov/ram, or

• e-mail your questions to [email protected].

Please allow at least 10 days for processing your SHARC. If you would like to have your SHARC sent by a method other than regular U.S. mail, please attach a note indicating a method, and follow the appropriate procedure below.

Complete the application and submit:

By mail to: NMFS, Alaska Region

Restricted Access Management (RAM)

P.O. Box 21668

Juneau, Alaska 99802-1668

Or deliver to: Federal Building

709 W. 9th Street, Suite 713

Juneau, Alaska 99801

Or fax to: 907-586-7354.

Express Mail Return

If you would like to have your SHARC sent to you by U.S. Postal Express Mail, send us an express mail envelope with the correct amount of postage prepaid or send express mail stamps UNATTACHED to an envelope. NOTE: If the express mail envelope you send is too small or the postage attached is less than the amount required, your SHARC will be sent to you by regular U.S. mail.

Return by Other Express Carriers

If you would like to have your SHARC sent to you by a private express carrier (e.g., Federal Express, UPS, DHL), submit your account number and name of carrier or a prepaid envelope with the permit application.

PROGRAM INFORMATION

The Halibut Subsistence Fishery is authorized by Federal regulations at 50 CFR Part 300 and provides for eligible persons to conduct subsistence halibut fishing in Convention waters off Alaska.

Subsistence halibut means halibut caught by a rural resident or a member of an Alaska Native tribe for direct personal or family consumption as food, sharing for personal or family consumption as food, or customary trade.

Eligible persons are residents of particular rural communities or rural areas and all identified members of Federally recognized Alaska Native tribes.

Rural Resident means, for purposes of the subsistence fishery for Pacific halibut in waters in and off Alaska:

● an individual domiciled in a rural community listed in the table at 50 CFR Part 300.65(g)(1), who has maintained a domicile in rural communities listed in the table at §300.65(g)(1), or in rural areas described at § 300.65(g)(3), for the 12 consecutive months immediately preceding the time when the assertion of residence is made and who is not claiming residency in another state, territory, or country; or

● an individual domiciled in a rural area described at 50 CFR Part 300.65(g)(3) and who has maintained a domicile in rural areas described at § 300.65(g)(3), or in rural communities listed in the table at §300.65(g)(1), for the 12 consecutive months immediately preceding the time when the assertion of residence is made, and who is not claiming residency in another state, territory, or country. The rural areas are as follows (for a full description including maps, please refer to the regulations referenced above):

● Southeast Alaska east of 141 W long., except for the land areas of the Ketchikan Gateway Borough on May 18, 2008, the land areas of the City and Borough of Juneau, and the Ketchikan and Juneau non-subsistence marine waters areas as these land and water areas are described in 50 CFR Part 300.65(g)(4).

● The Alaska Peninsula, Aleutian Islands, Kodiak Island Archipelago, and the area south of the northern boundary of the Bristol Bay Borough and south of 58° 39.2 N lat.

● Nelson, Nunivak, and Saint Lawrence Islands.

● All other areas of Alaska within 10 statute miles of mean high water on the Bering Sea and Pacific Ocean coasts, south of Cape Espenberg, including along the Kuskokwim River to Bethel, and that are not specified as non-rural land or water areas as defined in 50 CFR Part 300.65(g)(4).

COMPLETING THE APPLICATION

In the first box, please indicate whether you are applying for a:

• New applicant for a SHARC; or

• Renewing an existing SHARC. If renewing an existing SHARC, enter your current SHARC number.

BLOCK A – ALASKA RURAL SUBSISTENCE REGISTRANT INFORMATION

1. Enter your full name (First, Middle, Last). Please include any suffixes such as Jr., Sr., etc.

2. Enter your date of birth (Month/Day/Year).

3. Enter a daytime telephone number, including area code.

4. Enter your permanent mailing address, including P.O. Box, street, state, and zip code. The SHARC will be sent to this address. Please include your street address even if you have a P.O. Box number. If you have no street address, please include a description of the physical location of your domicile, such as latitude and longitude, if known, or direction and distance from a landmark or from a milepost on a road.

5. Enter your Community or Area of Residence (city and state or area of state). This must be one of the rural communities listed at 50 CFR 300.65(g)(1) or a rural area listed at 50 CFR 300.65(g)(3).

6. Enter the dates of your residence in this community or area.

BLOCK B – TYPE OF SUBSISTENCE HALIBUT REGISTRATION

Note: Your application will not be processed if all of the following sections are not completed.

• Check one option to indicate under what basis you are eligible to harvest subsistence halibut as a rural resident of Alaska. If you need assistance with this step, such as determining if you live in a rural area, please contact RAM (see the top of page 3 for contact information).

• Please complete Blocks B and C, and sign and date Block D.

BLOCK C – VERIFIER INFORMATION

NOTE: The verifying person MAY NOT be your wife, husband, parent, or child.

The verifying person MAY NOT be living at the rural residence listed by you.

1. Please provide the name of an adult person age 18 or older who can verify that the residence listed by you is your domicile and that it was your domicile for 12 months prior to the date of the application. 

2. Enter the verifier’s daytime telephone number, including area code, for the verifier.

3. Enter the verifier’s mailing address, including P.O. Box, street, state, and zip code.

BLOCK D – CERTIFICATION OF ELIGIBILITY

Please sign and date the application. You must sign and date the application certifying you are an eligible rural resident under 50 CFR 300.65(g)(1) or 50 CFR 300.65(g)(3) and that all information contained in the application is true, correct, and complete to the best of your knowledge and belief. The application will be considered incomplete without your signature and will not be processed.

SHARC Application for Rural Individual

Page 9 of 9