Trawl Rationalization Quota Share Permit Application

OMB Control No. 0648-0620, Expires on: 11/30/2014

QS Permit/Account Application Form Pacific Coast Groundfish Individual Fishing Quota

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 quota share (QS) permit and account. To complete the application process, any Economic Data Collection surveys due from the QS permit applicant must be deemed complete by the NOAA/Northwest Fisheries Science Center and the QS permit applicant must submit a complete trawl identification of ownership interest form. A QS permit is effective upon approval by NMFS.

Section A – QS Permit Applicant Information

The applicant must provide their full name as it will appear on the permit, as well as date of birth (for individuals) or tax identification number (if a business entity). Please provide the business mailing address, phone number, fax number and email address. NMFS will mail all pertinent information, including the user ID and password for the QS account and all renewals information, to the address of record.

Section B – Applicant Eligibility Certification

Applicants must certify their eligibility to own a QS permit, as outlined at 50 CFR 660.140 (d)(2)(i). Please read each question carefully and respond to each by checking the appropriate box.

Section C – 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 has 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 or belief. The form will not be considered without the authorized representative’s signature. NMFS may request that the authorized representative for a business entity include a copy of the corporate resolution or other document authorizing the individual to sign and certify on behalf of the business entity. The notary must sign and date this section, and affix a notary stamp or seal.

Supplemental Documentation

The applicant must submit a complete trawl identification of ownership interest form.

OMB Control No. 0648-0620, Expires on: 11/30/2014

QS Permit Application form Pacific Coast Groundfish Individual Fishing Quota

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

Section A – QS Permit Applicant Information
1. Legal Name of Quota Share Permit Applicant			2. TIN (if business) or DOB (if person)
	3. Business Mailing Address Street or PO Box				4. Business Phone Number ( )
					5. Business Fax Number (optional) ( )
	City	State		Zip Code	6. Business Email (optional)

Section B – Applicant Eligibility Certification

The applicant must be eligible to own a QS permit. Please review the eligibility requirements as outlined below [and at 50 CFR 660.140 (d)(2)(i)], and respond to the following question.

Only the following persons are eligible to own QS permits:

(A) A United States citizen, that is eligible to own and control a U.S. fishing vessel with a fishery endorsement pursuant to 46 U.S.C. 12113 (general fishery endorsement requirements and 75 percent citizenship requirement for entities);

(B) A permanent resident alien, that is eligible to own and control a U.S. fishing vessel with a fishery endorsement pursuant to 46 U.S.C. 12113 (general fishery endorsement requirements and 75 percent citizenship requirement for entities); or

(C) A corporation, partnership, or other entity established under the laws of the United States or any State, that is eligible to own and control a U.S. fishing vessel with a fishery endorsement pursuant to 46 U.S.C. 12113 (general fishery endorsement requirements and 75 percent citizenship requirement for entities). However, there is an exception for any entity that owns a mothership that participated in the west coast groundfish fishery during the allocation period and is eligible to own or control that U.S. fishing vessel with a fishery endorsement pursuant to sections 203(g) and 213(g) of the AFA.

Is the QS permit applicant eligible to own a QS permit, as outlined above?

 YES  NO

Section C – 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
	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 Part 904, a civil penalty up to $100,000 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: Some of the information collection described above is confidential under section 402(b) of the Magnuson-Stevens Act and under NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. TIN or DOB, business phone number, fax number, and email, and applicant eligibility criteria are not released to the public. The information collected is part of a Privacy Act System of Records, COMMERCE/NOAA #19, Permits and Registrations 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 0.50 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 suggestions for reducing this burden to NOAA/National Marine Fisheries Service, Northwest Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115. 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.

Quota Share Permit Application Form – Page 3 of 3