Mothership Annual Report

OMB Control No. 0648-0663; Expiration Date: XX/XX/XXXX

MS Coop Program Cost recovery Annual Report Pacific Coast Groundfish Trawl Rationalization Program

UNITED STATES DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration National Marine Fisheries Service, West Coast 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: Each fish buyer, as defined at 50 CFR 660.111 for the Mothership (MS) Coop Program, must submit this annual report containing the information listed below for the fishing year for all groundfish each fish buyer purchased from fish sellers in that year. This form must be completed in its entirety and submitted to the National Marine Fisheries Service (NMFS) at the address given above by March 31 each year.

Fish Buyer Name(s)

Owner of vessel registered to MS permit: _______________________________________________________

Operator of vessel registered to MS permit: _____________________________________________________

Owner of the MS permit registered to that vessel: ________________________________________________

MS Permit Number: ________________________________________________________________________

Total Weight Bought (in lbs) =

Total Ex-vessel Value Paid =

Total Fee Amount Collected =

Month	Weight Bought (lbs)	Ex-vessel Value	Fee Amount Collected	Date Disbursed to NMFS
May
June
July
August
September
October
November
December
Total:		$	$

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. Business phone number, fax number, and email 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: The trawl cost recovery program is required by the Magnuson-Stevens Act [16 USC §§ 1853a(e), 1854(d)(2)]. This collection of information is mandatory as specified at 50 CFR 660.115. This collection of information accompanies and documents payment of fees due for that program. Public reporting burden for this form 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 aspect of this collection, including suggestions for reducing this burden, to NOAA/National Marine Fisheries Service, West Coast 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.