Permit Fee Renewal Form

Revised: 03/14/2013 OMB Control No. 0648-0398; Expiration Date: 11/30/2015

	IFQ Permit Holder Fee Submission Form		U.S. Department of Commerce/NOAA National Marine Fisheries Service (NMFS) Operations & Management Division (OMD) P.O. Box 21668 Juneau, Alaska 99802-1668 (800) 304-4846 toll free / 586-7202 Juneau
Deadline: Submit by January 31 following the calendar year in which any IFQ landing was made
BLOCK A -- OVERPAYMENT
If your estimated Balance Due is less than zero (deficit), you MUST select one of the following options: [ ] Apply Overpayment to Future Fee Liabilities OR [ ] Issue Refund
BLOCK B -- IDENTIFICATION OF IFQ PERMIT HOLDER
1. Name of IFQ Permit Holder:				2. NMFS Person ID:
				3. Taxpayer ID No. (EIN or SSN):
				4. Date of Birth or Date of Incorporation:
5. Business Mailing Address: (Indicate if address is) Permanent [ ] or Temporary [ ]
6. Business Telephone Number:		7. Business Fax Number:			8. Business E-mail Address:
BLOCK C -- AGREEMENT WITH IFQ FEE LIABILITY SUMMARY
Check if you agree with your IFQ Fee Liability Summary: [ ] YES [ ] NO If YES, please date and sign your name where designated in Block D, complete Block E, and mail this Fee Submission Form with your payment or as indicated in Block E, in the envelope provided. If NO, complete Block F (Fee Calculation) using the fee calculation instructions and provide documentation to support your calculations. See pages 2 and 3 of instructions for additional information.

BLOCK D – SIGNATURE
1. Printed Name of IFQ Permit Holder or Authorized Representative:
2. Signature of IFQ Permit Holder or Authorized Representative:	3. Date:
BLOCK E -- METHOD OF PAYMENT
1. [ ] Personal Check [ ] Cashier’s Check [ ] Money Order [ ] Credit Card If paying by check or money order, make payable to National Marine Fisheries Service REMINDER! Sign your check. NOTE: If paying for multiple permit holders, include their completed and signed Fee Submission Forms.
2. If paying by credit care, indicate card type, card number, expiration date, and card validation code: [ ] Visa [ ] Mastercard [ ] American Express [ ] Discover Card No: ____________ Expiration Date: ____________ Card Validation Code (CVC) ____________ Amount of Payment: ____________ Name as Printed on Card: _________________________________________ Signature of Card Holder: __________________________________________ Date: _________________________ NMFS does not send verification of payment and strongly recommends you retain copies for your records.

STOP!

Have you completed BLOCK E and included payment of your IFQ FEE?

Have you made a copy of your Fee Submission Form and check/money order for your records?

NOTE: You must submit adequate documentation supporting your revised fee liability. Examples of such documentation include valid fish tickets, sales receipts, or check stubs that clearly identify the IFQ landing amount, species, date, time, and ex-vessel value or price.

BLOCK F – FEE CALCULATION
Permit Number	Date of Landing	Port Location	IFQ Pounds	GAF Pounds (Use standard price only)	Standard Ex-vessel Price	Actual Ex-vessel Price	Total
Sample	3/20/2005	Sitka	5000			$2.20	$11,000
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17. Ex-vessel Value Total (add lines 1-16):
18. Plus Total Adjustments (IFQ retro payments, bonuses):
19. Subtotal (add lines 17 and 18):
20. Fee Liability* (multiply the published fee percentage by line 19):
21. Less Pre-payments or Credits (if any):
22. Balance Due (enter result after subtracting line 21 from 20):
23. Enclosed Payment Amount:

*Your fee liability is based on the total value received for IFQ halibut or sablefish landed on your IFQ permit during the IFQ fishing year. It should represent the total dollar value of IFQ pounds before any deductions are made for goods and services provided (i.e., bait, ice, fuel, repairs, machinery replacement, etc.), multiplied by the NMFS published fee percentage for the IFQ fishing year.

Instructions for

IFQ PERMIT HOLDER FEE SUBMISSION FORM

This information is used to verify the identity of the applicant(s) and to accurately retrieve confidential records related to federal permits. The primary purpose for requesting the SSN/TIN is for the collection and reporting on any delinquent amounts arising out of such person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). Personal information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be disclosed to the public.

After each IFQ fishing year, NMFS will provide to an IFQ permit holder an IFQ Landing Summary and Estimated Fee Liability page. The IFQ permit holder must either accept the accuracy of the NMFS estimated fee liability associated with his or her IFQ landings for each IFQ permit or calculate a revised IFQ fee liability for all or part of his or her IFQ landings using this Fee Submission Form.

An IFQ permit holder who holds an IFQ permit against which a landing was made must submit to NMFS a complete IFQ permit holder Fee Submission Form provided by NMFS. An IFQ permit holder with IFQ and/or Guided Angler Fish (GAF) landings is responsible for self-collecting his or her own fee during the calendar year in which the IFQ fish and/or GAF is landed.

An IFQ permit holder must submit his or her IFQ fee liability payment(s) to NMFS at the address provided below no later than January 31 of the year following the calendar year in which the IFQ landings were made.

Payment must be made in U.S. dollars by personal check drawn on a U.S. bank account, money order, bank certified check, or credit card. There are two ways to pay the IFQ fees:

(1) Pay ONLINE via credit card or check (Notice of check fee) to NMFS at:

https://alaskafisheries.noaa.gov/webapps/ifqaccounts/Login

If paying by credit card, ALL requested card information must be provided. Do not mail cash.

(2) Fill out the IFQ Fee Submission form on the Alaska Region website at:

http://alaskafisheries.noaa.gov/ram/feesubmission.pdf

and mail the form with a check or money order made payable to NMFS at the address below

U.S. Dept. of Commerce/ National Oceanic and Atmospheric Administration (NOAA)

National Marine Fisheries Service (NMFS)

Office of Operations and Management Division (OMD)

P.O. Box 21668

Juneau, Alaska 99802-1668

Do not forget to sign and enclose your personal or certified check or money order.

NMFS does not send receipts for payments received by check or money order, so we strongly recommend that you retain a copy of this completed form and your check/money order for your records. Only payments received by credit card will be sent computer-generated receipts after those payments are processed.

If you need assistance in completing this form or you have questions about the IFQ Cost Recovery Program,

Call OMD toll free (800) 304-4846 (Option 5) or (907) 586-7202 (Option 5).

Program information, applications, and reports can also be located on the Alaska Region Internet site at

http://alaskafisheries.noaa.gov/ram/ifq.htm

COMPLETING THE FEE SUBMISSION FORM

All permit holders must complete Blocks A through E of the IFQ Permit Fee Submission form.

BLOCK A -- OVERPAYMENT

If your estimated Balance Due (Block F22) is less than zero, indicate whether you choose to apply the overpayment to future fee liabilities or to apply for a refund.

If you choose to receive a refund, note that all refunds will be issued out of the National Oceanic and Atmospheric Administration, Department of Finance, in Silver Spring, Maryland.

Please allow a minimum of eight weeks for your refund to be issued.

If you choose to apply the balance due amount to future fee liabilities, NMFS will credit your IFQ Fee Liability Account.

BLOCK B -- IDENTIFICATION OF IFQ PERMIT HOLDER

Enter the information requested below in the designated areas on the IFQ Permit Holder Fee Submission Form.

1. Name of IFQ Permit Holder: Full name of the individual, corporation, association, or partnership that is the holder of the permit.

2. NMFS Person ID: Identification number assigned to the permit holder by NMFS/RAM.

3. Taxpayer ID No. (EIN or SSN). Enter social security number (SSN) if applicant is an individual. Enter employer identification number (EIN) if applicant is a corporation, partnership, association or other non-individual business entity.

4. Date of birth or Date of incorporation. Enter date of birth if applicant is an individual. Enter date of incorporation if applicant is a corporation, partnership, association or other non-individual business entity.

5. Business Mailing Address: Check whether the address provided is a permanent or temporary address.

Permanent address: This is the address where NMFS will send information; include street or P.O. Box number, city, state, and zip code. This address will be updated in the official RAM database.

Temporary address: This address is used on a one-time-only basis for processing this form; RAM’s database will not be changed.

6-8. Business telephone number and business fax number, including area codes; and business e-mail address, if any.

Note: It is important to provide a number where messages can be left to avoid delay in processing the Fee Submission Form if any questions arise.

BLOCK C -- AGREEMENT WITH IFQ FEE LIABILITY SUMMARY

Indicate whether you agree with your IFQ Fee Liability Summary. The IFQ permit holder must either accept the accuracy of the NMFS estimated fee liability associated with his or her IFQ landings for each IFQ permit, or calculate a revised IFQ fee liability.

If YES, please date and sign your name where designated in Block D, complete Block E, and mail this Fee Submission Form with your payment or as indicated in Block E, in the envelope provided.

If NO, complete Block F (Fee Calculation) using the fee calculation instructions and provide documentation to support your calculations.

Note: You must submit adequate documentation supporting your revised fee liability. Examples of such documentation include valid fish tickets, sales receipts, or check stubs that clearly identify the IFQ landing amount, species, date, time, and ex-vessel value or price.

BLOCK D – SIGNATURE

1. Print or type the full name of the IFQ permit holder or authorized representative signing on behalf of the permit holder. Note: If an authorized representative is acting on behalf of the permit holder, written authorization signed by the permit holder must be submitted with the Fee Submission Form.

2. The IFQ permit holder or authorized representative must sign and date the application where indicated. The application will not be considered without the signature of the permit holder or authorized representative.

3. Indicate the date on which the Fee Submission Form is signed.

BLOCK E -- METHOD OF PAYMENT -- Do not mail cash --

If paying for multiple permit holders, attach each permit holder’s completed and signed Fee Submission Forms.

NMFS does not send receipts for payment received by check or money order, so we strongly recommend that you retain a copy of this completed form and your check/money order for your records.

1. Check the appropriate box to indicate the form of payment used to pay your IFQ Fee Liability. A copy of your check or money order should be retained for your own records.

Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize NMFS either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.

2. Check the appropriate box to indicate the type of credit card used to pay your IFQ Fee Liability.

Note: Only the credit cards listed are accepted for payment through NMFS at this time.

If paying by credit card, make sure ALL requested card information is provided:

Credit card number

Amount of payment

Card expiration date

Card Validation Code (CVC)

Name as printed on the card

Card holder’s signature and date signed

If any of the required credit card information is missing, your payment WILL NOT be accepted.

Return Item Service Fee

If the electronic fund transfer cannot be completed because there are insufficient funds in your account, NMFS may impose a one-time fee of $25.00 against your account, which we will also collect by electronic fund transfer.

BLOCK F -- FEE CALCULATION

Complete this block ONLY if you indicated in Block C that you did not agree with your IFQ Fee Liability Summary.

Note: You must submit adequate documentation supporting your revised fee liability. Examples of such documentation include valid fish tickets, sales receipts, or check stubs that clearly identify the IFQ landing amount, species, date, time, and ex-vessel value or price.

1-16. Permit Number: Enter permit number(s).

Date of Landing: Enter date(s) the landing(s) was/were made.

Port Location: Enter the port(s) where landing(s) was/were made.

IFQ Pounds: Enter the IFQ pounds landed (include any retained pounds) on permit(s) for specific date(s).

“IFQ pounds” is net weight for Halibut and round weight for Sablefish

GAF Pounds: Enter the number of GAF pounds landed (include any retained pounds) on permit(s) for specific date(s). “GAF pounds” is net weight for transferred Halibut.

NOTE: You may not claim actual ex-vessel value for any GAF pounds.

Standard Ex-Vessel Price: Enter the standard ex-vessel price located on your IFQ Fee Liability Summary.

If IFQ, you may use either the standard price or the actual price for each landing in your summary.

If GAF, you may not use actual price for any GAF Pounds; you may only use the standard ex-vessel price assigned on the Fee Liability Statement for GAF.

Actual Ex-Vessel Price: Enter the actual ex-vessel value for this permit.

If IFQ, you may use either the standard price or the actual price for each landing in your summary.

If GAF, you may not use actual ex-vessel price for GAF pounds.

Total: Multiply the total pounds landed on the permit(s) by the standard or actual ex-vessel price to get the

total for each landing.

17. Ex-vessel Value Total: Add lines 1 through 16 to get the subtotal of fees owed for all permits.

18. Plus Total Adjustments: Add total adjustments (IFQ retro payments, or bonuses paid in current year for

previous year).

19. Subtotal: Add lines 17 and 18.

20. Fee Liability: Multiply the permit(s) subtotal (line 19) by the published fee percentage.

Your fee liability is based on the total value received for IFQ halibut or sablefish landed on your IFQ permit during the IFQ fishing year. It should represent the total dollar value of IFQ pounds before any deductions are made for goods and services provided (i.e., bait, ice, fuel, repairs, machinery replacement, etc.), multiplied by the NMFS published fee percentage for the IFQ fishing year.

21. Less Pre-Payments or Credits: Subtract any pre-payments or credits from line 20. If you have a pre-payment

or credit, it will be indicated on your IFQ Fee Liability Summary.

22. Balance Due: This indicates your balance due or credit after subtracting line 21 from 20.

If you show a credit, return to Block A and check whether you would like your credit refunded or have it applied to future fee liabilities. If you show a balance due (owed), enter in line 22.

23. Enclosed Payment Amount: If you show a balance due, enter the amount of the payment you will

be submitting.

Return Item Service Fee

If the electronic fund transfer cannot be completed because there are insufficient funds in your account, we may impose a one-time fee of $25.00 against your account, which we will also collect by electronic fund transfer.

Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and collecting the information from your check, and explaining the purposes and routine uses which will be made of your check information, is available from our Internet site at https//pccotc.gov/pccotc/index.htm or call toll free at 1 (866) 945-7920 Option 4 to obtain a copy by mail. Furnishing the check information is voluntary, but a decision not to do so may require you to make payment by some other method.

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PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average 2.0 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 aspect of this collection of information, including suggestions for reducing the burden, to: NOAA National Marine Fisheries Service, Alaska Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, P.O. Box 21668, Juneau, AK 99802.

The TIN (EIN or SSN) is collected under the authority of 31 U.S.C.A 7701, Taxpayer Identity Number. The primary purpose for requesting the EIN or SSN is for the collection and reporting on any delinquent amounts arising out of such person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). Reporting of the EIN or SSN is mandatory, and permit applications, renewals and transfer requests will not be processed without this information. Personally identifiable information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be

disclosed to the public.

ADDITIONAL INFORMATION

Before completing this form please note the following: 1) 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; 2) This information is mandatory and is required to manage commercial fishing effort under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.); 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act as amended in 2006. It is also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.

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IFQ Permit Holder Fee Submission Form

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