Main Hawaiian Islands Non-commercial Bottomfish Permit A

OMB Control No: 0648-0577

Expires: 10/31/2014

U.S. DEPARTMENT OF COMMERCE

National Oceanic and Atmospheric Administration

national marine fisheries service

Pacific Islands Regional Office - SFD Permits

1845 Wasp Blvd., Bldg 176

Honolulu, Hawaii 96818

(808) 725-5000 ∙ Fax: (808) 725-5215

MAIN HAWAIIAN ISLANDS NON-COMMERCIAL BOTTOMFISH PERMIT

Please Print Legibly. Items marked with * are required. Note required documents.

I. APPLICANT INFORMATION

*APPLICANT NAME: ___________________________________________________________________________

First, Middle, and Last Name, or Business Name (if owner of vessel)

*DATE OF BIRTH or INCORPORATION: ___________________ *TAXPAYER ID NUMBER: ______________________________________ (SSN or EIN)

*MAILING ADDRESS:­­­­­­ ______________________________________________________ __________________ ______ ______________

Street/PO Box City State ZIP Code

*PHONE (______) ______________________ CELL PHONE (______) ______________________ FAX (______) ______________________

*EMAIL: ___________________________________________________________

*APPLICANT SIGNATURE: ______________________________________________________________ *DATE: __________________

Please check whether you want: ___ permit mailed, or ___ to pick up permit at NOAA NMFS Honolulu Service Center at Pier 38.

*VESSEL OPERATOR (Captain)? ___ Yes ___ No (Check only one)

*VESSEL OWNER? ___ Yes ___ No (Check only one) If Yes, complete section below.

II. VESSEL OWNERS ONLY

*VESSEL NAME: _______________________________________________________ *OFFICIAL NUMBER: _____________________________

DBOR registration or USCG documentation num

VESSEL RADIO CALL SIGN: ________________ (if available)

*BUSINESS CONTACT: _____________________________________________________________ *TITLE: _____________________________

(If vessel owned by a business) First, Middle, & Last Name, if not same as vessel owner Corporate officer, business owner, partner

Privacy Act Statement: Federal Regulations (at 50 CFR Part 665) authorize collection of this information. This information is used to verify the identity of the applicant(s) and to accurately retrieve confidential records related to federal fishery permits. The primary purpose for requesting the Taxpayer Identification Number (EIN/SSN) is for the collection and reporting on any delinquent amounts arising 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.

REQUIRED DOCUMENTS: 1) Submit a check payable to Department of Commerce, NOAA for the non-refundable application processing fee of $41.00.

2) Vessel owners must submit a copy of the vessel's current Hawaii Division of Boating and Ocean Recreation vessel registration certificate or U.S. Coast Guard Certificate of Documentation.

An application that is lacking required information, vessel registration or documentation, or payment will be considered incomplete. An incomplete application will be abandoned if it is not completed within 30 days after reception. You must inform PIRO within 15 days of any change of information on the application form (50 CFR 665.13). It is prohibited to file false information on any application for a fishing permit (50 CFR 665.15(b)).

Rev. 7/7/14

(

OMB Control No.: 0648-0577

Expires: 10/31/2014

side two)

PAPERWORK REDUCTION ACT INFORMATION

Public reporting burden for this collection is estimated as follows: 15 minutes for main Hawaiian Islands non-commercial bottomfish permit and 2 hours for all permit denial appeals. Each burden includes 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 aspects of this collection of information, including suggestions for reducing this burden, to NMFS Pacific Islands Regional Administrator, 1845 Wasp Blvd., Bldg. 176, Honolulu, Hawaii 96818.

This information is being collected to ensure accurate and timely records about the persons licensed to participate in fisheries under Federal regulations in the Western Pacific Region. This will enable NMFS and the Western Pacific Fishery Management Council to (a) determine who would be affected by changes in management; (b) inform license holders of changes in fishery regulations; and (c) determine whether the objectives of the fishery program are being achieved by monitoring entry and exit patterns and other aspects of the fisheries. The information is used in analyzing and evaluating the potential impacts of regulatory changes on persons in the regulated fisheries as well as in related fisheries. Responses to the collection are required to obtain the benefit of a license for the fishery involved (ref. 50 CFR 665.13). Data provided concerning the vessel and/or business of the respondents are handled as confidential under the Magnuson-Stevens Fishery Conservation and Management Act (Sec. 402(b)). 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.

Instructions for the Non-commercial Bottomfish Permit Application

Please print legibly. All fields required unless otherwise noted.

I. Applicant Information

Applicant Name: Print full name: First, Middle (initials OK), Last, and suffix. If the vessel owner is a business, print the full business name. A business may not apply for an individual permit; they may apply only for a vessel owner permit.

Date of Birth or Incorporation: Print date as MM/DD/YYYY.

Taxpayer ID Number: SSN for individuals, EIN for business owner of the vessel.

Mailing Address: Your current mailing address is required for mailing the permit or contacting you about your permit.

Phone: Primary phone number, including area code.

Cell phone, Fax, and Email: Provide additional contact information.

Applicant Signature and Date: Sign full name and write in the date you signed.

Mail or Pickup: Check whether you prefer the permit mailed to the address on the application form or to pick it up at NOAA Honolulu Service Center at Pier 38.

Vessel Operator: Check Yes if applicant is the vessel operator/captain, No if not.

Vessel Owner: Check Yes or No. If Yes, complete Section II. For Vessel Owners Only.

II. For Vessel Owners Only

Vessel Name: Print the vessel’s name, if available. If none, print N/A.

Official Number: Print the State of Hawaii vessel registration number as HAnnnnXX – where the nnnn is the number and the XX is the one or two character suffix, or the US Coast Guard vessel documentation number. Attach a copy of the current State vessel registration certificate or the USCG Certificate of Documentation.

Vessel Radio Call Sign: Print the radio call sign on your FCC license, if available.

Date of Incorporation: If the vessel owner is a business, corporation, LLC, etc., fill in the date of incorporation.

Business Contact and Title: Print the full name and title of the contact person for the business.

Include a check for the payment of the non-refundable application processing fee. The check should be made payable to: “Department of Commerce, NOAA.” Money orders or cash will not be accepted.

A complete application must include the signed application form, a check for the processing fee, and a copy of the vessel registration or documentation if a vessel owner is applying. If your application is not complete, the processing of your permit may be delayed. You will be notified of any deficiency. If you fail to correct the deficiency within 30 days following the date of the notice of deficiency, the application will be considered abandoned (50 CFR 665.13). It is a violation of Federal regulations to file false information on a permit application form (50 CFR 665.15(b)).

Mail the application and required documents to the address at the top of the first page or drop it off at the NOAA NMFS Honolulu Service Center, Pier 38, Honolulu, HI (M-F, 8 am – 4 pm). Please contact [email protected] for availability of an online application.