Form NOAA88-166 Fishermen's Contingency Fund 15-day Report

U.S. DEPARTMENT OF COMMERCE

NOAA FORM 88-166

NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION

Revised 10-2014
OMB Control No. 0648-0082

FISHERMEN'S CONTINGENCY FUND 15-DAY REPORT

Expiration Date: 01-31-2015

Claimant’s Name

SSN

Business Name

Tax ID#

Mailing Address

Phone (w)

City

State

Zip

Cell

Email Address

Phone (h)

Vessel Name

Vessel #

Date

Locational coordinates of obstruction (GPS)
Description of the nature of the damage or loss

Description of what caused the damage or loss (i.e. What did the vessel/gear hang on?)

Damage or loss discover on

(date) and

(time).

Vessel returned to port on __________ (date).

Remarks, additional information, comments, etc.

INSTRUCTIONS AND INFORMATION
1. You must report the above information within 15 days after the date your vessel first returned to port after discovering
such damage or loss to the Fishermen's Contingency Fund (FCF) at 301.427.8725 or to the address below.
2. You must also file a completed Claim Application within 90 days of the loss or damage. NOAA Form 88-164, FCF
Claim Application Form, may be used or see the FCF Regulations at 50 CFR Part 296.
3. In order to gain a presumption that your damage or loss was caused by an item related to Outer Continental Shelf oil
and gas activities, you must submit the above information to National Marine Fisheries Service (NMFS) within the 15day period. If the report is not submitted within the 15-day period, the presumption exception will not be allowed and
you will have to prove that the obstruction causing the loss or damage was related to the oil and gas activities.
4. Attached additional sheet(s), as needed.
5. Claimant must agree to repay all or any part of the award if the award should be subsequently reduced.
6. Privacy Act Statement. Section 3701 of Title 31, United States Code, authorizes collection of this information. This
information is part of an application for benefits and is required to obtain those benefits. The primary use of social
security numbers or taxpayer identification numbers is to verify the identity of the applicant(s) and to allow preparation
of IRS Forms 1099s for claim payments, as required pursuant to Section 6109 of the Internal Revenue Code.
7. Public reporting burden for the collection of information for a complete FCF claim (both Form 88-164 and 88-166) is
estimated to average 8 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing the collection of information. Send comments
regarding this burden estimate or any other suggestions for reducing this burden to NMFS FCF.
8. Confidential name and address information may be released via a NOAA website for informational purposes. All other
data submitted will be handled as confidential material in accordance with NOAA Administrative Order 216-100,
Protection of Confidential Fisheries Statistics. Notwithstanding any other provisions 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
requirements of the Paperwork Reduction Act, unless that collection of information displays a currently claim OMB
Control Number.
FCF Staff Initials
Contact information: NMFS F/MB5 FCF, 1315 East West Highway, 13th Floor, Silver Spring,
MD 20910. Telephone: 301.427.8725. Fax: 301.713.1306. Additional information at:
www.nmfs.noaa.gov/mb/financial_services/fcf.htm