Marine Mammal Authorization Program Registration Form

MARINE MAMMAL AUTHORIZATION PROGRAM
Registration Form
Regulations implementing section 118 of the Marine Mammal Protection Act (50 CF R 229.4) requires the owner of a commercial fishing
vessel engaged in a Category I or II fishery to obtain an authorization for the incidental take of marine mammals. Failure to obtain an
authorization, or to maintain a current and valid authorization, shall subject vessel owners to the penalties of the Marine Mammal
Protection Act.
Please PRINT LEGIBLY and in CAPITAL LETTERS, all responses in the blocks provided. See page 6 for complete instructions.
VESSEL NAME

VESSEL STATE REG. NO. / COAST GUARD DOC. NO.

HOME PORT OF VESSEL CITY

STATE

LENGTH (Ft)

COMM. VESSEL LIC. NO.

LAST NAME OF PRIMARY VESSEL OWNER

FIRST NAME OF PRIMARY VESSEL OWNER

M.I.

LAST NAME OF SECONDARY VESSEL OWNER

FIRST NAME OF SECONDARY VESSEL OWNER

M.I.

CORPORATE NAME (if applicable)

DATE OF INCORPORATION (if applicable)

MAILING ADDRESS (for business correspondence)

CITY

STATE

TELEPHONE NUMBER (including area code)

ZIP CODE

FAX NUMBER (including area code)

PRIMARY VESSEL OWNER
TAX IDENTIFICATION NUMBER/
SOCIAL SECURITY NUMBER

PRIMARY VESSEL OWNER
DATE OF BIRTH

SECONDARY VESSEL OWNER
TAX IDENTIFICATION NUMBER/
SOCIAL SECURITY NUMBER

SECONDARY VESSEL OWNER
DATE OF BIRTH

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.
LAST NAME OF OPERATOR (if different than owner)

FIRST NAME OF OPERATOR

M.I.

MAILING ADDRESS (for business correspondence)

CITY

STATE

ZIP CODE
-

TELEPHONE NUMBER (including area code)

FAX NUMBER (including area code)

For Administrative Use Only:
M.O.

Check

No. ____________ Received B

y: ___________________ Date: _________________

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Certificate Issued By:

_________

Date:

____________

OMB Control No. 0648-0293 (expires m/dd/2018)

MARINE MAMMAL AUTHORIZATION PROGRAM
Certification
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT I AM THE OWNER OF THE ABOVE NAMED VESSEL
(OR NON-VESSEL FISHING GEAR), OR THAT I AM AUTHORIZED TO REGISTER FOR THIS AUTHORIZATION ON
BEHALF OF THE OWNER, THAT I HAVE REVIEWED ALL INFORMATION CONTAINED IN THIS DOCUMENT, AND
THAT IT IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

_________________________________________________________
Signature

_________________________________________
Date

IF THIS REGISTRATION IS SIGNED BY A PERSON OTHER THAN THE OWNER OR AUTHORIZED REPRESENTATIVE OF THE ABOVE-NAMED
VESSEL, PLEASE COMPLETE THE FOLLOWING:
LAST NAME OF REPRESENTATIVE

FIRST NAME OF REPRESENTATIVE

M.I.

ADDRESS

CITY

STATE

ZIP CODE

Mail this completed registration form,
along with a check in the amount of $25.00, payable to the National Marine Fisheries Service,
to the nearest NMFS regional office.
Office addresses can be found at:
www.nmfs.noaa.gov/pr/interactions/mmap
(Please allow 30 days for processing)

This collection of information is mandated by the Marine Mammal Protection Act (16 U.S.C. 1387) and by implementing regulations contained at 50 CFR 229. 4. The
information supplied on this form will be used by the National Marine Fisheries Service to approximate fishing effort in various fisheries which impact marine mammal
populations in U. S. waters and to alert vessel owners of applicable rules and regulations regarding the incidental take of marine mammals in commercial fishing
operations. Certain information supplied on this form may be considered proprietary and therefore subject to data confidentiality restrictions of 50 CFR Part 229.11.
Public reporting burden for this collection of information is estimated to average 15 minutes per response for new applications, 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 of information, including suggestions for reducing this burden, to Director, Office of Protected
Resources, National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910, (301) 427-8402.
The National Marine Fisheries Service may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current
and valid OMB control number. The OMB Control number for this form is 0648-0293, which expires on m/dd/2018.

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OMB Control No. 0648-0293 (expires m/dd/2018)

MARINE MAMMAL AUTHORIZATION PROGRAM
Registration Form Instructions
VESSEL NAME: Enter the name of the vessel as it is identified for commercial fishing operations. For non-vessel
fisheries, leave this blank. A SEPARATE REGISTRATION FORM IS REQUIRED FOR EACH VESSEL, OR EACH FIXED
GEAR SITE FOR A NON-VESSEL FISHERY.
LENGTH (FT): Enter the overall length of the vessel, in feet.
HOME PORT OF VESSEL - CITY, STATE: Enter the city and state where the vessel is registered.
VESSEL STATE REGISTRATION NO./COAST GUARD DOCUMENTATION NO.: Enter either the vessel’s state
registration number OR Coast Guard Documentation number. One of these numbers must be provided or an
authorization cannot be granted. In the case of non-vessel fisheries, enter the site permit or set-net license number.
STATE COMMERCIAL VESSEL LICENSE NO.: Enter the vessel’s state commercia l fishery vessel license number, if
applicable. In Alaska, this is the ADFG commercial fishery vessel license number. In California, this is the CDFG
commercial fishery vessel license number.
PRIMARY VESSEL OWNER: Enter the vessel owner’s last name, first name, and middle initial.
SECONDARY VESSEL OWNER: If the vessel is jointly owned, enter the secondary vessel owner’s last name, first name,
and middle initial.
CORPORATE NAME: If the vessel is owned by a corporation, enter the full legal name of that corporation.
DATE OF INCORPORATION: If the vessel is owned by a corporation, enter the date it was incorporated.
MAILING ADDRESS, CITY, STATE, ZIP CODE, TELEPHONE NUMBER: Enter the address that the vessel owner or
corporate owner uses for business correspondence. Enter the vessel owner’s phone number, including area code.
SOCIAL SECURITY NUMBER: If the vessel owner participates in an Alaska Fishery, enter the vessel owner’s social
security number.
DATE OF BIRTH: Enter the vessel owner’s date of birth.
OPERATOR: If the operator of the vessel is different than the owner, enter the operator’s last name, first name, and
middle initial.
MAILING ADDRESS, CITY, STATE, ZIP CODE, and TELEPHONE NUMBER: Enter the address that the operator of the
vessel uses for business correspondence. Enter the vessel owner’s phone number and fax number, including area code.
FISHERIES CHECKLIST: Check the circle corresponding to the fishery or fisheries in which you will participate during
the next year. Registration for most fisheries has been integrated with existing state and Federal permitting and licensing
programs. If you have a valid permit to participate in any of the Category I or II fisheries currently listed on the Marine
Mammal Protection Act List of Fisheries (LOF), you are not required to submit an MMAP registration form and processing
fee in order to receive a Marine Mammal Authorization Certificate. However, if you participate in a fishery not included in
an existing state of Federal permitting or licensing program you must complete this form and mail it to NMFS, along
with the $25 processing fee.
CERTIFICATION: The vessel owner or operator must sign and date the registration form. If someone filled out the form
other than the vessel owner or operator, enter the representative’s full name and address.
MAILING INSTRUCTIONS: After completing the registration form, mail it, along with a check in the amount of $25,
payable to the National Marine Fisheries Service, to the nearest NMFS regional office address. A Marine Mammal
Authorization Program certificate or decal will be sent to you in the mail. The decal must be displayed on the port side of
the vessel’s cabin or hull, and the certificate must be in the possession of the vessel operator while engaged in
commercial fishing operations.
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OMB Control No. 0648-0293 (expires m/dd/2018)