Vessel Account Activation Form

OMB Control No. 0648-0620, Expires on: 11/30/2014

Vessel Account Registration Request Pacific Coast Groundfish Individual Fishing Quota

UNITED STATES DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration National Marine Fisheries Service, Northwest 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

This form must be completed and submitted to the National Marine Fisheries Service (NMFS) at the address given above to request a vessel account. To complete the request, any Economic Data Collection surveys due from the vessel owner must be deemed complete by the NOAA/Northwest Fisheries Science Center and the vessel owner must submit a complete trawl identification of ownership interest form. A vessel account is effective upon approval by NMFS. NMFS will mail a user ID and password upon establishing the vessel account.

Please note that any change in vessel ownership requires the new owner to request a separate vessel account in the name of the new owners. New vessel owners cannot use the prior owner’s vessel account to cover the vessel’s catch.

	1. Limited Entry Permit Number GF	2. Vessel Name		3. USCG or State Registered Vessel Number
4. Legal Name of Vessel Owner
	5. Business Mailing Address Street or PO Box				6. Business Phone Number ( )
					7. Business Fax Number (optional) ( )
	City	State	Zip Code		8. Business Email (optional)

Please sign below to certify that the above information is true, correct and complete to the best of your knowledge and return with a complete, notarized trawl identification of ownership interest form.

______________________________________________________________________________________________

Signature of Authorized Representative Title (If corporate officer) Date

____________________________________

Printed Name of Authorized Representative

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: Public reporting burden for this collection of information is estimated to average 0.25 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 suggestions for reducing this burden to NOAA/National Marine Fisheries Service, Northwest 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.