Notification of Entanglement or Interaction

OMB Control No. 0648-0703

Expiration Date:

NOTIFICATION OF ENTANGLEMENT OR INTERACTION WITH MARINE MAMMALS, ENDANGERED SPECIES, OR MARINE MIGRATORY BIRDS

FOR OFFICE USE ONLY
Date Received
Gulf Aquaculture Permit Number
Reviewer Initials and Date

Permittees must notify NOAA Fisheries via phone (XXX-XXX-XXXX) or web form (website TBD) within 24 hours of an entanglement or interaction event.

Permittees must also submit a Marine Mammal Authorization Program (MMAP) form within 48 hours when there is an incidental mortality or injury to a marine mammal only. The MMAP form can be found at: http://www.nmfs.noaa.gov/pr/interactions/mmap/

A separate Notification of Entanglement or Interaction form must be filled out for each species and event.

Part 1 – Contact Person Information

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.) MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

WORK TELEPHONE NUMBER CELL PHONE NUMBER GULF AQUACULTURE PERMIT NUMBER

_{Part 2 – Event Information}

: AM / PM

/ /

DATE OF EVENT (MM/DD/YYYY) APPROXIMATE TIME OF EVENT

Provide the GPS coordinates for the location where the event occurred. Report coordinates as degree minutes to at least the third decimal place.

LATITUDE (DEGREE MINUTES TO THIRD DECIMAL PLACE) LONGITUDE (DEGREE MINUTES TO THIRD DECIMAL PLACE)

List the species and number of individuals involved in the event. A separate Notification of Entanglement or Interaction form must be filled out for each species identified.

Species: _______________________________ Number of Individuals: _____________

Was this event an entanglement or interaction?

Entanglement = animal is physically caught in or entwined by fishing gear or equipment

Interaction = animal is observed interacting with or near fishing gear or equipment (e.g.,

removes or damages fish or bait on fishing gear, is observed eating discarded fish, net chewing)

Entanglement (continue to Part 3) Interaction (continue to Part 4)

Both (fill out Part 3 and Part 4)

_{Part 3 – Entanglement Details}

Did the entanglement result in a:

Live Release (complete 3a-c) OR Mortality (complete 3d-e)

1. If Live Release, please describe the number, nature and location of injuries observed (e.g., lacerations, visible blood, missing or injured appendages). If no injuries observed, please write “No injuries observed.”

2. If Live Release, was gear left on the animal? If so, approximately how much? Please describe the type of gear (e.g. material and speculations), where on the body, and how the animal was wrapped in the gear. If no gear was left on the animal, please write “No gear observed.”

3. If Live Release, please describe the animal’s condition and behavior once released (e.g., difficulty/inability to swim or use appendages, difficulty breathing, fast swim away).

4. If Mortality, please describe the number, nature and location of injuries observed (e.g., lacerations, visible blood, missing or injured appendages). If no injuries observed, please write “No injuries observed.”

5. If Mortality, please describe where on the body and how the animal was wrapped in the gear. was gear left on the animal? If so, approximately how much? Please describe the type of gear (e.g. material and speculations), where on the body, and how the animal was wrapped in the gear. If no gear was left on the animal, please write “No gear observed.”

Part 4 – Interaction Details

Please describe in detail the nature of the interaction behaviors you observed (e.g., stealing farmed fish, consuming fish feed, hooked or entangled in nets or cages, begging, eating discarded fish, resting on cage).

Was any fishing gear lost due to an interaction with the animal(s)?

Yes No Unknown

If fishing gear was lost, please describe the type and amount of gear lost:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Part 5 – Biological Information

If known, please provide biological information of the animal entangled (e.g. approximate length, weight, sex). If you do not have any of this information, write “unknown” in the additional information section below.

Length: ­­­_________________ circle one (cm, m, ft, in)

Weight: ­­­­­­­­­­_________________ circle one (lb, kg)

Sex: Male Female Unknown

Please provide any additional information: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Part 6 – Future Prevention

Please provide information on the potential and/or suspected cause(s) of the entanglement or interaction.

Please provide information on the action(s) being taken to prevent future entanglements or interaction.

Part 7- Signature

I hereby declare under penalty of perjury that the foregoing information is true and correct (28

U.S.C. section 1746; 18 U.S.C. section 1621; 18 U.S.C. section 1001).

PERMIT OWNER SIGNATURE DATE SIGNED (MM/DD/YYYY)

_{/ /}

PRINTED NAME POSITION IN COMPANY (if applicable)

Public reporting burden for this collection of information is estimated to average 30 minutes per response, 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 other suggestions for reducing this burden to the PRA Officer, National Marine Fisheries Service, F/SER26, 263 13th Ave South, St. Petersburg, FL 33701.

The National Marine Fisheries Service requires this information for the conservation and management of marine fishery resources. The data reported will be used to develop, implement, and monitor fishery management activities for a variety of other uses. Responses to this collection are required to obtain or retain a fisheries permit under the Magnuson - Stevens Act. Non-confidential information may be released via a NOAA Fisheries website. Non-confidential information means: Name, Street Address, City, State, Zip Code, Effective Date of Permit, Permit Types, Vessel Name, Vessel Identification Number, and in the case of a “for hire” vessel the Passenger Capacity, or individual, corporate and lease holders of permits. All other data submitted will be handled as confidential material in accordance with NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. 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.