Federal Permit Application for Southeast Region Vessel O

OMB Control Number 0648-0205; Expiration Date 04/30/2017

U.S. Department of Commerce, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13th Avenue South
St. Petersburg, FL 33701
Toll Free 877-376-4877 (8:00 a.m. - 4:30 p.m. ET)
727-824-5326 (8:00 a.m. - 4:30 p.m. ET)
Permits.sero.nmfs.noaa.gov

FEDERAL APPLICATION FOR
SOUTHEAST REGION ISSUED
OPERATOR CARD
FOR OFFICE USE ONLY
Reviewer’s Initials and Date

FOR OFFICE USE ONLY

Expiration Date

Application ID

Check or Money Order Number
and Amount

FEE: $50.00 REPLACEMENT FEE: $18.00
Application Fees are Non-Refundable. Make check or money order payable to the U.S. Treasury.
Atlantic Dolphin/Wahoo permits and South Atlantic Rock Shrimp permits are not valid unless the operator or a crew
member holds a valid Operator Card when underway fishing for Dolphin, Wahoo and/or Rock Shrimp in the Atlantic EEZ.
Illegible applications will be returned.
APPLICATION INSTRUCTIONS: Information is required for all blanks in Sections 1 & 2. Please list a number where you can
be reached or a message left if we have any questions. You must provide two (2) recent (less than 1 year old) passport
style photos in 2 inch X 2 inch size. The photos must have a plain white background and your face must be unobstructed
by sunglasses, hats, scarves, etc. Vision correcting glasses are permitted. Do not staple, glue, tape, paperclip or otherwise
attach the photos to the application.

SECTION 1 - VESSEL OPERATOR (CARD OWNER) PERSONAL INFORMATION
Are you a United States Citizen or permanent resident alien?

What is your Sex?
What is your
race? (Check
all that apply)

Male

YES

NO

Check here if you would you like to receive
digital updates (texts & emails). Provide your
digital contact information below.

Are you of Hispanic, Latino, or Spanish origin?

Female

Yes

No

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

Middle Name

First Name

Suffix - Jr, Sr, etc.

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Tax ID Number (SSN)

Mailing Address

Date of Birth (MM/DD/YYYY)

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Email

Apt #

City

Digital contact information
(number and provider):

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O2015.1X; Form Revision 12/17/2015

SECTION 2 - VESSEL OPERATOR (CARD OWNER) IDENTIFYING INFORMATION
Birth Place (City, State, Country)

Sex

Weight (lbs)

Eye Color

Height (ft & in)

If you are clean shaven or balding,
indicate your actual hair color.

Hair Color

Male

Brown

Green

Brown

Blonde

Female

Blue

Hazel

Black

Red

Grey

Other

Grey

Other

White

SECTION 3 - SIGNATURE - REQUIRED
Applicant Signature

Print Name

Date

Public reporting burden for this collection of information is estimated to average 21 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 any other suggestions for reducing this burden to PRA
Officer, National Marine Fisheries Service, F/SER26, 263 13th Avenue 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. Confidential name and address
information will be released via a NOAA Fisheries website. 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.

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