Mothership/Catcher Vessel Pacific Coast Groundfish Limit

OMB CONTROL NO. 0648-0203, Expires 8/31/2016

Mothership/Catcher Vessel Endorsed permit renewal form Pacific Coast Groundfish Limited Entry Permit

UNITED STATES DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration N ational Marine Fisheries Service West Coast Region , Fisheries Permits Office 7600 Sand Point Way NE, Bldg. 1 Seattle, WA 98115-0070 Phone (206) 526-4353 Fax (206) 526-4461 www.westcoast.fisheries.noaa.gov

The permit owner is requested to make any changes as appropriate to the addresses, phone and fax number and email address listed below. Please respond to the questions given and return form with payment. Any changes in the vessel registered to the permit, or as change of a permit owner will require submission of a permit transfer form.

Permit Number:

Gear Endorsement:

Size Endorsement:

Permit Owner:

Permit Owner's name(s):

Business Address:

Business Phone:

Fax Number:

Email address:

Vessel Owner:

Vessel Owner name (s):

Business address:

Business phone:

Fax number:

Email address:

Vessel name:

Vessel Official number:

COOP/NON COOP DECLARATION [REQUIRED]

Please indicate which fishery the permit intends to participate in for the next year:

Coop Fishery Non Coop Fishery

If you intend to participate in the coop fishery, please declare which Mothership Permit you intend to obligate your catch history assignment to: [Please provide the MS permit number below]

Catch History Assignment ID Number: MSCV MS Permit Number: MS0_________

SMALL BUSINESS QUESTION [REQUIRED]

As part of required analyses of the economic effects of rulemakings, The National Marine Fisheries Service (NMFS) must determine if permit and license owners participating in the fishery are large or small businesses as defined by the Small Business Administration (SBA).

SBA has established size criteria for all major industry sectors in the US, including fish harvesting and fish processing businesses. The SBA also has established "principles of affiliation" to determine whether a business concern is "independently owned and operated": business concerns are affiliates of each other when one concern controls or has the power to control the other, or a third party controls or has the power to control both. NMFS is now using the following size standards:

Primary Business:	Fish Harvesting	Seafood Product Preparation and Packaging*	Fish and Seafood Wholesale	Nonprofit Organizations
Small business size standard:	Combined annual receipts of $11 million or less for all affiliated operations worldwide.	Employs 750 or fewer persons on a full time, part time, temporary, or other basis, at all affiliated operations worldwide.	Employs 100 or fewer persons on a full time, part time, temporary, or other basis, at all affiliated operations worldwide.	Environmental, conservation, or professional organizations: Combined annual receipts of $15 million or less. Other organizations: Combined annual receipts of $7.5 million or less.

*includes catcher/processors and motherships

Is your business or organization:

• Independently owned and operated, and

• not dominant in its field of operation (including any affiliates), and

• considered small by the standards listed in the table above?

If you answered yes to all three questions, please check here:

If you answered no to any of these three questions, please check here:

If you have any questions about these standards or the definition of affiliation, please call West Coast Regional Economist Abigail Harley at 206-526-4273.

CERTIFICATION OF RENEWAL FORM [REQUIRED]

Please sign below to certify that the above information is true, correct and complete (edit if necessary) to the best of your knowledge and return this form with a check or money order for $XXXXX made payable to U.S. Department of Commerce, NOAA. Mail to the address given above.

______________________________________________________________________________

Signature of owner(s) Title (If corporate officer) Date

Print Name of Signatory: __________________________

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 as a federal crime 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 responses to the questions regarding coop participation and mothership obligation are confidential. 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 0.33 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 aspect of this collection of information, including suggestions for reducing the burden, to NOAA/National Marine Fisheries Service, West Coast Region, Attn: Program Manager, 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 penalty for failure to comply with, a collection of information subject to the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.