Recreational permit application

Papahānaumokuākea Marine National Monument

Permit Application - Recreation

OMB Control # 0648-0548

Page 7 of 7

Papahānaumokuākea Marine National Monument

RECREATION Permit Application

NOTE: This Permit Application (and associated Instructions) are to propose activities to be conducted in the Midway Atoll Special Management Area of the Papahānaumokuākea Marine National Monument. The Co-Trustees are required to determine that issuing the requested permit is compatible with the findings of Presidential Proclamation 8031. Within this Application, provide all information that you believe will assist the Co-Trustees in determining how your proposed activities are compatible with the conservation and management of the natural, historic and cultural resources of the Papahānaumokuākea Marine National Monument (Monument).

ADDITIONAL IMPORTANT INFORMATION:

• Any or all of the information within this application may be posted to the Monument website informing the public on projects proposed to occur in the Monument.

• In addition to the permit application, the Applicant must either download the Monument Compliance Information Sheet from the Monument website OR request a hard copy from the Monument Permit Coordinator (contact information below). The Monument Compliance Information Sheet must be submitted to the Monument Permit Coordinator after initial application consultation.

• Issuance of a Monument permit is dependent upon the completion and review of the application and Compliance Information Sheet.

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

Send Permit Applications to:

NOAA/Inouye Regional Center

NOS/ONMS/PMNM/Attn: Permit Coordinator

1845 Wasp Blvd, Building 176

Honolulu, HI 96818

[email protected]

PHONE: (808) 725-5800 FAX: (808) 455-3093

SUBMITTAL VIA ELECTRONIC MAIL IS PREFERRED BUT NOT REQUIRED. FOR ADDITIONAL SUBMITTAL INSTRUCTIONS, SEE THE LAST PAGE.

Papahānaumokuākea Marine National Monument

Permit Application Cover Sheet

This Permit Application Cover Sheet is intended to provide summary information and status to the public on permit applications for activities proposed to be conducted in the Papahānaumokuākea Marine National Monument. While a permit application has been received, it has not been fully reviewed nor approved by the Monument Management Board to date. The Monument permit process also ensures that all environmental reviews are conducted prior to the issuance of a Monument permit.

Summary Information

Applicant Name:  FORMTEXT      

Affiliation:  FORMTEXT      

Permit Category: Recreation

Proposed Activity Dates:  FORMTEXT      

Proposed Method of Entry (Vessel/Plane):  FORMTEXT      

Proposed Locations:  FORMTEXT      

Estimated number of individuals (including Applicant) to be covered under this permit:  FORMTEXT      

Estimated number of days in the Monument:  FORMTEXT      

Description of proposed activities: (complete these sentences):

1. The proposed activity would…

 FORMTEXT      

2. To accomplish this activity we would ….

 FORMTEXT      

3. This activity would help the Monument by …

 FORMTEXT      

Other information or background:

 FORMTEXT      

Section A - Applicant Information

1. Applicant

Name (last, first, middle initial):  FORMTEXT      

Title:  FORMTEXT      

1a. Intended field Principal Investigator (See instructions for more information):

 FORMTEXT      

2. Mailing address (street/P.O. box, city, state, country, zip):  FORMTEXT      

Phone:  FORMTEXT      

Fax:  FORMTEXT      

Email:  FORMTEXT      

For students, major professor’s name, telephone and email address:  FORMTEXT      

3. Affiliation (institution/agency/organization directly related to the proposed project):

 FORMTEXT      

4. Additional persons to be covered by permit. List all personnel roles and names (if known at time of application) here (e.g. John Doe, Visitor):

 FORMTEXT      

Section B: Project Information

5a. Project location(s): Ocean Based

Midway Atoll Land-based Shallow water Deep water

NOTE: Shallow water is defined by water less than 100 meters in depth.

NOTE: There is a fee schedule for people visiting Midway Atoll National Wildlife Refuge via vessel and aircraft.

Location Description:

 FORMTEXT      

5b. Check all applicable regulated activities proposed to be conducted in the Monument:

Drilling into, dredging, or otherwise altering the submerged lands other than by anchoring a vessel; or constructing, placing, or abandoning any structure, material, or other matter on the submerged lands

Anchoring a vessel

Deserting a vessel aground, at anchor, or adrift

Discharging or depositing any material or matter into the Monument

Touching coral, living or dead

Attracting any living Monument resource

Swimming, snorkeling, or closed or open circuit SCUBA diving within any Special Preservation Area or Midway Atoll Special Management Area

6. Purpose/Need/Scope State purpose of proposed activities:

 FORMTEXT      

*Considering the purpose of the proposed activities, do you intend to film / photograph federally protected species? Yes No

If so, please list the species you specifically intend to target.

 FORMTEXT      

For a list of terrestrial species protected under the Endangered Species Act visit:

http://www.fws.gov/endangered/

For a list of marine species protected under the Endangered Species Act visit:

http://www.nmfs.noaa.gov/pr/species/esa/

For information about species protected under the Marine Mammal Protection Act visit:

http://www.nmfs.noaa.gov/pr/laws/mmpa/

7. Answer the Findings below by providing information that you believe will assist the Co-Trustees in determining how your proposed activities are compatible with the conservation and management of the natural, historic, and cultural resources of the Monument:

The Findings are as follows:

a. How will the activity be conducted with adequate safeguards for the cultural, natural and historic resources and ecological integrity of the Monument?

 FORMTEXT      

b. How will the activity be conducted in a manner compatible with the management direction of this proclamation, considering the extent to which the conduct of the activity may diminish or enhance Monument cultural, natural and historic resources, qualities, and ecological integrity, any indirect, secondary, or cumulative effects of the activity, and the duration of such effects?

 FORMTEXT      

c. Is there a practicable alternative to conducting the activity within the Monument? If not, explain why your activities must be conducted in the Monument.

 FORMTEXT      

d. How does the end value of the activity outweigh its adverse impacts on Monument cultural, natural and historic resources, qualities, and ecological integrity?

 FORMTEXT      

e. Explain how the duration of the activity is no longer than necessary to achieve its stated purpose.

 FORMTEXT      

f. Provide information demonstrating that you are qualified to conduct and complete the activity and mitigate any potential impacts resulting from its conduct.

 FORMTEXT      

g. Provide information demonstrating that you have adequate financial resources available to conduct and complete the activity and mitigate any potential impacts resulting from its conduct.

     

h. Explain how your methods and procedures are appropriate to achieve the proposed activity's goals in relation to their impacts to Monument cultural, natural and historic resources, qualities, and ecological integrity.

 FORMTEXT      

i. Has your vessel been outfitted with a mobile transceiver unit approved by OLE and complies with the requirements of Presidential Proclamation 8031?

 FORMTEXT      

j. Demonstrate that there are no other factors that would make the issuance of a permit for the activity inappropriate.

 FORMTEXT      

ADDITIONAL FINDINGS FOR PROPOSED RECREATION ACTIVITIES

k. Explain how your activity is for the purpose of recreation, where recreation is defined as an activity conducted for personal enjoyment that does not result in the extraction of Monument resources and does not involve a fee-for-service transaction.

 FORMTEXT      

8. Procedures/Methods:

 FORMTEXT      

NOTE: If land or marine archeological activities are involved, contact the Monument Permit Coordinator at the address on the general application form before proceeding.

9. List any other associated Monument permits:

 FORMTEXT      

10. List all specialized gear and materials to be used in this activity:

 FORMTEXT      

11. List all Hazardous Materials you propose to take to and use within the Monument:

 FORMTEXT      

12. Describe any fixed installations and instrumentation proposed to be set in the Monument:

 FORMTEXT      

With knowledge of the penalties for false or incomplete statements, as provided by 18 U.S.C. 1001, and for perjury, as provided by 18 U.S.C. 1621, I hereby certify to the best of my abilities under penalty of perjury of that the information I have provided on this application form is true and correct. I agree that the Co-Trustees may post this application in its entirety on the Internet. I understand that the Co-Trustees will consider deleting all information that I have identified as “confidential” prior to posting the application.

_________________________________________________________________

Signature Date

SEND ONE SIGNED APPLICATION VIA MAIL TO THE MONUMENT OFFICE BELOW:

NOAA/Inouye Regional Center

NOS/ONMS/PMNM/Attn: Permit Coordinator

1845 Wasp Blvd, Building 176

Honolulu, HI 96818

FAX: (808) 455-3093

DID YOU INCLUDE THESE?

Applicant CV/Resume/Biography

Intended field Principal Investigator CV/Resume/Biography

Electronic and Hard Copy of Application with Signature

Statement of information you wish to be kept confidential

Material Safety Data Sheets for Hazardous Materials

7

RECREATION