Vessel operator permit application - initial and renewal

National Marine Fisheries Service
Greater Atlantic Region Permit Office

Initial/Renewal* Application for a Greater Atlantic
Vessel Operator Permit
Operator cards are required for any operator of a charter/party boat and or a commercial vessel
(including carrier and processor vessels) issued a vessel permit from the Greater Atlantic Region and
possessing or fishing for Atlantic Sea Scallops, Northeast Multispecies, Spiny Dogfish, Monkfish,
American Lobster, Atlantic Herring, Atlantic Surfclam, Ocean Quahog, Maine Mahogany Quahog,
Atlantic Mackerel, Loligo Squid, Illex Squid, Butterfish, Scup, Black Sea Bass, Golden Tilefish, Skates,
Atlantic Deep-Sea Red Crab, or Atlantic Bluefish, in or from the EEZ.
FIRST TIME APPLICANTS: fill in Section 1 below, sign and date the back of this application and
return it to us with one (1) passport or ID sized photo (see back).

IF USING THIS APPLICATION AS A RENEWAL: fill in Section 1 below, write your 8 digit number on
the line below, sign and date the back of this application, and return it to us with one (1) passport or ID
sized photo (see back).
Your vessel operator number___________________________________
*Preprinted renewal applications are automatically mailed to the address on file approximately 35 days
prior to the expiration date, but you may use this application to renew your permit (see below).

Please complete all sections of this application.
Incomplete applications will be returned and will be not be processed.
Submission of all application information is required.

Section 1

Last Name___________________________ First Name______________ MI___ SUFFIX________Suffix: Jr, Sr, III, IV, etc
Mailing Address___________________________________________________________________
City / ST / Zip Code___________________________/_____/______________________________
Phone Number________-________-_________

Date of Birth____/_____/_____ (MO/DAY/YR)

Eye Color______________________ Hair Color_________________________________________
Weight (lbs)_____________ Height (ft/in)______/____________________________

You must sign and date this application in Section 2 on back.
Form Revised 09/01/2013

OMB# 0648-0202

Form Approval Expires 07/31/2016

Please enclose ONE color passport or I.D. sized photo of yourself,
which is recent (taken no more than 1 year prior to the date of this application).

SAMPLE

Recommended
Picture Size

1½“high

1 ¼ inches wide
X
1 ½ inches high
1 ¼ “ wide

Section 2
I affirm that all information I have given on this application is true and correct.
Making a false statement on this application is punishable by law [18 USC
1001]. I understand that violations of Federal fisheries laws and regulations
may subject me to criminal and civil penalties including fine and/or revocation
of license. Further, as a condition of this operator's permit, I agree that if this
permit is suspended or revoked pursuant to 15 CFR part 904, I will not be on
board a Federally permitted fishing vessel in any capacity while the vessel is at
sea or engaged in offloading.

Signature of Applicant:

Date:

Return completed applications to:
Greater Atlantic Region Permit Office
55 Great Republic Drive
Gloucester, MA 01930-2276
Telephone: (978) 282-8437
Permit holder name, address, phone number, and the status of the holder's permit 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.
Public reporting burden for this collection of information is estimated to average 1 hour per
response, including time for reviewing instructions, searching existing data sources, gathering and
maintaining data needed, and completing and reviewing the information. Send comments regarding
this burden estimate or suggestions for reducing this burden to: NMFS, 55 Great Republic Drive,
Gloucester, MA 01930-2276. The purpose and use of these permits are to (1) register industry
participants and fishing vessels, (2) exercise influence over compliance, (3) provide a mailing list
for the dissemination of important information to the industry, (4) register participants to be
considered for limited entry, and (5) provide a universe for data collection samples. Both the
MSFCMA and Executive Orders 12866 et al, require the determination of this information.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any
person be subject 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.
Form Revised 09/01/2013

OMB# 0648-0202

Form Approval Expires 07/31/2016