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pdfNOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Statement of Financial Interests
For Regional Fishery Management Council Voting Members, Nominees and
Members of a Scientific and Statistical Committee
Who needs to file
a financial
disclosure?
You, because you were nominated by the Governor of a state or appointed by the
Secretary of Commerce to serve as a voting member of a Regional Fishery
Management Council (Council); or you are a nominee to or a member of a Scientific
and Statistical Committee (SSC).
What is the
purpose of a
financial
disclosure?
The duties and responsibilities of your position require you to file the Statement of
Financial Interests to fulfill the requirements of the Magnuson‐Stevens Act. The
purpose of this report is to assist you and NMFS in avoiding conflicts between official
duties and private financial interests or affiliations. You may not vote on any Council
decision that would have a significant and predictable effect on a financial interest
disclosed in your report. Under penalty of law, please ensure that the information you
provide is complete and accurate.
What must I
disclose on this
form?
When do I need to
file my financial
disclosure?
The Magnuson‐Stevens Act requires the disclosure of any financial interest in
harvesting, processing, lobbying, advocacy, or marketing activity that is being, or will
be, undertaken within any fishery over which a Council has jurisdiction. This also
includes employment with an entity that provides consulting, legal, or
representational services relating to harvesting, processing, lobbying, advocacy, or
marketing activities. You must disclose such financial interest held by yourself; your
spouse, minor child, partner; or any organization (other than the Council) in which you
are serving as an officer, director, trustee, partner, or employee. This does not include
financial interests in entities engaging in scientific fisheries research.
Nominees: This form must be filed by each nominee for Secretarial appointment with
the Assistant Administrator by April 15 or, if nominated after March 15, 1 month after
nomination by the Governor.
Members: A seated voting member appointed by the Secretary must file this form
with the Executive Director of the appropriate Council within 45 days of taking office;
and must file an update with the Executive Director of the appropriate Council within
30 days of the time any such financial interest is acquired or substantially changed.
All Council members must file this form annually by February 1st regardless of whether
any information on the form has changed.
SSC Nominees and Members: Nominees to an SSC must file this form with the
Regional Administrator for the geographic area concerned within 45 prior to
appointment; and must file an update with the Regional Administrator for the
geographic area concerned within 30 days of the time any such financial interest is
acquired or substantially changed. All SSC members must file this form annually by
February 1st regardless of whether any information on the form has changed.
Questions?
If you have any questions about how to complete this form, please contact your
Council Executive Director, NMFS Regional Office or the NOAA General Counsel for
your Council.
PENALTIES
Knowing and willful falsification of information required to be reported may subject you to criminal prosecution or subject
you to civil penalties. It is unlawful for an affected individual to knowingly and willfully fail to disclose, or to falsely
disclose, any financial interest as required by the Magnuson Stevens Act, or to knowingly vote on a Council decision in
violation of this Act. In addition to the criminal penalties applicable, a violation of this provision may result in removal
from Council or SSC membership.
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NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
STATEMENT OF FINANCIAL INTERESTS
Nominee or Member’s Name (Print last, first, middle initial) _____________________________________
Name of Council or Council Committee ____________________________________
Type of Appointment (list Nominee or Member) _________________________________
Type of Filing:
Annual
Supplemental
Nominee
Instructions
1. Carefully read the questions for Parts 1-3 on the following pages.
2. In Part 1, you must answer “yes” or “no” for each question provided. If you select “Yes,” check the box
by any applicable financial interest from the list below the question and provide the appropriate detail
explaining your selection. If you need more room to provide detail, please attach those pages to this
form.
3. In Part 2, you must answer “yes” or “no” for each question provided. If you select “Yes,” check the box
by any applicable financial interest from the list below the question and provide the appropriate detail
explaining your selection. If you need more space to provide detail, please attach those pages to this
form.
4. In Part 2, if you select “I have no spouse, partner, or minor children,” you may skip the rest of Part 2 and
move to Part 3. Answer Part 3, if necessary.
5. After you have completed the form, sign and date the form on the last page.
6. Submit the completed form to NMFS for Council nominees; to your Council Executive Director for
seated Council members; or to the Regional Administrator for the geographic area concerned for SSC
members or nominees.
Paperwork Reduction Act
Notwithstanding any other provision of law, no person is required to respond to nor shall a 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. The public reporting burden for this information, on this NOAA Form 88-195, is estimated to
average 45 minutes per response, including 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 aspect of
this collection of information, including suggestions for reducing this burden to the National Marine Fisheries Service, Office of the Chief
rd
Information Officer (F/CIO), 1315 East-West Highway, SSMC #3, 3 Floor, Silver Spring, Maryland 20910.
Public Access to Information
This form, as completed by seated members of the Regional Fishery Management Councils, will be retained by the Council, made available
on the Council’s websites, and made available for public review at reasonable hours at the Council’s Office and at each public hearing or
public meeting.
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NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Part 1: Personal Financial Interest
Section 1.1: Assets and Ownership
Question 1.1.1
Do you have any stock, equity or ownership interest (whole or partial ownership) in a company or business engaged in
any of the following activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the company or business. Please include
company or business name, date the interest began, and fishery or fisheries of interest.
Question 1.1.2
Do you have stock, equity or ownership interest (whole or partial ownership) in any fishing vessel engaged in the
following activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the vessel. Please include vessel name,
company or business name, date the interest began, gear type and fishery or fisheries of interest.
3
NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Question 1.1.3
Do you have stock, equity or ownership interest (whole or partial ownership) in any other entity engaged in the following
activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.
Question 1.1.4
Do you have any stock, equity or ownership interest (whole or partial) in a company, business, or other entity that provides any of the
following services related to any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Lobbying
Advocacy
Consulting
Legal
Representational Services
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.
Question 1.1.5
Do you have have any stock, equity or ownership interest in any entity that either owns (wholly or partially) or is owned
by (wholly or partially) another entity that provides any of the following services for any fishery under the jurisdiction of
the Council concerned?
No
Yes
Check all that apply:
Consulting
Legal
Representational Services
Lobbying
Advocacy
Marketing
Harvesting
Processing
Marketing
Provides equipment essential to any of the listed activities
Provides other services essential to any of the listed activities
4
NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include company or business
name, date the interest began, and fishery or fisheries of interest.
Section 1.2: Employment
Question 1.2.1
Do you have employment with any company or business engaged in the following activities in any fishery under the
jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting Provides equipment essential to any of the listed activities
Processing Provides other services essential to any of the listed activities
Marketing
Provides equipment essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include beginning date of
Provides other services essential to any of the above activities
employment, company or business name and fishery or fisheries of interest.
Question 1.2.2
Do you have employment with a fishing vessel engaged in the following activities in any fishery under the jurisdiction of
the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include beginning date
of employment, vessel name, gear type and fishery or fisheries of interest.
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NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Question 1.2.3
Do you have employment with any other entity engaged in the following activities in any fishery under the jurisdiction of
the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include beginning date of
employment, entity name and fishery or fisheries of interest.
Question 1.2.4
Do you have employment with any company, business, or other entity that provides any of the following services related
to any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Consulting
Lobbying
Legal
Advocacy
Representational Services
Please list and describe each applicable interest, as indicated above. Please include beginning date of
employment, entity name and fishery or fisheries of interest.
Question 1.2.5
Do you have employment with any entity that either owns (wholly or partially) or is owned by (wholly or partially)
another entity providing any of the following services, or providing equipment or services essential to harvesting,
processing, lobbying, advocacy, or marketing activities, in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Consulting
Processing
Legal
Representational Services Marketing
Provides equipment essential to any of the listed activities
Provides other services essential to any of the listed activities
6
NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Please list and describe each applicable interest, as indicated above. Please include beginning date of
employment, entity name and fishery or fisheries of interest.
Question 1.2.6
Do you have employment with an association or organization whose members include companies, vessels, or other
entities engaged in any of the following activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Lobbying
Advocacy
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include beginning date of
employment, association name and fishery or fisheries of interest.
Section 1.3: Other Service with an association or organization
Question 1.3.1
Are you serving as an officer, director, or trustee of any organization or association whose members include companies,
vessels, or other entities engaged in any of the following activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Lobbying
Advocacy
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include beginning date of service,
entity name and fishery or fisheries of interest.
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NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Part 2: Financial Interest of Spouses, Partners, and Minor Children
If you have no spouse, partner, or minor children, check the box below and proceed to Part 3.
I have no spouse, partner, or minor children
Section 2.1: Assets and Ownership
Question 2.1.1
Does your spouse, partner, or minor child have any stock, equity or ownership interest (whole or partial ownership) in a
company or business engaged in any of the following activities in any fishery under the jurisdiction of the Council
concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the company or business. Please include
company or business name, date the interest began, and fishery or fisheries of interest.
Question 2.1.2
Does your spouse, partner, or minor child have any stock, equity or ownership interest (whole or partial) in any fishing
vessel engaged in the following activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the vessel. Please include vessel name,
company or business name, date the interest began, gear type and fishery or fisheries of interest.
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NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Question 2.1.3
Does your spouse, partner, or minor child have any stock, equity or ownership interest (whole or partial) in any other
entity engaged in the following activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.
Question 2.1.4
Does your spouse, partner, or minor child have any stock, equity or ownership interest (wholly or partially) in a
company, business, or other entity that provides any of the following services for any fishery under the jurisdiction of
the Council concerned?
No
Yes
Check all that apply:
Consulting
Legal
Representational Services
Lobbying
Advocacy
Marketing
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.
Section 2.2 Employment of Spouse, Partner, or Minor Child
Question 2.2.1
Does your spouse, partner, or minor child have employment with any company or business engaged in the following
activities in any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
9
NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, company or business name and fishery or fisheries of interest.
Question 2.2.2
Does your spouse, partner, or minor child have employment with a fishing vessel engaged in the following activities in
any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, vessel name, gear type and fishery or fisheries of interest.
Question 2.2.3
Does your spouse, partner, or minor child have employment with any other entity engaged in the following activities in
any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Processing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, entity name and fishery or fisheries of interest.
Question 2.2.4
Does your spouse, partner, or minor child have employment with any company, business, or other entity that provides
any of the following services related to any fishery under the jurisdiction of the Council concerned?
No
Yes
Check all that apply: Consulting
Lobbying
Legal
Advocacy Representational Services
Please list person and relationship and describe each
applicable interest, as indicated above. Please include
beginning date of employment, entity name and fishery or fisheries of interest.
10
NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Question 2.2.5
Does your spouse, partner, or minor child have employment with any entity that either owns (wholly or partially) or is
owned by (wholly or partially) another entity providing any of the following services in any fishery under the jurisdiction
of the Council concerned?
No
Yes
Check all that apply:
Consulting
Legal
Representational Services
Harvesting
Processing
Lobbying
Advocacy
Marketing
Provides equipment essential to any of the listed activities
Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, entity name and fishery or fisheries of interest.
Question 2.2.6
Does your spouse, partner, or minor child have employment with an association or organization whose members include
companies, vessels, or other entities engaged in any of the following activities in any fishery under the jurisdiction of the
Council concerned?
No
Yes
Check all that apply:
Harvesting Consulting
Processing Legal
Lobbying
Representational Services
Advocacy
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, association name and fishery or fisheries of interest.
11
NOAA Form 88‐195
OMB NO 0648 0192
Expiration Date 3/31/17
Section 2.3: Service with an association or organization by Spouse, Partner, or Minor Child
Question 2.3.1
Does your spouse, partner, or minor child serve as an officer, director, or trustee of any organization or association
whose members include companies, vessels, or other entities engaged in any of the following activities in any fishery
under the jurisdiction of the Council concerned?
No
Yes
Check all that apply:
Harvesting
Consulting
Processing
Legal
Lobbying
Representational Services
Advocacy
Marketing
Provides equipment essential to any of the above activities
Provides other services essential to any of the above activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of service, entity name and fishery or fisheries of interest.
Part 3: Information Requested of Other Persons
In the event any of the required information, including holdings placed in trust, is not known to
you but is known to another person, you should request that other person to submit the
information on your behalf and should report such request in the space below.
Please report to whom you have requested information for Part 3. When available, have that person please list
and describe each applicable interest. Please include the percentage ownership or share holdings or any other
monetary or in‐kind enumeration. Please include entity name, date the interest began, and fisheries of interest.
I certify that the statements I have made on this form and all attached statements are true, complete, and
correct to the best of my knowledge.
Signature_____________________________________
Date (mm/dd/yyyy)_________________________
12
File Type | application/pdf |
File Modified | 2017-02-10 |
File Created | 2014-04-10 |