Form 88-195 Statement of Financial Interests

Statement of Financial Interests, Regional Fishery Management Councils

financial disclosure form_final_fillable_2017

Statement of Financial Interests, Regional Fishery Management Councils

OMB: 0648-0192

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NOAA 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. 

1 

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.

2 

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.  

5 

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.  

7 

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. 

8 

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 


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