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pdfOMB Control No. 0648-0551 Exp. Date: 11/30/2014
U.S. DEPT OF COMMERCE, NOAA
NMFS IFQ Program, F/SER29
263 13th Avenue South
St. Petersburg, FL 33701-5511
Toll Free 866-425-7627 (8 a.m. - 4:30 p.m. ET)
727-824-5305 (8 a.m. - 4:30 p.m. ET)
http://ifq.sero.nmfs.noaa.gov
NOAA FISHERIES SERVICE
FEDERAL APPLICATION
FOR GULF OF MEXICO
INDIVIDUAL FISHING QUOTA (IFQ)
ONLINE ACCOUNT
FOR OFFICE USE ONLY
Reviewer's Initials and Date ___________________________
Sanction Case Number if Sanctioned and date held
__________________________________________________
Date Sanction Released and Initials _____________________
Application ID
APPLICATION INSTRUCTIONS
1. Current IFQ participants need to complete this application to certify they are or are NOT a United States citizen or a permanent resident alien.
2. As of January 1, 2012, all United States citizens and permanent resident aliens are eligible for participation in the Gulf red snapper IFQ program.
This application is to establish an IFQ account for new participants and update account information for existing participants. However, a valid
commercial permit for Gulf reef fish, a Gulf red snapper IFQ vessel account, and Gulf red snapper IFQ allocation are required to possess (at
and after the time of the advance notice of landing), land or sell Gulf red snapper subject to this IFQ program.
3. Follow the instructions at the top of each section. Make sure all the information is correct then sign and date the application below. The IFQ
applicant signing the application must be an account holder listed in section 1 and a United States citizen or permanent resident alien.
4. Mail your completed application to: U.S. Department of Commerce, NOAA, National Marine Fisheries Service F/SER29, 263 13th Avenue South,
St. Petersburg, FL 33701-5505.
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the 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 other suggestions for reducing this burden to PRA Officer, National Marine Fisheries Service, F/SER2,
263 13th Avenue South, St. Petersburg, FL 33701-5505.
The National Marine Fisheries Service requires this information for the conservation and management of marine fishery resources. The data reported
will be used to develop, implement, and monitor fishery management activities for a variety of uses. Responses to this collection are required to obtain
or retain an IFQ online account under the Magnuson-Stevens Act. Non-confidential information will be released via a NOAA Fisheries Service website.
Non-confidential information means: name, address, city, state, zip code, etc. All other data submitted will be handled as confidential material in
accordance with NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. Notwithstanding any other provisions of the law,
no person is required to respond to, nor shall any person be subjected 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.
SIGNATURE OF APPLICATION
The undersigned certifies under penalty of perjury that the foregoing information is true and correct (28 USC 1746; 18 USC 1621; 18 USC 1001, 16
USC 1857). Knowingly supplying false information for the purpose of obtaining an IFQ Online Account is a violation of Federal law punishable by a
fine and/or imprisonment. Please note: The individual signing below MUST be either the IFQ account holder OR must be one of the officers or
shareholders that is a United States citizen or permanent resident alien listed in section 2 of this application.
Applicant Signature ________________________________ Position in Company (if applicable) ___________________________
Print Name_______________________________________ Date ____________________ UserID ____________
(if applicable)
Last form revision 03/11/2014
1. IFQ ONLINE ACCOUNT HOLDER INFORMATION
1) Check the appropriate box below if the applicant is a new or existing IFQ online account holder. Provide the USER ID for an existing account holder.
2) Complete this page for all IFQ online account holders. If the account holder is a business, enter the Federal ID number and date the business filed
with the state. If the account holder is an individual, enter their Social Security Number and date of birth.
3) Check the appropriate box below to certify that the applicant IS or IS NOT a United States citizen or permanent resident alien.
4) If the IFQ account is held by a business, please also complete Section 2 on page 4.
Check the appropriate box below:
NEW IFQ online account holder
EXISTING IFQ online account holder and provide the IFQ Online account holder’s UserID: ________________
E-mail address: _________________________________________________________________________________________________
IFQ ONLINE ACCOUNT HOLDER INFORMATION
Check one: Individual/Sole Proprietorship
Joint Ownership
Partnership
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name or Business Name
Corporation
First Name
If you are operating under a different name,
what is your Doing Business As (DBA) name?
Mailing Address
Apt/Suite
Other ______________
Middle Name
Suffix
City
State
County/Parish
Zip Code
Country
City
State
County/Parish
Zip Code
Country
Physical Address
Apt/Suite
Check if same as mailing address
Tax ID number (FED ID or SSN)
Date of Birth or Date Business Filed (mm/dd/yyyy)
Area Code
Select one:
Primary Phone Number
Home
Work
Cell
ADDITIONAL IFQ ONLINE ACCOUNT HOLDER INFORMATION
Check one: Individual/Sole Proprietorship
Joint Ownership
Partnership
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name or Business Name
Corporation
First Name
If you are operating under a different name,
what is your Doing Business As (DBA) name?
Mailing Address
Apt/Suite City
Other ______________
Middle Name
Suffix
State
County/Parish
Zip Code
Country
State
County/Parish
Zip Code
Country
Physical Address
Check if same as mailing address
Tax ID number (FED ID or SSN)
Apt/Suite City
Date of Birth or Date Business Filed (mm/dd/yyyy)
Area Code
Primary Phone Number
Select one: Home
2
Work
Cell
ADDITIONAL IFQ ONLINE ACCOUNT HOLDER INFORMATION
1) Only complete this page for all additional IFQ online account holders. If the account holder is a business, enter the Federal ID number and date the
business filed with the state. If the account holder is an individual, enter their Social Security Number and date of birth.
2) Check the appropriate box below to certify that the applicant IS or IS NOT a United States citizen or permanent resident alien.
IFQ online account holder’s UserID (if applicable):
ADDITIONAL IFQ ONLINE ACCOUNT HOLDER INFORMATION
Check one: Individual/Sole Proprietorship
Joint Ownership
Partnership
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name or Business Name
Corporation
First Name
If you are operating under a different name,
what is your Doing Business As (DBA) name?
Mailing Address
Apt/Suite
Other ______________
Middle Name
Suffix
City
State
County/Parish
Zip Code
Country
City
State
County/Parish
Zip Code
Country
Physical Address
Apt/Suite
Check if same as mailing address
Tax ID number (FED ID or SSN)
Date of Birth or Date Business Filed (mm/dd/yyyy)
Area Code
Select one:
Primary Phone Number
Home
Work
Cell
ADDITIONAL IFQ ONLINE ACCOUNT HOLDER INFORMATION
Check one: Individual/Sole Proprietorship
Joint Ownership
Partnership
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name or Business Name
Corporation
First Name
If you are operating under a different name,
what is your Doing Business As (DBA) name?
Mailing Address
Apt/Suite
Other ______________
Middle Name
Suffix
City
State
County/Parish
Zip Code
Country
City
State
County/Parish
Zip Code
Country
Physical Address
Check if same as mailing address
Tax ID number (FED ID or SSN)
Apt/Suite
Date of Birth or Date Business Filed (mm/dd/yyyy)
Area Code
Select one:
3
Primary Phone Number
Home
Work
Cell
2. OFFICER/SHAREHOLDER INFORMATION FOR
CORPORATION/BUSINESS/LLC THAT HOLD THE IFQ ONLINE ACCOUNT
1) If this IFQ online account is held by a business, then complete this section for EACH officer or partner associated with the business.
Provide the information for all officers or partners that are shown on your most recent annual report. If your business is structured as a corporation,
identify all shareholders in the corporation that own at least 1% or more of the shares, as well as the percentage of all shares in the corporation held by
each shareholder. Individuals holding less than 1% of the shares (minor shareholders) should not be individually listed. Total shareholders must
equal 100%. For all provide position held in business, name, address, social security number, date of birth, and telephone number.
2) Check the appropriate box below to certify that the applicant is or is NOT a United States citizen or permanent resident alien.
Business name _____________________________________ Federal Tax ID number ____________________
Officer or Shareholder Information
Check all that apply: President/CEO
Shareholder
Vice President
Secretary
Treasurer
Director/Manager
Other __________________
Percent (%) of corporation held: _______________________
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name
First Name
Mailing Address
Middle Name
Suffix
Apt/Suite
City
State
County/Parish
Zip Code
Country
Apt/Suite
City
State
County/Parish
Zip Code
Country
Physical Address
Check if same as mailing address
SSN
Date of Birth (mm/dd/yyyy)
Area Code
Select one:
Primary Phone Number
Home
Work
Cell
Additional Officer or Shareholder Information
Check all that apply: President/CEO
Shareholder
Vice President
Secretary
Treasurer
Director/Manager
Other ________________
Percent (%) of corporation held: _______________________
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name
Mailing Address
First Name
Middle Name
Suffix
Apt/Suite
City
State
County/Parish
Zip Code
Country
Apt/Suite
City
State
County/Parish
Zip Code
Country
Physical Address
Check if same as mailing address
SSN
Date of Birth (mm/dd/yyyy)
Area Code
Select one:
Primary Phone Number
Home
Work
Cell
_________ MINOR SHAREHOLDERS - Check here if one or more of your shareholders each individually hold shares that total less than 1% of the total shares of the
corporation/business/LLC. For example, there might be three shareholders whose total shares added together is 2% of the total shares but each shareholder
individually only holds 0.66% of the shares.
________ TOTAL PERCENTAGE (%) of corporation/business/LLC held by minor shareholder(s) that individually holds less than 1% of the total shares of the
corporation/business/LLC.
4
ADDITIONAL OFFICER/SHAREHOLDER INFORMATION FOR
CORPORATION/BUSINESS/LLC THAT HOLD THE IFQ ONLINE ACCOUNT
1) If this IFQ online account is held by a business, then complete this section for EACH officer or partner associated with the business.
Provide the information for all officers or partners that are shown on your most recent annual report. If your business is structured as a corporation,
identify all shareholders in the corporation that own at least 1% or more of the shares, as well as the percentage of all shares in the corporation held
by each shareholder. Individuals holding less than 1% of the shares (minor shareholders) should not be individually listed. Total shareholders must
equal 100%. For all provide position held in business, name, address, social security number, date of birth, and telephone number.
2) Check the appropriate box below to certify that the applicant is or is NOT a United States citizen or permanent resident alien.
Additional Officer or Shareholder Information
Check all that apply: President/CEO
Shareholder
Vice President
Secretary
Treasurer
Director/Manager
Other ________________
Percent (%) of corporation held: _______________________
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name
First Name
Mailing Address
Middle Name
Suffix
Apt/Suite
City
State
County/Parish
Zip Code
Country
Apt/Suite
City
State
County/Parish
Zip Code
Country
Physical Address
Check if same as mailing address
SSN
Date of Birth (mm/dd/yyyy)
Area Code
Select one:
Primary Phone Number
Home
Work
Cell
Additional Officer or Shareholder Information
Check all that apply: President/CEO
Shareholder
Vice President
Secretary
Treasurer
Director/Manager
Other ________________
Percent (%) of corporation held: _______________________
Certify Citizenship Status:
The applicant IS a United States citizen or permanent resident alien.
The applicant IS NOT a United States citizen or permanent resident alien.
Prefix
Last Name
Mailing Address
First Name
Middle Name
Suffix
Apt/Suite
City
State
County/Parish
Zip Code
Country
Apt/Suite
City
State
County/Parish
Zip Code
Country
Physical Address
Check if same as mailing address
SSN
Date of Birth (mm/dd/yyyy)
Area Code
Select one:
Primary Phone Number
Home
Work
Cell
_________ MINOR SHAREHOLDERS - Check here if one or more of your shareholders each individually hold shares that total less than 1% of the total shares of the
corporation/business/LLC. For example, there might be three shareholders whose total shares added together is 2% of the total shares but each shareholder
individually only holds 0.66% of the shares.
________ TOTAL PERCENTAGE (%) of corporation/business/LLC held by minor shareholder(s) that individually holds less than 1% of the total shares of the
corporation/business/LLC.
5
| File Type | application/pdf |
| Author | janet.l.miller |
| File Modified | 2014-08-01 |
| File Created | 2014-03-11 |