Landing Transaction Request Form

OMB Control No. 0648-0551 Exp. Date 11/30/2014

LANDING TRANSACTION CORRECTION REQUEST
Instructions: Please complete this form if you have a landing transaction that should be corrected. This form must be completed
and signed by the IFQ dealer and the IFQ Fisherman within 15 days of the original transaction. By completing and signing this
form, both the IFQ dealer and fisherman acknowledge the information below is accurate. Please mail this form to National Marine
Fisheries Service, Sustainable Fisheries Division, 263 13th Avenue South, St. Petersburg, Florida 33701-5505. Any other corrections
to landing transactions should be reported via the IFQ Customer Service phone line at 1-866-425-7627.
Approval Code from Transaction to be Corrected: DL-__________________
IFQ Dealer: _______________________________

Date of Transaction to be Corrected: ___________

IFQ Fisher: _______________________________________________

Species _____________ Incorrect Pounds: ______ Correct Pounds: ______ Incorrect Price: $______ Correct Price: $______
Species _____________ Incorrect Pounds: ______ Correct Pounds: ______ Incorrect Price: $______ Correct Price: $______
Species _____________ Incorrect Pounds: ______ Correct Pounds: ______ Incorrect Price: $______ Correct Price: $______
Other Correction (please describe): ____________________________________________________________________________
Reason for the Landing Transaction Correction (e.g. duplicate entry, wrong amount of pounds, etc): __________________________________
_________________________________________________________________________________________________________

I, (Dealer) ________________________________________, hereby declare under penalty of perjury that the foregoing information is true and
correct. (28 U.S.C. § 1746; 18 U.S.C. § 1621; 18 U.S.C. § 1001).

Signature of IFQ Dealer: __________________________ Date: ____________

I, (Fisher) ________________________________________, hereby declare under penalty of perjury that the foregoing information is true and
correct. (28 U.S.C. § 1746; 18 U.S.C. § 1621; 18 U.S.C. § 1001).

Signature of IFQ Fisher: __________________________ Date: ____________
Under the provisions of the Paperwork Reduction Act of 1995 (PL 104-13) and the Privacy Act of 1974 (PL 93-579), you are advised that disclosure of the requested information is mandatory for the
purpose of managing the Gulf of Mexico Reef Fish fishery. The requested information is used to ensure proper compliance with Gulf reef fish IFQ programs. Confidentiality of the information
provided will be treated in accordance with NOAA Administrative Order 216-100. The public reporting burden for this collection of information is estimated to be 5 minutes. The estimate of public
reporting burden for this collection of information includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Written comments regarding the burden-hour estimate or other aspects of the collection-of-information requirements, or suggestions for reducing this burden, should be
sent to PRA Officer, NMFS, Southeast Regional Office, 263 13th Avenue South, St. Petersburg, FL 33701-5505.
Rev. 12/13/13