Main Hawaiian Islands Non-commercial Bottomfish Permit A

OMB Control No: 0648-0577
Expires: 01/31/2018

U.S. DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
NATIONAL MARINE FISHERIES SERVICE

Pacific Islands Regional Office - SFD Permits
1845 Wasp Blvd., Bldg 176
Honolulu, Hawaii 96818
(808) 725-5000 ∙ Fax: (808) 725-5215

MAIN HAWAIIAN ISLANDS NON-COMMERCIAL BOTTOMFISH PERMIT
Please Print Legibly. Items marked with * are required. Note required documents. Non-refundable application processing fee is $47.00, payable to
Department of Commerce, NOAA.
I.

APPLICANT INFORMATION

*APPLICANT NAME: ___________________________________________________________________________
First, Middle, and Last Name, or Business Name (if owner of vessel)

*DATE OF BIRTH or INCORPORATION: ___________________ *TAXPAYER ID NUMBER: ______________________________________ (SSN or EIN)
*MAILING ADDRESS: ______________________________________________________ __________________
Street/PO Box

City

______

______________

State

ZIP Code

*PHONE (______) ______________________ CELL PHONE (______) ______________________ FAX (______) ______________________
*EMAIL: ___________________________________________________________
Under penalty of perjury, I hereby declare that I, the undersigned, am the applicant or authorized to complete and certify this application on behalf of the
applicant, and the information contained herein is true, correct, and complete to the best of my knowledge.

*APPLICANT SIGNATURE: ______________________________________________________________ *DATE: __________________
It is a violation of Federal regulations to file false information on a permit application form (50 CFR 665.15(b)).
Please check whether you want: ___ permit mailed, or ___ to pick up permit at NOAA NMFS Honolulu Service Center at Pier 38.
*VESSEL OPERATOR (Captain)? ___ Yes ___ No (Check only one)
*VESSEL OWNER? ___ Yes ___ No (Check only one) If Yes, complete section below.
II.

VESSEL OWNERS ONLY

*VESSEL NAME: _______________________________________________________ *OFFICIAL NUMBER: _____________________________
VESSEL RADIO CALL SIGN: ________________ (if available)

DBOR registration or USCG documentation num

*BUSINESS CONTACT: _____________________________________________________________ *TITLE: _____________________________
(If vessel owned by a business)

First, Middle, & Last Name, if not same as vessel owner

Corporate officer, business owner, partner

_________________

OMB Control No.: 0648-0577
Expires: 01/31/2018

Instructions for the Non-commercial Bottomfish Permit Application
Please print legibly. All fields required unless otherwise noted.
I. Applicant Information
Applicant Name: Print full name: First, Middle (initials OK), Last, and suffix. If the vessel owner is a business, print the full business name. A business
may not apply for an individual permit; they may apply only for a vessel owner permit.
Date of Birth or Incorporation: Print date as MM/DD/YYYY.
Taxpayer ID Number: SSN for individuals, EIN for business owner of the vessel.
Mailing Address: Your current mailing address is required for mailing the permit or contacting you about your permit.
Phone: Primary phone number, including area code.
Cell phone, Fax, and Email: Provide additional contact information.
Applicant Signature and Date: Sign full name and write in the date you signed.
Mail or Pickup: Check whether you prefer the permit mailed to the address on the application form or to pick it up at NOAA Honolulu Service Center
at Pier 38.
Vessel Operator: Check Yes if applicant is the vessel operator/captain, No if not.
Vessel Owner: Check Yes or No. If Yes, complete Section II. For Vessel Owners Only.
II. For Vessel Owners Only
Vessel Name: Print the vessel’s name, if available. If none, print N/A.
Official Number: Print the State of Hawaii vessel registration number as HAnnnnXX – where the nnnn is the number and the XX is the one or two
character suffix, or the US Coast Guard vessel documentation number. Attach a copy of the current State vessel registration certificate or the
USCG Certificate of Documentation.
Vessel Radio Call Sign: Print the radio call sign on your FCC license, if available.
Date of Incorporation: If the vessel owner is a business, corporation, LLC, etc., fill in the date of incorporation.
Business Contact and Title: Print the full name and title of the contact person for the business.
REQUIRED DOCUMENTS:
1) Submit a check payable to Department of Commerce, NOAA for the non-refundable application processing fee. Cash will not be accepted.
2) Vessel owners must submit a copy of the vessel's current Hawaii Division of Boating and Ocean Recreation vessel registration certificate or U.S.
Coast Guard Certificate of Documentation.
An application that is lacking required information, vessel registration or documentation, or payment will be considered incomplete. An incomplete
application will be abandoned if it is not completed within 30 days after reception. You will be notified of any deficiency. If you fail to correct the
deficiency within 30 days following the date of the notice of deficiency, the application will be considered abandoned (50 CFR 665.13). It is a violation
of Federal regulations to file false information on a permit application form (50 CFR 665.15(b)). You must inform PIRO within 15 days of any change
of information on the application form (50 CFR 665.13). It is prohibited to file false information on any application for a fishing permit (50 CFR
665.15(b)).
Mail the application and required documents to the address at the top of the first page or drop it off at the NOAA NMFS Honolulu Service Center, Pier
38, Honolulu, HI (M-F, 8 am – 4 pm). Please contact [email protected] for availability of an online application.

OMB Control No.: 0648-0577
Expires: 01/31/2018

PRIVACY ACT STATEMENT
Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and Management Act, 16 U.S.C 1801
et seq., the Western and Central Pacific Fisheries Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq), the Marine Mammal Protection
Act, and the Endangered Species Act. The authority for the mandatory collection of the Tax Identification Number (TIN) is 31 U.S.C. 7701.
Purpose: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service (NMFS) requires the use of permits or registrations by
participants in the United States. Information on NOAA Fisheries permit applicants and renewing holders includes vessel owner contact information,
date of birth, TIN and vessel descriptive information. Permit holder information may be used as sampling frames for surveys.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants. Disclosure of this
information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within NMFS offices, in order to coordinate monitoring
and management of sustainability of fisheries and protected resources, as well as with the applicable State or Regional Marine Fisheries
Commissions and International Organizations. Disclosure of this information is also subject to all of the published routine uses as identified in the
Privacy Act System of Records Notice COMMERCE/NOAA-19, Permits and Registrations for the United States Federally Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of
eligibility for a permit.
PAPERWORK REDUCTION ACT INFORMATION
Public reporting burden for this collection is estimated as follows: 15 minutes for main Hawaiian Islands non-commercial bottomfish permit and 2
hours for all permit denial appeals. Each burden includes 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 aspects of
this collection of information, including suggestions for reducing this burden, to NMFS Pacific Islands Regional Administrator, 1845 Wasp Blvd., Bldg.
176, Honolulu, Hawaii 96818.
This information is being collected to ensure accurate and timely records about the persons licensed to participate in fisheries under Federal
regulations in the Western Pacific Region. This will enable NMFS and the Western Pacific Fishery Management Council to (a) determine who would
be affected by changes in management; (b) inform license holders of changes in fishery regulations; and (c) determine whether the objectives of the
fishery program are being achieved by monitoring entry and exit patterns and other aspects of the fisheries. The information is used in analyzing and
evaluating the potential impacts of regulatory changes on persons in the regulated fisheries as well as in related fisheries. Responses to the collection
are required to obtain the benefit of a license for the fishery involved (ref. 50 CFR 665.13). Data provided concerning the vessel and/or business of
the respondents are handled as confidential under the Magnuson-Stevens Fishery Conservation and Management Act (Sec. 402(b)). 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.