NMS General Permit Application Form

NOAA NATIONAL MARINE SANCTUARIES PERMIT APPLICATION

OMB # 0648-0141

Expires: 4/30/2018

(12-2011)

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Refer to "Instructions for Submitting Applications for National Marine Sanctuary Permits and Authorizations" for guidance on how to properly complete this application. Applicants are responsible for reviewing the instructions in their entirety to ensure are all application requirements are met.

Note: for certain activities, completion of this application may not be required. Consult the instructions and the Office of National Marine Sanctuaries (ONMS) permit website prior to completing and submitting this application to see if this is the case for your proposed activity.

Section A - General
Sanctuary(s) in which you are applying to work: Channel Islands Gray's Reef Monterey Bay Cordell Bank Greater Farallones Olympic Coast NMS of American Samoa Hawaiian Islands Humpback Whale Stellwagen Bank Florida Keys Monitor Thunder Bay Flower Garden Banks
Select one of the following: New application Renewal of previously issued permit Change or modification to previously issued permit (Note: expired permits cannot be renewed or modified)	For permit renewals or modifications only, enter the previously issued ONMS permit number:

Section B - Applicant Information
Honorific First Name Last Name		Middle Initial
Organization address: Address Line 1: Address Line 2: City: State: Zip Code:	Phone: Fax: Email:	Ext:
Institution represented (if applicable):	Title or Department:
Co-applicant or additional investigator authorized to conduct activities (if applicable): First Name Last Name Institution

Section C - Project Information
Project title (maximum 300 characters):
Project dates (mm/dd/yyyy format): Requested permit start date: Requested permit end date:	Does this activity involve collections? No - If checked, no collection of sanctuary resources are allowed Yes - Complete Collections Data Form and submit with application

Section C - Project Information (Continued)

Project abstract (maximum 3000 characters - field will scroll):

Methods and protocols to be employed in the field (maximum 10000 characters - field will scroll):

Section C - Project Information (Continued)
Proposed location of activities: Throughout sanctuary(s) or Specific locations within a sanctuary Will this activity occur within any special sanctuary zone (such as marine reserves, research-only areas, sanctuary preservation areas, or state preserves)? No Yes - Provide justification in Section E	If activities are to be conducted in specific locations within sanctuary, describe where: See instructions for details. Coordinate data may also be required.

Section D - Environmental Impacts

Answer the following questions as accurately as possible to assist in the consideration of this application. Maximum 1000 characters per question. See instructions for additional guidance on how to complete these fields.

Describe any direct impacts on sanctuary resources that would result from this activity:

Describe any indirect impacts on sanctuary resources that would result from this activity:

Select if, to your knowledge, any of the following have been completed (or are being completed) for this proposal: Federal environmental impact statement, analysis, or review

State or local environmental impact statement, analysis, or review Other analysis of the environmental effects of this activity

Section E - Rationale

Answer the following questions as accurately as possible to assist in the consideration of this application. Maximum 1000 characters per question. See instructions for additional guidance on how to complete these fields.

Describe why this activity needs to be conducted within the sanctuary(s):

If this activity is proposed to occur in any special sanctuary zone (e.g., marine reserves, research-only areas, sanctuary preservation areas, state preserves), explain why this is necessary and how it will further the understanding of the zone:

Section E - Rationale (Continued)
Describe how the proposed methods are appropriate for this activity:
Describe how the permit duration requested is appropriate for this activity:
Provide a statement explaining applicant qualifications and financial ability to complete the project (include project funding source):

Section F - Other Information

Requests for ONMS assistance (see instructions before completing):

Other permits, authorizations, or approvals obtained or required:

Check the boxes as appropriate, provide copies of any already received, and notify ONMS staff of the status of pending requests.

Marine Mammal Protection Act Coastal Zone Management Act (Federal Consistency)

Endangered Species Act U.S. Army Corps of Engineers permit

National Historic Preservation Act Other Federal, state, or local permit(s)

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. Public reporting for this collection of information is estimated to average 1.5 hours per response for most activities, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing this application. See the instructions for details regarding this burden estimate.

Privacy Act Statement

Authority: The collection of this information is authorized under the National Marine Sanctuaries Act (NMSA) (16 U.S.C. 1431 et seq.) and the associated regulations defined in 15 CFR Part 922.

Purpose: To manage and understand national marine sanctuary resources, NOAA’s Office of National Marine Sanctuaries (ONMS) issues permits to allow certain activities beneficial to sanctuaries that would otherwise be prohibited by sanctuary regulations. Information collected on NOS permit applications include applicant contact information, project details and rationale, and environmental impacts.

Routine Uses: The Department will use this information to determine permit eligibility. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within the Office of the National Marine Sanctuaries, in order to coordinate monitoring and management of National Marine Sanctuaries. 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-12, Marine Mammals, Endangered and Threatened Species, Permits and Authorizations Applicants.

Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of eligibility for a permit.

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