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OMB Control No. 0648-0272
APPLICATION FOR
ELIGIBILITY
TO RECEIVE QS/IFQ
Expiration Date: 03/31/2018
U.S. Dept. of Commerce/NOAA
National Marine Fisheries Service (NMFS)
Restricted Access Management Program (RAM)
P.O. Box 21668
Juneau, AK 99802-1668
(800) 304-4846 toll free / 586-7202 in Juneau
(907) 586-7354 fax
Those persons applying to receive Quota Share (QS) or Individual Fishing Quota (IFQ) by transfer must submit this
application to the Regional Administrator, to obtain a Transfer Eligibility Certificate (TEC).
BLOCK A - APPLICANT INFORMATION
1. Name (full name, including middle initial):
2. NMFS Person ID:
3. Taxpayer ID Number (Employer ID No. or SSN):
4. Business Mailing Address:
[__] Permanent
5. Business Telephone Number:
[__] Temporary
6. Business Fax Number:
7. E-mail Address (if available):
NOTE: The Applicant must be a U.S. citizen or U.S. corporation, partnership, or other non-individual business
entity to receive QS/IFQ by transfer.
8. Are you a U.S. citizen?
[ ] YES [ ] NO
If YES, enter Date of Birth ______________________________________
9. Are you a U.S. corporation, partnership, association or other non-individual business entity?
[ ] YES
[ ] NO
If YES, enter Date of Incorporation _______________________________
10. Are you a resident of Adak, Alaska?
[ ] YES
[ ] NO
If YES, enter date residency began _________________________________
Application for Eligibility to Receive QS/IFQ
Page 1 of 6
BLOCK B-- FREEZER SHARES
Is this TEC intended for an Entity that wishes to buy or lease Category A Quota Shares only?
YES [ ]
NO [ ]
IF YES, and you are a corporation, partnership, association, or other non-individual entity, please complete and
attach a QS Holder: Identification of Ownership Interest form.
NOTE: You may be required to submit further evidence of eligibility, i.e., that you are the type of entity that would
have been eligible to document a vessel under U.S. laws in effect in 1988, 1989, and 1990.
BLOCK C - COMMERCIAL FISHING EXPERIENCE
Duplicate this section, or attach a separate sheet of paper, if necessary,
to display all of the Applicant’s commercial fishing experience.
1. Species (one per block):
2. Gear:
3. Location:
4. Date From (MM / YY):
5. Date To (MM / YY):
6. Number of Actual Days Spent
Harvesting Fish:
7. Duties Performed While Directly Involved in the Harvesting of Fish (Be Specific):
8. Vessel Name:
9. ADF&G or USCG Number:
10. Vessel Owner:
11. Vessel Operator:
12. Reference Name (person other than yourself):
13. Reference's Relationship to You:
14. Reference's Business Telephone Number:
15. Reference's Business Mailing Address:
Application for Eligibility to Receive QS/IFQ
Page 2 of 6
BLOCK D - NOTARY CERTIFICATION
The applicant or authorized representative of the applicant: by my signature below, I declare that I have examined this
application in its entirety, and to the best of my knowledge and belief, the information presented here is true, correct,
and complete.
1. Signature of Applicant (or Authorized Representative):
2. Date:
3. Printed Name of Applicant (If completed by an Authorized Representative, attach authorization):
4. Notary Public Signature:
ATTEST
6. Affix Notary Stamp or Seal Here:
5. Commission Expires:
PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for
reviewing the instructions, searching the existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to Assistant Regional Administrator, Sustainable Fisheries Division,
NOAA National Marine Fisheries Service, P.O. Box 21668, Juneau, AK 99802-1668.
ADDITIONAL INFORMATION
Before completing this form, please note the following: 1) Notwithstanding any other provision of 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;
2) This information is mandatory and is required to manage commercial fishing efforts under 50 CFR part 679 and under section
402(a) of the Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C. 1801, et seq.); 3) Some information collected
on this application form is made available to the public on the NMFS, Alaska Region, webpage (www.alaskafisheries.noaa.gov).
Other information is confidential under section 402(b) of the Magnuson-Stevens Act and NOAA Administrative Order 216-100,
which sets forth procedures to protect confidentiality of fishery statistics.
PRIVACY ACT STATEMENT
AUTHORITY: The collection of this information is authorized by the Magnuson-Stevens Fishery Conservation and Management Act,
16 U.S.C. 1801 et seq.
PURPOSE: NMFS uses the information provided on this application to verify the identity of the applicant and to accurately retrieve
confidential records related to Federal permits to determine eligibility to receive quota share or individual fishing quota by transfer.
The primary purpose for requesting the SSN/TIN is for the collection and reporting on any delinquent amounts arising out of such
person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). Personal
information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be disclosed to the public.
ROUTINE USES: Disclosure of this information is subject to the published routine uses identified in the Privacy Act System of
Records Notice COMMERCE/NOAA-19, Permits and Registrations for the United States Federally Regulated Fisheries. NMFS posts
some information from this form on its public website (www.alaskafisheries.noaa.gov), including the business name, address, and
NMFS ID number of the person eligible to receive quota share or individual fishing quota by transfer. In addition, NMFS may share
information submitted on this application form with other State and Federal agencies or fishery management commissions, including
staff of the North Pacific Fishery Management Council and Pacific States Marine Fisheries Commission.
DISCLOSURE: Providing this information is voluntary; however, the failure to provide complete and accurate information will
prevent the determination of eligibility to receive quota share or individual fishing quota by transfer.
Application for Eligibility to Receive QS/IFQ
Page 3 of 6
INSTRUCTIONS
APPLICATION FOR ELIGIBILITY TO RECEIVE QS/IFQ
Quota Share (QS) was initially issued to persons who owned or leased vessels that made legal commercial fixed-gear
landings of Pacific halibut or sablefish during 1988, 1989, or 1990 off Alaska. The application period for QS ended on
July 15, 1994. Once issued to a person by NMFS, QS is held by that person until it is transferred, suspended, or revoked.
Currently, QS may only be obtained through transfer. QS is transferable to other initial issuees or to those who have
become transfer-eligible through obtaining NMFS' approval.
Those persons applying to receive QS or Individual Fishing Quota (IFQ) by transfer must submit to the Regional
Administrator an Application for Eligibility to Receive QS/IFQ to obtain a Transfer Eligibility Certificate (TEC).
If participant is a U.S. corporation, partnership, association or other non-individual business entity, he or she must
complete and submit a Quota Share Holder: Identification of Ownership form. Download this form from NMFS Alaska
Region website at https://alaskafisheries.noaa.gov/, or call RAM and request the form be mailed or faxed to you.
Except for residents of Adak, Alaska, to be eligible, persons must have 150 or more days of experience working as
part of a harvesting crew in any U.S. commercial fishery. Work in support of harvesting but not directly related to it
is not considered harvesting crew work. An eligible community resident of Adak receiving IFQ derived from QS held by
an Aleutian Islands Community Quota Entity (CQE) is not required to meet the 150-day criteria for purposes of receiving
IFQ from an Aleutian Islands CQE.
Type or print legibly in ink and retain a copy of completed application for your records.
Please allow at least 10 working days for your application to be processed.
An application may be submitted to NMFS by mail or delivery. Fax submittal is not acceptable due to the Notary
requirements. RAM will not process an application that does not bear original signatures (faxed applications will be
returned). All signatures must be witnessed by a Notary Public (or, in some remote areas, the community Postmaster or
Postmistress).
When completed, submit the original application
by mail to:
NMFS, Alaska Region
Restricted Access Management (RAM)
P.O. Box 21668
Juneau, AK 99802-1668
or deliver to:
Room 713, Federal Building
709 West 9th Street
Items will be sent to you by first class mail, unless you provide alternate instructions and include a prepaid mailer with
appropriate postage or corporate account number for express delivery. Additional information is available from RAM, as
follows:
Website: https://alaskafisheries.noaa.gov/
Telephone (toll free): 800-304-4846 (press “2”)
Telephone (in Juneau): 907-586-7202 (press “2”)
e-Mail: [email protected]
Application for Eligibility to Receive QS/IFQ
Page 4 of 6
COMPLETING THE APPLICATION
BLOCK A - APPLICANT INFORMATION
1. Name: Full name, including middle initial, as it should appear on the Transfer Eligibility Certificate.
2. NMFS Person ID: NMFS will supply this number, if you do not already have one.
3. Taxpayer ID Number:
If an individual, enter social security number (SSN).
If a corporation, partnership, association, or other non-individual business entity, enter employer identification
number
4. Indicate whether permanent or temporary.
Permanent: Permanent mailing address, including street or P.O. Box, city, state, and zip code.
Temporary: Enter the address including street or P.O. Box, city, state, and zip code if you want the TEC
documentation sent somewhere other than your permanent address.
5–7. Business Telephone Number, Business Fax Number, and Business E-mail address (if available)
8. Indicate whether you are a U.S. citizen. If YES, enter Date of Birth
9. Indicate whether you are a U.S. corporation, partnership, association, or other non-individual business entity.
If YES, enter Date of Incorporation. Attach a Quota Share Holder: Identification of Ownership form.
10. Indicate whether you are a resident of Adak, Alaska.
If YES, enter date residency began.
BLOCK B - FREEZER SHARES
Indicate whether the TEC is intended for an entity that wishes to buy or lease Category A Quota Shares ONLY.
If YES, and you are a U.S. corporation, partnership, association, or other non-individual entity, please complete
and attach a Quota Share Holder: Identification of Ownership form.
Note: You may be required to submit further evidence of eligibility, i.e., that you are the type of entity
that would have been eligible to document a vessel under U.S. laws in effect in 1988, 1989, and 1990.
BLOCK C - COMMERCIAL FISHING EXPERIENCE
(Copy this section if necessary to display all of the applicant’s commercial fishing experience)
1. Species: Enter any targeted species in a U.S. commercial fishery (only one fishery per block).
2. Gear Type: Enter any gear type used to legally harvest in a U.S. commercial fishery.
3. Location: Enter actual regulatory, statistical, or geographic harvesting location.
4. Date From: Enter starting date (including month and year) of fishing experience.
5. Date To: Enter ending date (including month and year) of fishing experience.
6. Number of Actual Days Spent Harvesting Fish during the claimed period in questions 4 and 5.
7. Duties Performed While Directly Involved in the Harvesting of Fish: List or describe your duties as a member of
a harvesting crew for the claimed period in questions 4 and 5.
Application for Eligibility to Receive QS/IFQ
Page 5 of 6
8. Vessel Name: Enter the registered name of the vessel upon which above duties were performed.
9. ADF&G or USCG Number: Enter the State of Alaska, Department of Fish & Game (ADF&G) vessel registration
number or the U.S. Coast Guard (USCG) documentation number of the vessel listed in number 8.
10.
Vessel Owner: Enter the name of the individual(s) or corporation(s) whose name is listed on the vessel
ownership papers.
11. Vessel Operator: Enter the name of the person (may be yourself) in charge of operating the vessel.
12. Reference Name: Enter the name of a person (other than yourself) who is able to verify the above experience.
13. Reference’s Relationship to You: Enter your reference’s relationship to you.
14. Reference’s Business Telephone Number: Enter your reference’s business telephone number, including the area
code.
15. Reference’s Business Mailing Address: Enter your reference’s business mailing address, including street or
P.O. box number, city, state, and zip code.
BLOCK D - NOTARY CERTIFICATION
Enter printed name and signature of applicant or authorized representative and date the application. Signature certifies
that all information set forth in the application is true, correct, and complete to the best of the applicant’s knowledge and
belief. If completed by authorized representative, attach authorization.
Enter Notary Public Signature, date commission expires, and Notary Stamp or Seal
Application for Eligibility to Receive QS/IFQ
Page 6 of 6
File Type | application/pdf |
Author | soliva |
File Modified | 2018-03-09 |
File Created | 2018-03-09 |