IFQ fee form

Revised: 07/20/2018 OMB Control No. 0648-0758 Expiration Date: 01/31/2019

IFQ Permit Holder Fee Submission Form

N OAA/National Marine Fisheries Service Office of Operations & Management Division (OMD) P.O. Box 21668 Juneau, Alaska 99802-1668 Fax: 907-586-7255 (800) 304-4846 (Option #5) or (907) 586-7105

Fee Submittal Deadline: January 31

Payment may be submitted ONLINE at https://alaskafisheries.noaa.gov/webapps/efish/login

BLOCK A -- OVERPAYMENT

If your estimated Balance Due is less than zero (deficit), you MUST select one of the following options:

[ ] Apply Overpayment to Future Fee Liabilities OR [ ] Issue Refund

BLOCK B -- IDENTIFICATION OF IFQ PERMIT HOLDER OR RQE
1. Name of IFQ Permit Holder or RQE:		2. NMFS Person ID:
3. Permanent Business Mailing Address:
4. Telephone Number:	5. E-mail Address:

BLOCK C -- AGREEMENT WITH IFQ FEE LIABILITY SUMMARY

Only applicable for IFQ Permit Holders

Check if you agree that your IFQ Fee Liability Summary represents the actual value of all IFQ received:

[ ] YES [ ] NO

If YES, and you have not paid on-line, please date and sign your name where designated in Block D, complete Block E, and mail this Fee Submission Form with your payment.

If NO, you must complete Block F -- Fee Calculation. You must complete this section even if you have made an on-line payment. After you have completed this worksheet, complete Blocks A through D and return it with your payment and supporting documentation.

BLOCK D -- METHOD OF PAYMENT

NMFS no longer accepts credit card payments using this form. Credit card payments must be made online.

[ ] Personal Check [ ] Cashiers Check [ ] Money Order [ ] Payment made On-Line

Prior to December 1, 2019, payment must be made in U.S. dollars by personal check drawn on a U.S. bank account,

money order, bank-certified check, or electronically by credit card.

Beginning on December 1, 2019, NMFS will no longer accept payment by personal check, cashier’s check, or money order. All payments must be made electronically through automated clearing house, credit card, or electronic check drawn on a U.S. bank account.

REMINDER!

Sign your check. If paying for multiple permit holders, include their completed and signed Fee Submission Forms.

All checks or money orders should be made payable to “National Marine Fisheries Service”

NMFS DOES NOT SEND VERIFICATION OF PAYMENT AND STRONGLY RECOMMENDS

YOU RETAIN COPIES FOR YOUR RECORDS.

BLOCK E – APPLICANT SIGNATURE
Under penalties of perjury, I hereby declare that I, the undersigned, completed this application and that the information contained herein is true, correct, and complete to the best of my knowledge and belief.
1. Printed Name of IFQ Permit Holder or RQE (If completed by representative, attach authorization):
2. Signature of IFQ Permit Holder or RQE:	3. Date:

STOP!

Have you completed BLOCK E and included payment of your IFQ FEE?

Have you made a copy of your Fee Submission Form and check/money order for your records?

Note: You must submit adequate documentation supporting your revised fee liability. Examples of such documentation include valid fish tickets, sales receipts, or check stubs that clearly identify the IFQ landing amount, species, date, time, and ex-vessel value or price.

	BLOCK F – FEE CALCULATION
Permit Number	Date of Landing	Port Location	IFQ Pounds	GAF Pounds (Use standard price only)	Standard Ex-vessel Price	Actual Ex-vessel Price	Total
Sample	3/20/2005	Sitka	5000			$2.20	$11,000
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17. Ex-vessel Value Total (add lines 1-16):
18. Plus Total Adjustments (IFQ retro-payments, bonuses):
19. Subtotal (add lines 17 and 18):
20. Fee Liability* (multiply the published fee percentage by line 19):
21. Less Pre-payments or Credits (if any):
22. Balance Due (enter result after subtracting line 21 from 20):
23. Enclosed Payment Amount:

*Your fee liability is based on the total value received for IFQ halibut or sablefish landed on your IFQ permit during the IFQ fishing year. It should represent the total dollar value of IFQ pounds before any deductions are made for goods and services provided (i.e., bait, ice, fuel, repairs, machinery replacement, etc.), multiplied by the NMFS published fee percentage for the IFQ fishing year.

Instructions for

IFQ PERMIT HOLDER FEE SUBMISSION FORM

This information is used to verify the identity of the applicant(s) and to accurately retrieve confidential records related to Federal permits.

After each fishing year, NMFS will provide to an IFQ permit holder or an RQE an IFQ Landing Summary and Estimated Fee Liability page. The IFQ permit holder must either accept the accuracy of the NMFS estimated fee liability associated with his or her IFQ landings for each IFQ permit or calculate a revised IFQ fee liability for all or part of his or her IFQ landings using this Fee Submission Form.

An IFQ permit holder who holds an IFQ permit against which a landing was made or an RQE that holds recreational fishing quota (RFQ) must either submit payment online (https://alaskafisheries.noaa.gov/webapps/efish/login) or submit payment to NMFS with a complete IFQ Permit holder Fee Submission Form provided by NMFS. An IFQ permit holder with IFQ and/or Guided Angler Fish (GAF) landings and an RQE with RFQ landings are responsible for self-collecting his or her own fee during the calendar year in which the fish is landed.

An IFQ permit holder or RQE must submit his or her fee payment(s) to NMFS no later than January 31 of the year following the calendar year in which the landings were made.

NMFS no longer accepts credit card payments using this form. Credit card payments must be made online (https://alaskafisheries.noaa.gov/webapps/efish/login).

Prior to December 1, 2019, payment must be made in U.S. dollars by personal check drawn on a U.S. bank account, money order, bank-certified check, or electronically by credit card.

On or after December 1, 2019, payment must be made electronically in U.S. dollars by automated clearing house, credit card, or electronic check drawn on a U.S. bank account.

If paying by mail, send form and payment to:

Administrator, Alaska Region, NMFS

Attn: IFQ Fee Coordinator

Office of Operations and Management Division (OMD)

P.O. Box 21668

Juneau, Alaska 99802-1668

NMFS does not send receipts for payments received by check or money order, so we strongly recommend that you retain a copy of this completed form and your check/money order for your records. Only payments received by credit card will be sent computer-generated receipts after those payments are processed.

If you need assistance in completing this form or you have questions about the IFQ Cost Recovery Program,

♦ Call OMD toll free (800) 304-4846 (Option 5) or

(907) 586-7105

♦ Program information, applications, and reports can also be located on the Alaska Region Internet site at

https://alaskafisheries.noaa.gov/fisheries/ifq

COMPLETING THE FORM

If paying by mail, all permit holders must complete Blocks A through E of the IFQ Permit Fee Submission form.

BLOCK A -- OVERPAYMENT

If your estimated Balance Due (Block F22) is less than zero, indicate whether you choose to apply the

overpayment to future fee liabilities or to apply for a refund.

♦ If you choose to receive a refund, note that all refunds will be issued out of the National Oceanic and

Atmospheric Administration, Department of Finance, in Silver Spring, Maryland.

Please allow a minimum of eight weeks for your refund to be issued.

♦ If you choose to apply the balance due amount to future fee liabilities, NMFS will credit your IFQ Fee Liability Account.

BLOCK B -- IDENTIFICATION OF IFQ PERMIT HOLDER OR RQE

1. Name of IFQ Permit Holder or RQE: Full name of the individual, corporation, association, or partnership that is the holder of the IFQ permit or full name of the RQE.

2. NMFS Person ID: Identification number assigned to the permit holder or RQE by NMFS/RAM.

3. Permanent Business Mailing Address:

Include street or P.O. Box number, city, state, and zip code. This is the address where NMFS will send information. This address will be updated in the official RAM database.

4-5. Business telephone number and E-mail Address: Business telephone number, including area codes, and e-mail address.

Note: It is important to provide a number where messages can be left to avoid delay in processing the Fee Submission Form if any questions arise.

BLOCK C -- AGREEMENT WITH IFQ FEE LIABILITY SUMMARY

Indicate whether you agree with your IFQ Fee Liability Summary. The IFQ permit holder must either accept the accuracy of the NMFS estimated fee liability associated with his or her IFQ landings for each IFQ permit, or calculate a revised IFQ fee liability. This block is not applicable to an RQE.

If YES, and you have not paid on-line, please date and sign your name where designated in Block E, complete Block D,

and mail this Fee Submission Form with your payment.

If NO, You must complete this worksheet even if you have made an on-line payment. After you have completed Block F (Fee Calculation), you must complete Blocks A through D of this form and return it with your payment and supporting documentation.

Note: You must submit adequate documentation supporting your revised fee liability. Examples of such documentation include valid fish tickets, sales receipts or check stubs that clearly identify the IFQ landing amount, species, date, time, and ex-vessel value or price.

BLOCK D -- METHOD OF PAYMENT – Do not mail cash –

NMFS no longer accepts credit card payments using this form.

To make a credit card payment, go to https://alaskafisheries.noaa.gov/webapps/efish/login

If paying for multiple permit holders, attach each permit holder’s completed and signed Fee Submission Forms.

Indicate method of payment:

If Personal Check, Cashier’s Check, or Money Order:

Make payable to National Marine Fisheries Service (NMFS).

(Reminder! Sign your check; and if paying for more than one permit holder, include all Fee Submission forms.)

Payments may be made by electronic check through the NMFS secure, on-line system at https://alaskafisheries.noaa.gov/webapps/efish/login. To use this feature, permit holders may log in using their user name and password, and follow the directions on the site to complete the payment. On-line payments are processed through Pay.gov, a secure system for electronic payments used by many government agencies.

BLOCK E – SIGNATURE

Printed name and signature of permit holder or RQE.

If completed by authorized representative, attach authorization.

BLOCK F -- FEE CALCULATION

Complete this block ONLY if you indicated in Block C that you DO NOT AGREE with your IFQ Fee Liability Summary. This block is not applicable to an RQE.

Note: You must submit adequate documentation supporting your revised fee liability. Examples of such documentation include valid fish tickets, sales receipts, or check stubs that clearly identify the IFQ landing amount, species, date, time, and ex-vessel value or price.

1-16. Permit Number: Enter permit number(s).

Date of Landing: Enter date(s) the landing(s) was/were made.

Port Location: Enter the port(s) where landing(s) was/were made.

IFQ Pounds: Enter the number of IFQ pounds landed (include any retained pounds) on permit(s) for specific date(s). “IFQ pounds” is net weight for Halibut and round weight for Sablefish

GAF Pounds: Enter the number of GAF pounds landed (include any retained pounds) on permit(s) for specific date(s). “GAF pounds” is net weight for transferred Halibut

Note: You may not claim actual ex-vessel value for any GAF pounds.

Standard Ex-Vessel Price: Enter the standard ex-vessel price located on your IFQ Fee Liability Summary.

If IFQ, you may use either the standard price or the actual price for each landing in your summary.

If GAF, you may not use actual price for any GAF pounds; you may only use the standard ex-vessel price

assigned on the Fee Liability Statement for GAF.

Actual Ex-Vessel Price: Enter the actual ex-vessel value for this permit.

If IFQ, you may use either the standard price or the actual price for each landing in your summary.

If GAF, you may not use actual ex-vessel price for GAF pounds

Total: Multiply the total pounds landed on the permit(s) by the standard or actual ex-vessel price to get the

total for each landing.

17. Ex-vessel Value Total: Add lines 1 through 16 to get the subtotal of fees owed for all permits.

18. Plus Total Adjustments: Add total adjustments (IFQ retro payments or bonuses paid in current year for

previous year).

19. Subtotal: Add lines 17 and 18.

20. Fee Liability: Multiply the permit(s) subtotal (line 19) by the published fee percentage.

Your fee liability is based on the total value received for IFQ halibut or sablefish landed on your IFQ permit during the IFQ fishing year. It should represent the total dollar value of IFQ pounds before any deductions are made for goods and services provided (i.e., bait, ice, fuel, repairs, machinery replacement, etc.) multiplied by the NMFS published fee percentage for the IFQ fishing year.

21. Less Pre-Payments or Credits: Subtract any pre-payments or credits from line 20. If you have a pre-payment

or credit, it will be indicated on your IFQ Fee Liability Summary.

22. Balance Due: This indicates your balance due or credit after subtracting line 21 from 20.

If you show a credit, return to Block A and check whether you would like your credit refunded or have it applied

to future fee liabilities.

If you show a balance due (owed), fill in line 22.

23. Enclosed Payment Amount: If you show a balance due, enter the amount of the payment you will be submitting.

Notice to Customers Making Payment by Check

When you provide a check as payment, you authorize NMFS either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.

Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and collecting the information from your check, and explaining the purposes and routine uses which will be made of your check information, is available from our Internet site at https//pccotc.gov/pccotc/index.htm or call toll free at 1 (866) 945-7920 Option 4 to obtain a copy by mail. Furnishing the check information is voluntary, but a decision not to do so may require you to make payment by some other method.

Return Item Service Fee

If the electronic fund transfer cannot be completed because there are insufficient funds in your account, we may impose a one-time fee of $25.00 against your account, which we will also collect by electronic fund transfer.

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PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average one minute for electronic fee submission and 30 minutes for non-electronic fee submission, including the time for reviewing the 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 aspect of this collection of information, including suggestions for reducing the burden, to: NOAA National Marine Fisheries Service, Alaska Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, P.O. Box 21668, Juneau, AK 99802.

ADDITIONAL INFORMATION

Before completing this form please note the following: 1) 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; 2) This information is mandatory and is required to manage commercial fishing effort under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.); 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act as amended in 2006. It is also confidential under 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, accurately retrieve confidential records related to Federal permits, and verify that the appropriate fees are paid.

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 may post some information from this form on its public website (www.alaskafisheries.noaa.gov). In addition, NMFS may share information submitted on this 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 or failure to pay the fee may result in NMFS revoking the permit holder’s QS or IFQ transfer privileges and the permit holder owing additional interest, penalties, and late fees.

IFQ Permit Holder Fee Submission Form

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