Tier 3 application

OMB CONTROL NO.: 0648-0679

Expires: xx/xx/xxxx

U.S. Department of Commerce NOAA/National Marine Fisheries Service Greater Atlantic Region Permit Office 55 Great Republic Drive Gloucester, MA 01930 Tel: (978) 282-8438							Initial Application for a Federal Limited Access Tier 3 Longfin Squid Permit
	Section 1 - Write in Owner, Contact, and Vessel Information
	Owner name					Name of Vessel
	Mailing address					Vessel Permit Number
	City, State					USCG Documentation / State Registration
	Zip Code					Phone Number
	Section 2A – Limited Access Tier 3 Longfin Squid Permit Category Description (SMB1C)
	A vessel can be issued only one limited access category for longfin squid. Limited Access Tier 3 longfin Squid Permit (SMB1C) criteria are that you must have at least 5,000 lb best year landings during 1997-2013. If you meet this criteria you will be issued a Limited Access Tier 3 longfin Squid Permit (SMB1C). Please read the enclosed permit holder letter for more information regarding eligibility criteria for each category.
	Section 2B – Check off one or more gears to be used with the longfin squid permit
		120 –Purse Seine		210 - Beach Seine				220 - Boat Seine		310 - Bottom Trawl
		320 –Midwater Trawl		330 – Other Trawls				410 – Dredge		700 – Gill/Entangling Nets
		800 –Pots and Traps		911 - Handlines				912 - Rod and Reel		913 - Tub Trawl
		920 – Longlines/Setlines		1010 - Harpoons				1200 – Other Gears		1400 – Diving Gear

Please sign and date the back of this form.

Initial Application for a Federal Limited Access Squid Permit – page 2

If you have already renewed the vessel’s permit(s) for the 2018 permit year:

1. Complete all sections and return this application to the address on the front of this form.

If your vessel has not been issued a permit for the 2018 permit year or your vessel is replacing another qualifying vessel, you must:

1. Complete all sections and return this application to the address on the front of this form.

2. Complete the Application for Vessel Upgrade, Replacement, and Confirmation of Permit History form and return it along with your application.

3. Complete the vessel ownership form and return it along with your application.

4. Include a copy of the vessel’s unexpired Coast Guard Documentation or State Registration.

Confirmation of Permit History (CPH) - If your vessel has sunk, been destroyed, or sold to another person without its permit history, you may apply for a CPH using the following instructions:

1. Complete all sections and return this application to the address on the front of this form.

2. Complete the vessel ownership form and return it along with your application.

3. To verify that you have retained the permit history of a vessel you no longer own, please provide one of the following:

   1. A bill of sale or document stating that the permit history has been retained by you (the seller) and signed by you and the buyer; or

   2. A copy of the confirmation of permit history.

4. To verify that the vessel has been destroyed or is no longer seaworthy, please provide one of the following:

   1. Coast Guard accident report;

   2. Insurance adjustor’s report; or

   3. Verification from certified marine surveyor that vessel is no longer seaworthy.

Section 3 – Applicant’s Name and Signature
_____ Applying using retained history No Longer Own Vessel Vessel Sold Vessel Destroyed See CPH instructions above for more information	I, the undersigned, am the owner or legally authorized agent of the owner of the vessel named in Section 1 above. I affirm, subject to the penalties provided in 18 USC 1001, that all information that I have given in obtaining this permit is true and correct. Print Name: _______________________________________________ Signature:______________________________________Date:_________________

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the 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 suggestions for reducing this burden to the Assistant Regional Administrator, Sustainable Fisheries Division, NOAA National Marine Fisheries Service, 55 Great Republic Drive, Gloucester, MA 01930. All landings and catch data, and any other information protected under federal law, will be kept confidential. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected 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.

Any information submitted on this NOAA approved permit application form, which is not otherwise protected under federal law, may be disclosed upon request. To avoid a delay in processing, please verify and complete all sections and include all information requested on this form. OMB CONTROL NO.: 0648-0679 Expires: XX/XX/XXXX

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 High Seas Fishing Compliance Act, the Tuna Conventions Act of 1950, the Antarctic Marine Living Resources Convention Act, the Western and Central Pacific Fisheries Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq), the Marine Mammal Protection Act, the Endangered Species Act and the Fur Seal Act.

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 and vessel descriptive information. Permit holder information may be used as sampling frames for surveys, as part of Fishery Management Council (FMC) analysis to support FMC decisions.

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.

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