Application for replacement of certificates or permits

Revised: 02/20/2018

OMB Control No. 0648-0272 Expiration Date: 03/31/2018

APPLICATION FOR
REPLACEMENT OF CERTIFICATES
OR PERMITS

United States Department of Commerce/NOAA
National Marine Fisheries Service (NMFS)
Restricted Access Management Program (RAM)
P.O. Box 21668
Juneau, AK 99802-1668
Telephone (800) 304-4846 toll free or
(907) 586-7202 in Juneau
Fax: (907) 586-7354

BLOCK A - IDENTIFICATION OF APPLICANT
1. Name:

2. NMFS Person ID:

3. Business Mailing Address:

[ ] Permanent or [ ] Temporary

4. Date of Birth or Date of Incorporation:

5. Business Telephone Number:

6. Business Fax Number:

7. E-mail Address (if available):

BLOCK B – REPLACEMENT REQUEST
(Check Only the Items That Apply)

PART I – BSAI Crab Permits and Scallop Permits
[]

Crab Annual IFQ Fishing Permit:

Permit Number

[]

Crab Annual IPQ Fishing Permit:

Permit Number

[]

Registered Crab Receiver:

Permit Number

[]

Crab Federal Vessel Permit:

Permit Number
Vessel ADF&G Number:

[]

Crab IFQ Hired Master Permit:

Skipper Name:
Skipper NMFS ID Number:

[]

Crab QS or PQS Transfer Eligibility Certificate (TEC)

[]

Crab License Limitation License (LLP):

[]

Scallop License Limitation License (SLLP): License Number

License Number

Application for Replacement of Certificates, Permits, or Licenses
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PART II – Pacific Halibut and Sablefish IFQ Program Permits
[]

Halibut/Sablefish IFQ Fishing Permit:

Permit Number

[]

Halibut/Sablefish IFQ/CDQ Hired Master Permit for individual permit holder:
Permit Number

Species

[]

Halibut/Sablefish Transfer Eligibility Certificate (TEC): NMFS Person ID Number

[]

Registered Buyer Permit:

Permit Number

PART III – Federal Groundfish Permits
[]

Federal Fisheries Permit (FFP):

Permit Number

[]

Federal Processor Permit (FPP):

Permit Number

Vessel ADF&G Vessel Registration Number (if stationary floating processor)
[]

Groundfish License Limitation License (LLP):

License Number

[]

American Fisheries Act (AFA) Inshore Cooperative: Permit Number

[]

AFA Inshore Processor:

Permit Number

[]

AFA Catcher Vessel Permit:

Permit Number

[]

AFA Catcher/Processor Permit:

Permit Number

[]

AFA Mothership Permit:

Permit Number

PART IV – Halibut Subsistence
[]

Subsistence Halibut Registration Certificate (SHARC):
Tribal SHARC Number

[]

Or

Subsistence Halibut Community Harvest Permit:

Rural Resident SHARC Number
Permit Number

PART V – Charter Halibut
[]

Charter Halibut Permit: Permit Number
BLOCK C - REASON FOR REPLACEMENT REQUEST

[ ] Lost [ ] Destroyed [ ] Stolen [ ] Other (explain)
BLOCK D – SIGNATURE OF APPLICANT
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, the
information is true, correct, and complete.
1. Signature of Applicant or Authorized Representative:
2. Date:
3. Printed Name of Applicant or Authorized Representative (Note: If authorized representative, attach authorization):

Application for Replacement of Certificates, Permits, or Licenses
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INSTRUCTIONS
APPLICATION FOR
REPLACEMENT OF CERTIFICATES, PERMITS, OR LICENSES
Use this application to request a replacement for a certificate or permit that was previously issued by NMFS and
that subsequently was lost, destroyed, or stolen.
Please type or print legibly in ink and retain a copy of the completed application for your records.
When completed, submit application:
by mail to:

NMFS Alaska Region
Restricted Access Management (RAM)
P.O. Box 21668
Juneau, Alaska 99802-1668

or deliver to:

709 West 9th Street, Room 713
Juneau, AK 99801

or fax to:

(907) 586-7354

Allow at least 10 business days for your application to be processed.
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: http://www.alaskafisheries.noaa.gov
Telephone (toll free): 800-304-4846 (press “2”)
Telephone (in Juneau): 907-586-7202 (press “2”)
e-Mail: [email protected]

COMPLETING THE APPLICATION
Provide the information requested below regarding the replacement of the item(s) requested.
BLOCK A - IDENTIFICATION OF APPLICANT
1. Name: The full name of the applicant that is the holder of the permit or certificate, and/or license being
replaced.
2. NMFS Person ID: The identification number assigned to the applicant by NMFS, RAM.
3. Business Mailing Address: Enter the business mailing address, including street or P.O. Box number, state,
and zip code, where the item(s) should be sent.
Check whether the address provided is a permanent or temporary address. If you check “Permanent
Address,” we will update the official RAM database. If you choose “Temporary Address,” we will use it
for this one application only and we will not change the RAM database.

Application for Replacement of Certificates, Permits, or Licenses
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4. Date of Birth or Date of Incorporation.
Enter date of birth if applicant is an individual;
Enter date of incorporation if applicant is a corporation, partnership, association, or other non-individual
business entity.
5-7. Business Telephone and Fax Numbers and email address: The business telephone and business fax
numbers, including the area codes, and email address.
Note: It is important to provide a number where NMFS may leave a message to avoid delay in processing the
application if any questions arise.
BLOCK B - REPLACEMENT REQUEST (Parts I through V)
Check the block for each of the items you are requesting to be replaced. Fill out only the information that pertains
to the items that have been checked.
BLOCK C - REASON FOR REPLACEMENT REQUEST
Indicate the reason(s) for replacement of the items checked in Block B.
BLOCK D – SIGNATURE OF APPLICANT
Printed name and signature of applicant and date signed. If completed by authorized representative, attach authorization.
PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 30 minutes 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 determine that the certificate, permit, or license that was
previously issued by NMFS is eligible to be replaced and to replace that item.
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 will
prevent NMFS from replacing the item requested for replacement.
Application for Replacement of Certificates, Permits, or Licenses
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