Highly Migratory Species Observer Notification Form

04/30/2020

OMB Control #0648-0593. Expires 12/31/2021

Highly Migratory Species Observer Notification Form
This form is provided for your response. Please provide the information requested below and return by mail or e-mail
([email protected]) at least 5 days prior to your estimated departure. If the vessel is not fishing or is involved in another fishery
during the selection period, please indicate this under Vessel Fishing Status.

Captain's Name: _____________________ Vessel Name: _____________________________
Documentation/Vessel Number: __________________________ Overall Length: ________(ft)
Crew Size: ______ (include skipper) Bunk Capacity: ______Life Raft Capacity: _______
Contact Person/Telephone Number(s): _________________________________
Communication Equipment (please check)

Commercial Fishing Vessel Safety
Examination Decal

Cellular phone:

Serial Number:

VHF:
Date of expiration: _____/______ Month/ Year

Single Side Band:
Call sign:

Vessel Fishing Status:
Port of Departure:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________ State: ___________________________
Telephone Number: (

) _________________________

Departure Date: ____________ Departure Time: ________ (AM or PM)
Dock Facility: _______________________________________________________________

Expected Landing Port:
Street: ______________________________________________________________________
City: ______________________________ State: ____________________
Telephone Number: (

) _______________________

Anticipated Landing Date: _____________

I certify under penalty of perjury under the laws of the United States of America that the information given on
this form is true and correct, and that I have full authority to execute this form.

Signature

Date _______________________

For the Pelagic Observer Program, please return by mail to SEFSC Pelagic Observer Program, 75
Virginia Beach Dr. Miami, FL 33149 or e-mail (popobserver@ noaa.gov). For questions call 800-8580624.
For the Shark Observer Program, please return by mail to SEFSC Shark Bottom Longline Observer
Program, 3500 Delwood Beach Rd, Panama City, FL 32408-7403 or fax to (850) 235-3559. For questions
call (850) 234-6541.
Public Burden Statement - Effective 4/30/2020
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor
shall a person be subject to a penalty for failure to comply with an information collection
subject to the requirements of the Paperwork Reduction Act of 1995 unless the information
collection has a currently valid OMB Control Number. The approved OMB Control Number for this
information collection is 0648-0593. Without this approval, we could not conduct this
information collection. Public reporting for this information collection is estimated to be
approximately 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 information collection. All responses to this information collection are
mandatory. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the NOAA/NMFS/SEFSC
at: 75 Virginia Beach Drive, Miami, FL 33149, Attn: Fisheries Biologist Andy Davis,
[email protected]