Reimbursement Invoice for Contract Observers - Meal reim

May 2020

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

Invoice Instructions
This invoice will be used to obtain reimbursement for observer expenses incurred during a deployment
aboard a U.S. commercial long-line vessel. (Complete all areas in bold/highlighted) [INVOICE MUST BE
SUBMITTED WITHIN 90 DAYS OF RECEIVING NOTICE]

TRIP NUMBER - office use only
VESSEL NAME - name of vessel that carried observer
ORGANIZATION CODE - office use only
DATES OF TRIP - dates observer was aboard vessel
MEAL EXPENSES - calculate food costs: (rate) x (days at sea) = subtotal. Observer's
personal food may be deducted from subtotal. If so, a copyo of the receipt will be
provided.
COMPANY NAME - Name of insurance company
AGENT NAME - Insurance contact
PHONE - Insurance contact number

TOTAL - total cost incurred (food and/or insurance)
CORPORATION/OWNER NAME - person or entity whose name will appear on check
TIN - (Taxpayer Identification Number) - Social security number, if check is going to an
individual or EIN (corporate number), if paying a corporation
MAILING ADDRESS - address where you would like the check sent
PHONE - contact number for additional information
DATE - date of signature
SIGNATURE - signature of authorized person
Please return to:

IMPORTANT

Pelagic Observer Program
Southeast Fisheries Science Center
75 Virginia Beach Dr.
Miami FL, 33149

or

Use included, brown
envelope - no postage
necessary

1 - We need a SSN or EIN or the check will not be processed
2 - We need original signatures on the invoice, please do not fax!
3 - Remember the information at the bottom of the invoice tells us who to
make check out to and where to send it, please write legibly.
4 - Insurance agencies - if you will be receiving the check, remember that
the "Corporation/Owner name" field is NOT the vessel, but the company
name.

Allow 3-4 weeks to receive payment. Please contact our office if you have not received payment within 3 months of
sending invoice. If you have any questions concerning this invoice or payment schedule, please call us at 1-800-858-0624.

THIS PAGE LEFT BLANK INTENTIONALLY

NMFS/SEFSC/POP

MEALS

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

REIMBURSEMENT INVOICE FOR CONTRACT OBSERVERS
VESSEL NAME

ORGANIZATION CODE

TASK NUMBER

FN7100
MEAL EXPENSES

LIABILITY INSURANCE
*ATTACH ENDORSEMENT AND BILLING STATEMENT

DAYS AT SEA

$25 / DAY

Vessel ID:

1

X

33GENF200035

DATES OF TRIP

U8LCBACP00

RATE

AGR #:

TRIP NUMBER

TO
SUBTOTAL

DAYS AT SEA

#N/A

COMPANY NAME
AGENT NAME
PHONE
COMPANY / OWNER NAME

TIN (Taxpayer Identification Number)
TOTAL

MAILING ADDRESS

PHONE

DATE

SIGNATURE

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]