Charter/Headboat Trip Summary Form

Please Use BLACK or BLUE Ink Only (See Instructions on Back)

OMB 0648-0371 Exp. 12/31/20XX

ATLANTIC HMS CHARTER HEADBOAT TRIP SUMMARY FORM
Departure
Date (MM/DD/YY)
Time (military)

HMS Permit
Number:
Vessel Number:
(Coast Guard or State) ______________________

Landing
Date (MM/DD/YY)
Time (military)

Contact Phone
Number:
(_______)________-___________
Contact Name:
(Please Print) ____________________________
State
Port of
Departure: ______________________
Target(s):
(Check all that apply)

Gear Type:

Number of Anglers on Trip:
Number of Crew Members:
(including captain)
Number of Lines Fished:

□ Bluefin
□ Yellowfin
□ Albacore
□ Marlin
□ Swordfish
□ Sailfish
□ Other (List) ________________________

□ Bigeye
□ Pelagic Sharks

□ Skipjack
□ Coastal Sharks

□ Rod & Reel (Anchored/Drifting)
□ Rod & Reel (Trolling)
□ Other (List) ________________________

Coordinates of where the majority of fishing was conducted: LAT

□ Greenstick

deg

LONG

deg

Fished with: □ Articial Lure If using bait, □ Circle Hooks
hook type:
□ J Hooks
□ Live Bait
□ Dead Bait

If using bait, □ Mackerel □ Squid
type used:
□ Menhaden □ Herring
□ Ballyhoo □ Butterfish
□ Other (List) ______________
TRIP EXPENSES
Quantities Used

Unit Cost
Fuel:

Price per Gallon

$

.

Gallons Used:
Pounds:

Trip Cost

$

.

Tackle: Trip Cost

$

.

Ice:

$

.

Bait:

Trip Cost

Used Own Ice Maker:

Other Trip Costs: (Specifically for this trip)

$

.

Trip Payout: (See instructions)

Owner

$

.

Captain

$

.

Crew/Mate

$

.

and/or
Count:

□ Yes

□ No
REVENUE

Total Trip Fare:
(Not including tips)

.

I certify the information contained on this form is accurate and complete to the best of my knowledge:
Captain Name (Please Print): _____________________ Captain Signature: _________________________
Please keep the yellow copy for your records and mail the white copy to:QuanTech, Inc., 2020 14th Street North, Suite 560, Arlington, VA 22201

Instructions for the Trip Summary Form
NOTE: We appreciate your participation in the Atlantic Highly Migratory Species (HMS) Charter Headboat Economic Study.
All data provided are CONFIDENTIAL and will be used to determine the effects of existing and proposed management policies
on fishery participants. Please note that consistent and accurate reporting is extremely helpful for achieving the benefits of
conservation and management of Atlantic HMS fisheries.
Please use a ballpoint pen and print clearly to record the following:
• HMS Permit Number and Vessel Number: U.S. Coast Guard documentation number or state registration number as recorded on HMS
permit.
• Contact Name and Contact Phone Number: Name and telephone number of the person completing the form.
• Port & State of Departure: location of port from which the trip commenced.
• Date of Departure: calendar date (month/day/year) on which the trip was started.
• Time of Departure: military time (24 hour clock) at which the boat left port.
• Date of Landing: calendar date (month/day/year) the vessel arrived back at port if an overnight trip.
• Time of Landing: military time (24 hour clock) at which the boat returned to port.
• Number of Anglers on Trip: number of paying individuals taken fishing on the trip.
• Number of Crew Members: number of persons paid as crew (including captain).
• Number of Lines Fished: maximum number of fishing lines in the water at one time.
• Target: group of fish species targeted on the trip (check all that apply).
Pelagic Sharks: Blue, Oceanic Whitetip, Shortfin Mako, Thresher, and Porbeagle
Coastal Sharks: Tiger, Nurse, Lemon, Blacktip, Spinner, Bull, Finetooth, Blacknose, Hammerheads,
Bonnethead, Atlantic Sharpnose
• Gear Type: Type of fishing gear and fishing method used on the trip. If other, please indicate the type of gear used. Check all that
apply.
• Latitude and Longitude: Coordinates in degrees of the spot where the majority of fishing occurred.
• Fished with: Type of bait/lure used – artificial, live bait, or dead bait – on the trip (check all that apply).
• Hook Type: If bait was used on the trip did the boat use circle or J-hooks.
• Type of Bait Used: If live or dead bait was used on the trip, what species of bait was used.
• Fuel: price per gallon paid for fuel used during trip. If you did not refuel for the trip, record price paid when fuel was last purchased;
indicate gallons actually used during the trip. Exclude fuel purchased but not used.
• Bait: record amount of bait used during trip by count or pounds and total cost of bait purchased.
• Tackle: total cost of tackle (hooks, line, sinkers, lures) purchased for the trip.
• Ice: Total cost of ice purchased for the trip. Leave blank if you used your own ice machine to produce ice for the trip.
• Used Own Ice Maker: Check yes if you used your own ice machine to produce ice for this trip.
• Other Trip Costs: Other costs incurred specifically for this trip excluding items listed elsewhere on this trip summary form.
• Trip Payout: Payout ($) to different members of the crew. If the captain and owner are the same person, put the individual’s share of
the fare under owner and place X’s in the captain boxes.
Owner: Portion of trip fare paid to the owner.
Captain: Portion of trip fare paid to the captain.
Crew/Mate: Portion of trip fare paid to the crew/mate.
• Total Trip Fare: The total fare charged for the trip, not including tips.
• Captain Signature and Name: signature of the person completing the form (normally, this should be the captain for the trip although
the vessel owner may complete the second portion of the form).
Remove this page and keep yellow copy for your records. Please mail white page(s) for each week (Monday through Sunday) on
Mondays. NOTE: if the vessel made no for-hire HMS trips, please complete and mail a No Fishing for Highly Migratory Species
Reporting Form.
PAPERWORK REDUCTION ACT STATEMENT: Atlantic highly migratory species vessel logbooks provide information on fishing effort, target catch
and bycatch in the fisheries for tunas, sharks and swordfish. This information is the basis for quota monitoring and stock assessment and is used to meet
international obligations to report fishery statistics to the International Commission for the Conservation of Atlantic Tunas. Public reporting burden for
this information collection, including time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and
completed & reviewing the collection of information, is estimated to average: 12 minutes per response for the set form (daily report); 30 minutes per
response for the trip expense and earnings summary; 2 minutes per response for the no-fishing report; and 30 minutes per response for the annual
expenditures form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to: Highly Migratory Species Management Division, National Marine Fisheries Service, F/SF1, 1315 East West Highway, Silver Spring, MD
20910. Providing the requested information in the vessel logbook is mandatory, if selected, and is necessary for managing the Atlantic highly migratory
species fisheries in accordance with the Atlantic Tunas Convention Act (16 U.S.C. 971 et seq.) and the Magnuson-Stevens Fishery Conservation and
Management Act (16 U.S.C. 1801 et seq.). In accordance with NOAA Administrative Order 216-100, it is agency policy not to release confidential
fisheries statistics, other than in aggregate form. 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.