NMS Permit Application

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NOAA NATIONAL MARINE SANCTUARIES
PERMIT APPLICATION

OMB # 0648-0141
Expires: x/xx/20xx

Refer to “Instructions for Submitting Applications for National Marine Sanctuary Permits and Authorizations” for guidance on
how to properly complete this application. Applicants are responsible for reviewing the instructions in their entirety to ensure
the application meets all requirements.
Note: for certain activities, completion of this application may not be required. Consult the Office of National Marine
Sanctuaries (ONMS) permitting webpage or contact the local permit coordinator (under “Where to Apply” on the webpage)
prior to completing and submitting this application. Review the list of sanctuary prohibitions to see if your proposed project
involves an otherwise prohibited activity for a sanctuary, and would therefore require a permit.
Section A – General
Sanctuary or sanctuaries in which you are applying to work:
Gray's Reef
Channel Islands
Greater Farallones
Cordell Bank
Hawaiian Islands Humpback Whale
NMS of American Samoa
Mallows Bay-Potomac River
Florida Keys
Monitor
Flower Garden Banks

Monterey Bay
Olympic Coast
Stellwagen Bank
Thunder Bay
Other

Enter a n y previously issued ONMS permit
number(s) relevant to this project or issued to the
applicant:

Select one of the following:
New application
Amendment or modification to previously issued permit
(Note: expired permits cannot be amended or modified)

Section B - Applicant Information

Dr.
Honorific
Title

First Name

Organization Address:

Last Name
Institution represented (if applicable)

Phone:

Middle Initial
Department (if applicable)

Ext:

Address Line 1:
Address Line 2:
City:

Email:

State:
Zip Code:

Co-applicant (if applicable):

Dr.
Honorific

First Name

Organization address:
Address Line 1:
Address Line 2:
City:
State:

Last Name
Phone:

Institution
Ext:

Email:

Zip Code:

Title

Institution represented (if applicable)

Department (if applicable)

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Section C - Project Information
Project title and summary (maximum 300 characters):

Project dates (mm/dd/yyyy format):
Requested permit start date:
Requested permit end date:

Section C - Project Information (Continued)
Project abstract (maximum 3000 characters - field will expand as needed):

Methods and protocols proposed to be employed (maximum 10000 characters - field will expand as needed). For field experiments or
monitoring, provide details on what will occur, how, when, where, and for how long. If equipment is required, fully describe and attach
supporting diagrams, as applicable. For collections, provide sampling season and frequency and justification for sample numbers. For all
projects (including lab component) provide experimental design and statistical analysis methods:

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Section C - Project Information (Continued)
Proposed location of activities:
Will this activity occur within any special
management zone (such as marine reserves, notake areas, research areas, sanctuary preservation
areas, or state preserves)?

Describe specific location(s) within sanctuary where activities are proposed to
be conducted. Provide a map showing GPS coordinates in decimal degrees for
individual points, point with radius, or polygon(s) with bounding coordinates.
List any special management zone(s) by name.

No
Yes – List zone names in box to right
and provide justification in Section E

Section D - Collections Data
Complete this section when requesting collections as part of this activity. Collections include biological, geological and hydrological
samples. Describe the type, quantity, and size of sample to be collected. Also describe the intended sampling location. Provide
scientific nomenclature where possible. Complete/attach additional pages if necessary. Leave blank if project does not include
collections.
Location: Identify GPS
Sample Limits: Identify
Type of Collection (e.g., species Quantity: Identify number of
coordinates in decimal degrees,
name, sediment type, or water samples per year or per permit maximum or minimum size, or
site name, and note if in special
other
relevant
parameters.
sample).
period (if less than one year).
management zone.

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Section E- Environmental Effects
Answer the following questions as accurately as possible. Maximum 1000 characters per question.
Describe any direct effects on sanctuary resources or qualities that would occur at the same time and place as a result of this activity
(e.g., If equipment is used, describe level and scope of disturbance to species, habitats, or maritime heritage resources. If samples are
proposed, explain resulting effects to individuals or populations.):

Describe any indirect effects on sanctuary resources or qualities are those effects cause by the action that are that are later in time or
farther removed in distance, or incidental to other species or habitats as a result of the activity, but still reasonably foreseeable (e.g., If
equipment is used, does it have the potential to move and cause unintended effects to species, habitats, or maritime heritage resources?
Will field experiments alter the behavior of non-target species?):

Section F - Rationale
Answer the following questions as accurately as possible. Maximum 1000 characters per question.
1.

Describe how the proposed activity would be conducted in a manner compatible with the National Marine Sanctuaries Act’s primary
objective to protect sanctuary resources and qualities, including the extent to which the activity may diminish or enhance sanctuary
resources or qualities.

2.

Describe why this activity needs to be conducted within the sanctuary or sanctuaries to achieve its purpose.

3.

Section F - Rationale (Continued)
If this activity is proposed to occur in any special management zone (e.g., marine reserves, no-take areas, research areas, sanctuary
preservation areas, NOAA regulated overflight zones, state preserves), explain why this is necessary and how it would further the
understanding of the zone.

4.

Describe how the proposed methods and procedures are appropriate to achieve the proposed activity’s stated purpose and would
avoid, minimize, or mitigate adverse effects on sanctuary resources and qualities as much as possible.

5.

Describe how the proposed duration, seasonality and frequency of the activity requested are appropriate for this activity and are no
greater than necessary to achieve the activity’s stated purpose.

6.

Describe how the expected end value of the proposed activity furthers sanctuary goals and purposes and outweighs any potential
adverse effects on sanctuary resources and qualities.

7. Provide a statement explaining why the applicant and all personnel are professionally qualified to conduct and complete the
proposed activity.

8.

Provide information to demonstrate that the applicant has adequate financial resources available to conduct and complete the
proposed activity and meet the terms and conditions of the permit.

9.

Provide information relevant to any other sanctuary-specific permit review criteria, as applicable. Enter N/A if not applicable.

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Section G - Other Information

Identify any other permits, authorizations, or approvals obtained or required to conduct the proposed activity, including
in the case of applications for authorizations, a copy of the application for a valid lease, license, approval or other
authorization from any federal, state, or local authority of competent jurisdiction.
Check the boxes as appropriate if other permits or authorizations are required. Identify the status of the application(s) as
not yet submitted, in progress, or received. Provide permit number(s) and copies of any permit(s) already received.
Permit number if applicable
Marine Mammal Protection Act (MMPA) permit or authorization
Endangered Species Act (ESA) permit or authorization
U.S. Army Corps of Engineers permit
Other federal, state, or local permit(s) or authorization(s)
Check the boxes as appropriate, if consultations are required. Identify the status of the consultation(s) as not yet submitted, in
progress, or completed. Provide copies of any final assessments or analyses.

N/A
N/A
N/A
N/A
N/A
N/A

Endangered Species Act (ESA) Section 7
Coastal Zone Management Act (CZMA) Federal Consistency Determination or Negative Determination
Magnuson-Stevens Fishery Conservation Act - Essential Fish Habitat (EFH)
National Historic Preservation Act (NHPA) Section 106
Executive Order 13175 - Consultation and Coordination with Indian Tribal Governments
Other tribal, federal, state, or local consultation(s)

Check the boxes as appropriate, if to your knowledge, any of the following environmental analyses are required. Provide title of the
analysis and any associated decision document. Provide the name of agency responsible for the analysis. Identify the status of the
environmental review as not initiated, in progress, or completed.
Federal environmental impact statement, environmental assessment, or categorical exclusion memorandum prepared
pursuant to the National Environmental Policy Act. Include the associated Record of Decision or Finding of No
Significant Impact, if the final agency decision has been determined.
State or local environmental impact statement, analysis, or review.

I certify that this application is accurate and complete. I understand that incomplete applications will not be acted upon until any
required additional information is provided. I further understand that applications not received within the timelines outlined in the
instructions may not be processed in time for my activity to begin as planned. I authorize the ONMS to seek peer reviews of my
proposal, if deemed necessary.
Signature of applicant:
Signature of co-applicant, if applicabl
blee):

Date:
Date:

(Options for authenticating this document: Provide digital signature; provide signed and scanned last page; or provide acknowledgement
using the paragraph above by email.)
Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to a collection
of information unless it displays a valid OMB control number. Public reporting for this collection of information is estimated to average 1.5
hours per response for most activities, including the time for reviewing instructions, gathering and maintaining data, and completing and
reviewing this application. See the instructions for details regarding this burden estimate.
Privacy Information: We will only use personally identifiable information submitted in this application for the purpose of considering
the permit application. We do not collect or use information for commercial marketing. We may share the information you give us with
another government agency if your inquiry relates to that agency. To view the full privacy policy, please visit https://www.osec.doc.gov/opog/
privacy/NOAA-pias.html

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