Pacific Islands Federal Fisheries Permit Application

OMB Control No: 0648-0490
Expires: 02/xx/20xx

U.S. DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
NATIONAL MARINE FISHERIES SERVICE

Pacific Islands Regional Office - SFD Permits
1845 Wasp Blvd., Bldg 176
Honolulu, Hawaii 96818
(808) 725-5190

PACIFIC ISLANDS PERMIT APPLICATION

MISCELLANEOUS PELAGIC, BOTTOMFISH, PRECIOUS CORALS
Please print legibly. All items required. Do not mail application or check. See instructions on page 2 for submitting applications and paying any
required fees online or via secure email. Submit a separate application for each permit. It is prohibited to file false information on any application for a
fishing permit (50 CFR 665.15(b)).
PERMIT TYPE
1. PELAGIC:

___ Hawaii Longline Limited Entry Permit – Transfer or Renewal ($57 non-refundable application processing fee)
We encourage you to renew your Hawaii permit online ($34 reduced fee; see instructions on page 2)
For Hawaii Closed Area Exemption (contact Pacific Islands Region for form)
___ Western Pacific General Longline Permit (Guam, Northern Mariana Islands, PRIA) (No Fee)
___ Western Pacific Receiving Vessel Permit (all areas) (No Fee)
___ Pacific Remote Island Areas Troll & Handline (No Fee)

LOBSTER and DEEPWATER SHRIMP (Use the Pacific Islands Crustacean Permit application form)

2. BOTTOMFISH:

___ Guam (large vessel)
___ Pacific Remote Island Areas
(No Fee)
(CNMI: Use the Northern Mariana Islands Bottomfish Permit application form)
3. PRECIOUS CORAL: ___ (No Fee) Permit Area (see instructions):
VESSEL NAME: _________________________________________________________ VESSEL OFFICIAL NO: __________________________
VESSEL OWNER(s): _________________________________________________________________ RADIO CALL SIGN: __________________
First, Middle, & Last Name or Business Name

PERMIT HOLDER(s): _________________________________________________________________
First, Middle, & Last Name or Name of Business to be designated Permit Holder

________________________________
Taxpayer ID Number (SSN or EIN)

DATE OF BIRTH (Individual) OR INCORPORATION (Business) OF PERMIT HOLDER: ______________________________________________
BUSINESS CONTACT: _____________________________________________________________ TITLE: ______________________________
First, Middle, & Last Name, if not same as permit holder

Corporate officer, business owner, partner

BUSINESS MAILING ADDRESS: ___________________________________________ __________________
Street/PO Box

BUSINESS PHONE (_____) ___________________

City

______
State

_______________
ZIP Code

CELL (_____) ___________________

EMAIL: _______________________________________________________________________
Under penalty of perjury, I hereby declare that I, the undersigned, am the applicant or authorized to complete and certify this application on behalf of the
applicant, and the information contained herein is true, correct, and complete to the best of my knowledge.

APPLICANT: ____________________________________ ________________________________________
Printed Name and Signature of Permit Holder, Corporate Officer, Partner, or Designated Agent

DATE: _____________________

APPLICANT TITLE: ___ Permit holder; ___ Corporate member or officer, or partner; ___ Designated agent; or ___ Other _______________________________
(Check only one. Provide letter of authorization for designated agent.)

For Hawaii Longline Permit Transfer: to be completed and signed by originating permit holder (transferor). Under penalty of perjury, I hereby declare that I,
the undersigned, am the current permit holder and the information contained herein is true, correct, and complete to the best of my knowledge.

PERMIT TRANSFERER: ______________________________ __________________________________________ DATE: ________________
Printed Name & Signature of Permit Holder Transferring Permit

Permit Number to be Transferred:

(page 2)

INSTRUCTIONS

OMB Control No. 0648-0490
Expires: 02/xx/20xx

Note: We encourage you to renew your Hawaii longline limited entry permit online for a reduced fee. (See instructions under Submitting
Completed Applications)
Permit Type: Check which permit you are applying for. Note: for the Hawaii longline permit, only renewal or transfer is allowed. A non-refundable
application processing fee is required only for the Hawaii longline permit.
Permit Area: (for Precious Coral) - Specify: X-P-AS (American Samoa Exploratory Area), E-B-1 (Makapuu Established Bed, Hawaii), E-B-2 (Auau
Channel Established Bed, HI), C-B-1 (Keahole Pt. Conditional Bed, HI), C-B-2 (Kaena Pt. Conditional Bed, HI), X-P-H (Hawaii Exploratory Area – all
other HI areas except NWHI), X-P-G (Guam Exploratory Area), and X-P-CNMI (Northern Marianas Exploratory Area). See regulations at 50 CFR
665 for details.
Vessel Information: Fill in the vessel name, official number (USCG documented vessel number or registered number for undocumented vessels),
radio call sign, and name of vessel owner. If the vessel has no name, please draw a line in the vessel name field. Registration of a new or
replacement vessel to the Hawaii longline permit is a transfer, and the permit holder must have ownership interest in the replacement vessel.
Permit Holder Information: Fill in the name of the person(s) or business(es) to whom the permit will be issued. The permit will be issued to this
permit holder. Provide the taxpayer ID number: SSN for individual, or EIN for a business. Fill in the date of birth of the individual or the date of
incorporation for the business. Any change in the name of the permit holder for a Hawaii longline permit is a transfer.
Fill in the name of the person who will be the main contact for the permit holder, if not the same person as the permit holder, or if the permit holder is
a business. Provide the mailing address, phone numbers, and email of the permit holder. This will be the address of record.
Applicant: The person who submits the application must print their name and sign the form. Fill in application date and applicant title. If the applicant
is not the permit holder or is not a member or officer of the business that holds the permit, the permit holder must provide a signed letter of
authorization designating the applicant as the agent.
For Hawaii Longline Permit Transfers: This section must be completed by the current permit holder who is transferring the permit (transferer) to
another person or business (transferee). The current permit holder(s) must print their name, write their signature, and date it. The permit number
being transferred must be provided. If there is more than one permit holder, all permit holders must confirm the transfer. NMFS may request
additional documentation to verify the transfer.
Required Documents. You must submit the following with the application:
1) A copy of the vessel’s current U.S. Coast Guard Certificate of Documentation (documented vessel) or registration certificate from a state/territorial
agency (undocumented vessel) showing current vessel owner.
2) If a renewal, provide a copy of the current Protected Species Workshop certificate of the vessel owner (see below).
3) If the applicant is a designated agent, attach a signed letter from the permit holder authorizing the applicant as the agent.
The vessel owner must have a current Protected Species Workshop (PSW) certificate to renew the Hawaii longline permit. If the vessel owner is a
business, an officer or authorized representative of the company must have a current PSW certificate. Contact [email protected] for workshop
information.
Submitting Completed Applications:
Do not mail applications and fee payments.
Renew Hawaii longline permits online via the National Permit System (NPS) per instructions at www.fisheries.noaa.gov/pacific-islands/commercialfishing/renew-your-hawaii-longline-permit-online. Renewals via NPS are charged a lower processing fee. If you choose to renew your Hawaii longline
permit using this form, you will be charged the processing fee shown on the first page for document submission.
Applications to transfer Hawaii longline permits or for other permit applications listed above must be submitted on this form to the Permits Office via
secure email and online fee payment per instructions at www.fisheries.noaa.gov/pacific-islands/commercial-fishing/apply-pacific-islands-fishingpermit.
Contact the Permits Office at [email protected] or (808) 725-5190 with any questions.
An application that is lacking required information, vessel registration or documentation, or payment will be considered incomplete. An incomplete
application will be abandoned if it is not completed within 30 days following notification of the deficiency (50 CFR 665.13(c)(2)). You must inform
PIRO within 15 days of any change of information on the application form (50 CFR 665.13(d)). It is prohibited to file false information on any
application for a fishing permit (50 CFR 665.15(b)).

(page 3)

OMB Control No. 0648-0490
Expires: 02/xx/20xx

PRIVACY ACT STATEMENT
Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C 1801
et seq.), the Western and Central Pacific Fisheries Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq.), the Marine Mammal
Protection Act (16 U.S.C. 1362 et seq.), and the Endangered Species Act (16 U.S.C. 1531 et seq.). The authority for the mandatory collection of the
Tax Identification Number (TIN) is 31 U.S.C. 7701.
Purpose: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service (NMFS) requires the use of permits or registrations by
participants in the United States. Information on NOAA Fisheries permit applicants and renewing permit holders includes vessel owner contact
information, date of birth, Tax Identification Number, and vessel descriptive information. Permit holder information may be used as sampling frames
for surveys.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants. Disclosure of this
information is permitted within NMFS offices under the Privacy Act of 1974 (5 U.S.C. 552a) to coordinate monitoring and management of fisheries
and protected resources, as well as with the applicable State or Regional Marine Fisheries Commissions and International Organizations. Disclosure
of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/NOAA19, Permits and Registrations for the United States Federally Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of
eligibility for a permit.
PAPERWORK REDUCTION ACT INFORMATION
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 0648-0490. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 1 hour for Hawaii
longline permit transfer, 30 minutes per other permit application, and 2 hours per permit denial appeal, 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 voluntary. Send comments regarding this burden estimate or any other aspect of this information collection,
including suggestions for reducing this burden to the NMFS Pacific Islands Regional Office at [email protected]

(page 4)

OMB Control No: 0648-0490
Expires: 02/xx/20xx

Pacific Islands Federal Fisheries Permit Application

SUPPLEMENTAL INFORMATION FOR:
** MAIN HAWAIIAN ISLANDS LONGLINE FISHING PROHIBITED AREA EXEMPTION**
ELIGIBLE VESSEL: ______________________________________ OFFICIAL NUMBER: ____________________
Basis for Exemption Eligibility (ALL items must be checked and supporting documents attached to be eligible):
___ Applicant currently holds a Hawaii longline limited entry permit
___ Applicant was the owner or operator of a vessel that made landings of pelagic management unit species taken on longline gear
prior to 1970 from waters now closed to longline fishing.
___ Applicant was the owner or operator of a vessel that made landings of pelagic management unit species taken on longline gear in
at least five (5) years since (and including) 1970 from waters now closed to longline fishing.
___ Applicant was the owner or operator of a vessel that made at least 80 percent of its landings of longline-caught pelagic
management unit species in any calendar year in waters now closed to longline fishing.
Legible copies of supporting document(s) for exemption eligibility attached (check all applicable):
___ State of Hawaii Catch Reports ___ Vessel fishing logs ___ Auction receipts
___ Signed affidavits (original) ___ Other (specify): ____________________________________________
SIGNATURE OF APPLICANT:____________________________________________________ DATE: __________________________
PRIVACY ACT STATEMENT
Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and Management Act (16 U.S.C 1801
et seq.), the Western and Central Pacific Fisheries Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq.), the Marine Mammal
Protection Act (16 U.S.C. 1362 et seq.), and the Endangered Species Act (16 U.S.C. 1531 et seq.). The authority for the mandatory collection of the
Tax Identification Number (TIN) is 31 U.S.C. 7701.
Purpose: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service (NMFS) requires the use of permits or registrations by
participants in the United States. Information on NOAA Fisheries permit applicants and renewing holders includes vessel owner contact information,
date of birth, Tax Identification Number, and vessel descriptive information. Permit holder information may be used as sampling frames for surveys.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants. Disclosure of this
information is permitted within NMFS offices under the Privacy Act of 1974 (5 U.S.C. 552a) to coordinate monitoring and management of fisheries
and protected resources, as well as with the applicable State or Regional Marine Fisheries Commissions and International Organizations. Disclosure
of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/NOAA19, Permits and Registrations for the United States Federally Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of
eligibility for a permit.
PAPERWORK REDUCTION ACT INFORMATION
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 0648-0490. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 2 hours per prohibited
area exemption application, 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 voluntary. Send comments
regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the NMFS Pacific
Islands Regional Office at [email protected]