Report for the Deposit or Harvest of Aquacultured Live R

U.S. Department of Commerce, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13th Avenue South
St. Petersburg, FL 33701
Toll Free 877-376-4877 (9:00 a.m. - 4:00 p.m. ET)
727-824-5326 (9:00 a.m. - 4:00 p.m. ET)
https://www.fisheries.noaa.gov/permits-and-forms

REPORT FOR THE DEPOSIT OR
HARVEST OF AQUACULTURED LIVE
ROCK

OMB Control No. 0648-205;
Expiration Date: 01/31/2024

FOR OFFICE USE ONLY
Reviewer Initials and
Date Entered

INSTRUCTIONS: Complete section 1 and either section 2 or 3 with all information. Please sign, date, and print your name in
section 4. You must fill out a seperate report for each deposit or harvest activity. Do not list deposits or harvests done on the
same date on the same report. You must make a seperate report for each deposit of materials that are from different sources,
suppliers and/or geographic origin, even if made on the same date.
1. PERMIT HOLDER INFORMATION
Permit holder as shown on the permit

Site number the material was
deposited to or harvested from

AQU2. DEPOSIT INFORMATION

Name of the source/supplier of the deposited material

Mailing Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Physical Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Check box if same as Mailing Address

Geographic origin of the deposited material

Date Deposited (dd/mm/yyyy)

Average Dimensions (inches) ( e.g. 12" x 12")

Total Weight Deposited (Pounds)

3. HARVEST INFORMATION - FILL OUT ONLY IF LANDED OUTSIDE THE STATE OF FLORIDA

NOTE: If landing INSIDE the state of Florida, you must report to the Fisheries Department Monitoring Section of the Florida Fish and Wildlife Research
Institute using standard form #33-610 (Marine Fisheries Trip Ticket). Call the trip ticket office at 727/896-8626 for more information.
Name of the purchaser of the harvested material

Mailing Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Physical Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Check box if same as Mailing Address

Date Harvested (mm/dd/yy)

Total Weight Harvested (pounds)

Price Per Pound

Total Dollar Value

4. SIGNATURE
SIGNATURE

PRINTED NAME

POSITION IN COMPANY

DATE

DEP2020.1P, Form Revison 05/11/2020

Public Burden Statement - 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 0648-0205. Without this approval, we could not conduct this survey or
information collection. Public reporting for this information collection is estimated to be approximately
15 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 required to obtain benefits. Send comments regarding
this burden estimate or any other aspect of this information collection, including suggestions for
reducing this burden to the: PRA Officer, National Marine Fisheries Service, F/SER26, 263 13th Avenue
South, St. Petersburg, FL 33701.
Privacy Act Statement - Authority: The collection of this information is authorized under the MagnusonStevens Fishery Conservation and Management Act (16 U.S.C 1801 et seq.), the High Seas Fishing
Compliance Act, the Tuna Conventions Act of 1950, the Antarctic Marine Living Resources Convention
Act, the Western and Central Pacific Fisheries Convention Implementation Act (16 U.S.C. 6901 et
seq.), the Marine Mammal Protection Act, the Endangered Species Act and the Fur Seal Act. 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 National Marine Fisheries Service (NMFS) requires the
use of permits or registrations by participants in the United States. Information on NMFS permit
applicants and renewing holders includes vessel owner contact information, date of birth, TIN and
vessel descriptive information. Permit holder information may be used as sampling frames for surveys,
as part of Fishery Management Council (FMC) analysis to support FMC decisions.
Routine Uses: The Department will use this information to determine permit eligibility and to identify
fishery participants. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C.
Section 552a), to be shared within NMFS offices, in order to coordinate monitoring and management of
sustainability 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/NOAA-19, 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.