Monument Permit Application

U.S. DEPARTMENT OF COMMERCE

OMB Control No: 0648-0664
Expires: xx/xx/xxxx

\ National Oceanic and Atmospheric Administration
NATIONAL MARINE FISHERIES SERVICE

Pacific Islands Regional Office - SFD Permits
1845 Wasp Blvd., Bldg. 176
Honolulu, Hawaii 96818
Ph: (808) 725-5190; Em: [email protected]

For Office Use Only:
PIRO Permit No. __________________________

Pacific Islands Permit Application
MARINE NATIONAL MONUMENT FISHING PERMIT
Please Print Legibly. All items are required. Required documents and Instructions are on page 2.
1. TYPE OF PERMIT (Check only one. See instructions for specific information:
____ Non-commercial Fishing

or

____ Recreational Charter Fishing

2. NEW PERMIT ____ OR RENEWAL ____?
3. MONUMENT PERMIT AREA (Check only one. See instructions for specific information):
____ Marianas Trench (Islands Unit)

____ Pacific Remote Islands (charter only)

____ Rose Atoll

4. VESSEL NAME: _____________________________________________________ 5. VESSEL OFFICIAL NO: ______________________

USCG or state registration number

6. VESSEL LENGTH: _______________ (feet)

7. RADIO CALL SIGN: ______________________ (if assigned by FCC)

8. VESSEL OWNER: ___________________________________________________________________________________________________
First, Middle, & Last Name or Business Name
9. TAXPAYER ID NUMBER (SSN or EIN): _______________________________
10. DATE OF BIRTH (Individual) OR INCORPORATION (Business): _______________________________ (MM/DD/YYYY)
11. MAILING ADDRESS: ______________________________________________________ __________________ _____ ______________
City
State
ZIP Code
Street/PO Box
12. PHONE (______) ____________________

CELL PHONE (______) ____________________

EMAIL: __________________________________________________________________________
13. VESSEL OPERATOR(S):
1. Name: __________________________________________________________________________ Phone: ________________________
Mailing Address: _________________________________________________________________________________________________
2. Name: __________________________________________________________________________ Phone: _______________________
Mailing Address: _________________________________________________________________________________________________
Under penalty of perjury, I hereby declare that I, the undersigned, am the vessel owner or operator, or authorized to certify this application
on behalf of the vessel owner, and the information contained herein is true, correct, and complete to the best of my knowledge.
14. APPLICANT: ___________________________________ _________________________________________ DATE: __________________
Printed Name and Signature of Person Submitting Application
15. APPLICANT TITLE: ___ Vessel owner, ___ Vessel operator, ___ Corporate officer or partner, ___ Designated agent*, or
___ Other ________________________

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INSTRUCTIONS
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TYPE OF PERMIT: Please check the appropriate box for the type of permit you are applying. Non-commercial fishing means fishing that
includes, but is not limited to, sustenance, subsistence, traditional indigenous, and recreational fishing. Recreational charter fishing means
operating or fishing from a vessel carrying a passenger for hire who is engaged in recreational fishing. Check only one box.
NEW APPLICATION OR RENEWAL: Check only one box.
MONUMENT PERMIT AREA: Please check the appropriate Monument Permit Area you are applying. Check only one box. If you are
seeking to fish in more than one Monument Permit Area, you must apply separately for each area.
Additional Specific Information:
 NMFS may issue fishing permits for the Rose Atoll Marine National Monument only to community residents of, or charter
businesses legally established in, American Samoa.
 NMFS may issue fishing permits for the Islands Unit of the Marianas Trench Marine National Monument only to community
residents of Guam and the Northern Mariana Islands, or charter businesses legally established in those islands.
 You are required to obtain all other applicable federal permit(s) for fishing within the Marianas Trench Marine National Monument
outside of the Islands Unit. See https://www.fisheries.noaa.gov/pacific-islands/resources-fishing/pacific-islands-fishing-permits
for a list of applicable federal permits for fishing in the EEZ around Guam and the Northern Mariana Islands.
 For the Pacific Remote Islands Marine National Monument, use this application only if you own or operate a vessel that
will engage in recreational charter fishing activities. If your fishing will not involve recreational charter fishing, you must
obtain the applicable federal fishing permit(s) for the Pacific Remote Islands Marine National Monument. See
https://www.fisheries.noaa.gov/pacific-islands/resources-fishing/pacific-islands-fishing-permits for a list of applicable federal
permits for fishing in the EEZ around the Pacific Remote Island Areas.
VESSEL NAME: Write in the vessel name.
VESSEL OFFICIAL NUMBER: Write in either the U.S. Coast Guard documentation number, or state/territorial agency vessel registration
number.
VESSEL REGISTERED LENGTH: Write in the vessel’s length overall in feet, as listed on the U.S Coast Guard document or
state/territorial agency vessel registration.
RADIO CALL SIGN: If you have one, write in the call sign assigned by the FCC to your vessel’s radio. It would probably start with a W. If
you do not have a call sign, write N/A.
VESSEL OWNER: Write in the First, Middle, & Last Name(s), or Business Name of the vessel’s registered owner as listed on the U.S
Coast Guard document or state/territorial agency vessel registration.
TAXPAYER ID NUMBER: Write in the Social Security Number (SSN) of the applicant. If the vessel owner is a business, write in the
Employer Identification Number (EIN) obtained from the U.S. Internal Revenue Service.
DATE OF BIRTH OR DATE OF INCORPORATION: If an individual owns the vessel, write in the vessel owner’s full birth date. If a
business owns the vessel, write in the full date of incorporation.
MAILING ADDRESS: Write in the vessel owner’s primary mailing address. NMFS will use this address as the official address of record for
all mail to the permit holder.
PHONE: Write in the vessel owner’s primary phone number.
CELL PHONE & EMAIL: Please provide additional contact information for the vessel owner.
VESSEL OPERATOR(S): Write in the First, Middle, & Last Name, and provide contact information for each individual that will operate the
vessel while in the Monument Permit Area, if not the registered owner. Each vessel operator, if not the same as vessel owner, is required
to obtain a Monument permit.
APPLICANT: Print your name and sign on the line. The applicant must sign the form. Then, fill in the date the application was signed
APPLICANT TITLE: Check only one for the applicant’s relationship to the vessel owner.

OTHER REQUIRED DOCUMENTS:
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Copy of the vessel’s current U.S. Coast Guard Certificate of Documentation (documented vessel), or registration certificate from a state or
territorial agency (undocumented vessel) showing the current vessel owner.
Proof of residency or location of business (copy of identification, check, bill, business registration, certificate of good standing, or other
document verifying local address), and
* A signed and dated letter from the permit holder authorizing the applicant as the agent, if the applicant is acting as a designated agent for
the vessel owner.

Filing false information on any application for a fishing permit is prohibited (50 CFR 665.15(b), 18 U.S.C. 1001). You must inform PIRO within 15
days of any change of information on the application form (50 CFR 665.13).
Submit the application to the Pacific Islands Region Permit Office via electronic submission. Do not mail the application. Please follow the
instructions here: https://www.fisheries.noaa.gov/pacific-islands/commercial-fishing/apply-pacific-islands-fishing-permit

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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, and the Endangered Species 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 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, TIN 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 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.

Paperwork Reduction Act 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 0648-0664. Without this approval, we
could not conduct this information collection. Public reporting burden for this collection is estimated at 15 minutes per application, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. All responses to this information collection are mandatory. Send comments regarding this burden estimate or any other aspects of this
collection of information, including suggestions for reducing this burden, to Pacific Islands Regional Office at [email protected].