Pacific Halibut Permit Application

Online Mock-Up for Pacific Halibut Permits (pursuant to proposed rule 0648-BK83)

OMB # 0648-0203, Expiration: XX/XX/20XX

Directions: Please complete the IPHC Regulatory Area 2A permit application form and submit. The applicant is required to complete any field with an * next to it. A confirmation email will be sent to the vessel owner email address provided on this application.

We will process your application and mail the permit following the applicable deadline date.

1. Select the type of permit for which you are applying:

 Recreational Pacific Halibut Charter

 Incidental Commercial Pacific Halibut during Salmon Troll

 Incidental Commercial Pacific Halibut during Longline Sablefish Fishery

 Directed Commercial Fishery

2. Vessel Name*: _____________________________________________________

3. Vessel Document Number*: ___________________________________________ ___________________________________

4. Vessel Overall Length (ft)*: ___________________________________________

5. Vessel Weight (Gross Tons)*:__________________________________________

6. Vessel Weight (Net Tons)*: ___________________________________________

7. Year Built: _________________________________________________________

8. Home Port: _________________________________________________________

9. Number of Crew: ____________________________________________________

10. Owner’s Name or Company’s Name*: __________________________________

11. Owner/Company Mailing Address*: ____________________________________

12. Owner/Company City*: ______________________________________________

13. Owner/Company State*: ______________________________________________

14. Owner/Company Zip Code*: ___________________________________________

15. Owner/Company Telephone Number*: ___________________________________

16. Owner/Company Cell Phone: ___________________________________________

17. Owner/Company Email Address*: _______________________________________

18. Co-owner Name: _____________________________________________________

19. Is the Vessel Owner different than the Vessel Captain?

 Yes

 No

20. State Vessel Registration Number*: ______________________________________

21. State of Vessel Registration Number*:

 Alaska

 Washington

 Oregon

 California

22. Provide ALL state vessel registration numbers indicating the applicable state.

23. I declare that the above information is true to the best of my knowledge and understand that any false statement may invalidate the IPHC vessel permit.*

Applicant’s Name: __________________________________________________

Privacy Act Statement

Authority:  The collection of this information is authorized under 5 U.S.C. § 301, Departmental regulations; Executive Order 12656, Assignment of emergency preparedness responsibilities; Homeland Security, Federal Continuity Directive 1, requiring Federal agencies to account for its personnel during emergencies; and Departmental Administrative Order 210-1, Emergency Readiness for Departmental Continuity.

Purpose:  The Department of Commerce (Department) is collecting this information to ensure managers, supervisors, continuity of operations (COOP), and other appropriate staff and individuals have the most current personal contact information for contacting you in the event of an emergency or if needed for a shift and cannot be contacted otherwise.  As an example, the information will be used to ensure employee accountability as it relates to protection and safe being in a catastrophic situation.

Routine Uses:  The Department will use this information to send notifications, alerts, and/or activations and to relay critical updates and guidance to Department personnel in response to an emergency scenario or exercise.  Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among Department staff for work-related purposes.  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/DEPT-18, Employees Personnel Files Not Covered by Notices of Other Agencies.

Disclosure:  Furnishing this information is mandatory.  The failure to provide accurate information may delay or prevent you from receiving notifications in the event of an emergency. The failure to provide this information also may have an effect on your Federal service under certain circumstances.  For example, failure to supply this information may delay or make it impossible to notify you in the event of an emergency about a change to your duty location and/or the Department’s needs for your service in an emergency, which may result in you being placed in an absent without leave status.

PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to NOAA/National Marine Fisheries Service, West Coast Region, Attn: Program Manager, Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to penalty for failure to comply with, a collection of information subject to the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.