Shrimp Observer Notification

August 2020

OMB Control #0648-0593. Expires 4/30/2023

Shrimp - Observer FAX Notification Form
This form is provided for your response. Please complete and return this form at least 48 hours prior to
your estimated departure. The information can be mailed to: NOAA/NMFS, Galveston Laboratory,
4700 Avenue U, Galveston, TX 77551 or Faxed to (409-766-3489); ATTN: MIKE HARRELSON,
PAT CRYER, ELLEN SIKES, KAYLA CHAPMAN and/or JASON WILLIAMS. If the vessel is
not fishing or is involved in another fishery during the selection period, please state in the comment
section of this form which fishery and gear used (include contact number).
Captain's Name: _______________________________ Vessel Name: ____________________________
Documentation/Vessel Number: _______________________________ Overall Length: __________ (ft)
Crew Size: _______ (include skipper)

Bunk Capacity: _________

Life Raft Capacity: __________

Contact Person/Telephone Number(s): _____________________________________________________
Communication Equipment (please list)
Cellular / SAT phone:
VHF:

Commercial Fishing Vessel Safety
Examination Decal
Serial Number:
Date of issuance
________/________
Month
Year

Single Side Band:
Call sign:
Vessel Fishing Status:
Port of Departure:

Dock Facility: _________________________________________________________________________
Street: _______________________________________________________________________________
City: ___________________________ State: _____
Departure Date: ___/___/___

Phone Number: (

Time: ___:___ (AM or PM)

) _______-____________

Anticipated Landing Date: ___/___/___

Expected Landing Port: (if different from port of departure)
Dock Facility: _________________________________________________________________________
Street: _______________________________________________________________________________
City: ____________________________ State: ______

Phone Number: (

) ______-_____________

Primary Language: (if other than English) ________________________
Comments: __________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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 0648-0593. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 65 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 mandatory 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 National Marine Fisheries Service, Shrimp and Reef Fish Observer Programs at: 4700
Avenue U, Galveston, Texas 77551, Attn: Fisheries Administrator, Elizabeth Scott-Denton.