Inspection Request Form (Observer Sampling Station, Vide

Revised: 10/7/2020

OMB Control No. 0648-0330, Expiration Date: 03/31/2024

INSPECTION REQUEST FORM
(OBSERVER SAMPLE STATION, VIDEO, BIN MONITORING and
AT-SEA SCALES)
FISHERIES
Note: Inspections will be scheduled within ten (10) working days of receiving a request. Requests
for inspections in Dutch Harbor and Kodiak will be scheduled within ten (10) days, but may be
delayed several days due to weather or logistics.
VESSEL INFORMATION
Vessel Name:

Federal Fisheries Permit:

Vessel Contact Phone:

Vessel Contact E-mail:

Address of Vessel Location for Inspection:

Vessel Contact Name:

Phone on Vessel:

VIDEO SYSTEM SELECTION
Select Video Monitoring Systems To Be Inspected: (more than one may be selected)

□Video Bin Monitoring Option □Chinook Salmon Bycatch □BSAI Longline C/Ps □Flow Scale □Deck Sorting
Name of Video Installer to install & maintain system:
Will video installer be on site at inspection?

□ Yes

□ No

Name of Video Installer to install & maintain system:

Requested Inspection Date:

Requested Inspection Time:

VIDEO MONITORING DIAGRAM ATTACHMENT
You must attach a diagram that is clearly labeled and drawn to scale showing:
 Location of each camera & its coverage area
 Location of any additional video equipment, including monitors & hard drives
 All locations where sorting occurs
 Location of motion-compensated flow scale
Chinook Salmon Bycatch Monitoring:
 Location of salmon storage container

Inspection Request Form
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Revised: 10/7/2020

OMB Control No. 0648-0330, Expiration Date: 03/31/2024

OBSERVER SAMPLING STATION
Observer Sampling Station and At-Sea Scale Inspections should be scheduled at least one hour apart.
Would you like your observer sampling station
inspection on a different date and time than the video
inspection?
□ Yes
□ No

If YES, what date and time?

Diagram for trawl C/Ps & motherships, clearly labeled and drawn to scale showing the location(s) where all
catch will be weighed, the location where observers will sample unsorted catch, and the location of the
observer sampling station, including the observer sampling scale and table.
Diagram for all other vessels, to scale showing the location(s) where catch comes on board the vessel, the
location where observers will sample unsorted catch, the location of the observer sampling station,
including the observer sampling scale and table.
AT-SEA SCALES
Observer Sampling Station and At-Sea Scale Inspections should be scheduled at least one hour apart.
Would you like your at-sea scale inspection on a different
date and time than the video inspection?
□ Yes □ No
Will repair company be on site at inspection?
□ Yes □ No

If YES, what date and time?

Repair Company Name:

Prior to the at-sea scale inspection make sure:
 The scale is installed in a rigid and level manner
 The display & printer are connected and operational
 Belts leading to the scale are connected and operational (not applicable to platform and hanging scales)
 Test weights & test weight certification documents are available for inspection (platform scales only)
 A crew member will be available to help the inspector transport test materials and conduct the testing

At-sea Scales, BSAI Longline C/Ps Video, and Flow
Scale:

Bin Monitoring, Chinook Salmon Bycatch
Monitoring, and Observer Sample Station:

NOAA/NMFS, Alaska Region
PO Box 21668
Juneau, AK 99802-1668
Ph: 907-586-7228
Fax: 907-586-7465

FMA Observer Program
7600 Sand Point Way NE, Bldg 4
Seattle, WA 98115
Ph: 206-526-4007
Fax: 206-526-4066
Email: [email protected]

Fax, mail, or email completed forms and diagrams to:

Email: [email protected]

Fax, mail, or e-mail completed forms and diagrams to:

Inspection Request Form
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Revised: 10/7/2020

OMB Control No. 0648-0330, Expiration Date: 03/31/2024

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 0648-0330. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be
approximately 10 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 maintain or retain benefits pursuant to 50 CFR part
679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.) as amended in 2006.
Send comments regarding this burden estimate or any other aspect of this information collection, including
suggestions for reducing this burden to Assistant Regional Administrator, Sustainable Fisheries Division,
NOAA National Marine Fisheries Service, P.O. Box 21688. Juneau, AK 99802-1668).

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.
Purpose: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service collects permit
holder information forms for the At-Sea Scales Program, which was developed in response to the need for
catch accounting methods that were more precise and verifiable at the level of the individual haul and less
dependent on estimates generated by at-sea observers. This was necessary due to the implementation of
large-scale catch share programs that required NMFS to provide verifiable and defensible estimates of quota
harvest. NMFS also established a set of performance based standards to allow shoreside processors to
describe how they will ensure that all delivered catch can be effectively monitored by NMFS-authorized
personnel, and that all catch is accurately sorted and weighed by species.
Routine Uses: The Department will use this information to identify fishery participants and evaluate the
qualifications of the applicants. 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 required to obtain or retain the benefit of participation in either an atsea scales program or shore-based catch monitoring program; failure to provide complete and accurate
information will prevent the determination of eligibility for registration in either of these programs.

Inspection Request Form
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