PIPA Crustacean

OMB Control No: 0648-0490
Expires: 03/31/2024

U.S. DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
NATIONAL MARINE FISHERIES SERVICE

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

PACIFIC ISLANDS PERMIT APPLICATION

CRUSTACEAN

Please print legibly. Items marked with an asterisk (*) are required. Note required documents and instructions on page 2. Do not mail application and
check. Send application via secure email and pay the non-refundable application processing fee online per instructions on page 2.
*PERMIT TYPE:

___ Lobster (Fee to be determined)
___ Deepwater Shrimp ($71 non-refundable application processing fee)

*PERMIT AREA:

___ 2. Main Hawaiian Islands

(Limited Entry permit required for Lobster in Permit Area 1 is no longer being issued.)

___ 3. American Samoa
___ 4. Pacific Remote Island Areas
___ 5. Guam and Northern Mariana Islands

*VESSEL NAME: ____________________________________________________
*VESSEL LENGTH: _______________ (feet)

*VESSEL OFFICIAL NO: ______________________

USCG or state registration number

RADIO CALL SIGN: ______________________

*VESSEL OWNER: ________________________________________________________________________
First, Middle, & Last Name or Business Name

___________________________
*Taxpayer ID Number (EIN or SSN)

*DATE OF BIRTH (Individual) OR INCORPORATION (Business): _______________________________ (MM/DD/YYYY)
*BUSINESS CONTACT: ____________________________________________________________ *TITLE: ______________________________
First, Middle, & Last Name, if not same as vessel owner

Corporate officer, business owner, partner

*BUSINESS MAILING ADDRESS: ________________________________________________ __________________ _____ ______________
Street/PO Box

City

State

ZIP Code

*BUSINESS PHONE __________________________ CELL PHONE __________________________ (include area codes)
*EMAIL: __________________________________________________________
Under penalty of perjury, I hereby declare that I, the undersigned, am the vessel owner or authorized to complete and 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.

*APPLICANT: ___________________________________ __________________________________________ *DATE: ____________________
Printed Name of Person Submitting Application

Signature of Applicant

*APPLICANT TITLE: ___ Vessel owner, ___ Corporate officer or partner, ___ Designated agent**, or ___ Other ____________________________
(Check only one)

*Application is for a new permit? ___ or a renewal? ___ Previous permit number if renewal: _______________________________

An application that is lacking required information, vessel registration or documentation, or payment will be considered incomplete. An incomplete
application will be abandoned if it is not completed within 30 days following notification of the deficiency (50 CFR 665.13(c)(2)). You must inform
PIRO within 15 days of any change of information on the application form (50 CFR 665.13(d)). It is prohibited to file false information on any
application for a fishing permit (50 CFR 665.15(b)).
Revised 10/18/2021

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INSTRUCTIONS
Please print all information legibly. Illegible writing may cause delays or errors in permit processing. All items marked with an asterisk (*) on the form
must be completed.
Permit Type: Check which permit you are applying for. You may apply for both permits with one application form, but remember to provide the fee
payment for the deepwater shrimp permit. Separate permits will be issued for lobster and shrimp.
Permit Area: Check the area where you will be fishing. You may check more than one if you will be fishing other areas.
Vessel Name: Write the vessel name that is marked on the vessel and/or listed on the US Coast Guard (USCG) certificate of documentation or
state/territory vessel registration form. If the vessel is undocumented and has no name, please write N/A or None.
Vessel Official No.: Write the vessel’s USCG documented number or state/territory undocumented vessel registration number.
Vessel Length: Write the length overall as documented by the USCG or state/territory registration.
Radio Call Sign: Write the call sign registered with the FCC if available.
Vessel Owner: Write the official vessel owner as documented by the USCG or state/territory registration. The vessel owner is the permit holder.
Taxpayer ID Number: For individuals, this is your Social Security Number (SSN); for businesses, this is the Employer Identification Number (EIN).
Date of Birth or Incorporation: Write the date of birth for individuals, or date of incorporation for businesses.
Contact Person, Business Address, Business Phone and other contact information: Write the contact person name, contact person title,
vessel owner’s mailing address, and vessel owner’s telephone number. These will be the address and phone number of record. Provide the cell
phone number and email.
Applicant and Date: The vessel owner (if individual), officer or member of the business or corporation, or designated agent must print their name
and write their signature. Write the full date (MM/DD/YYYY) when the application is signed.
Applicant Title: Check the role of the applicant. If the applicant is a designated agent, then a written, signed, and dated letter of authorization from
the vessel owner naming the applicant as a designated agent is required.
Required Documents. You must submit the following with the application form.
1) A copy of the vessel's current U.S. Coast Guard Certificate of Documentation (documented vessel) or registration certificate from a state/territorial
agency (undocumented vessel) showing the current vessel owner.
2) **If the Applicant is not the vessel owner, you must provide a signed letter or an email from the vessel owner authorizing the applicant to act as an
agent for the vessel owner.
Send the application via secure email and pay the fee online following the instructions at https://www.fisheries.noaa.gov/pacific-islands/commercialfishing/apply-pacific-islands-fishing-permit.
An application that is lacking required information, vessel registration or documentation, or payment will be considered incomplete. An incomplete
application will be abandoned if it is not completed within 30 days following notification of the deficiency (50 CFR 665.13(c)(2)). You must inform
PIRO within 15 days of any change of information on the application form (50 CFR 665.13(d)). It is prohibited to file false information on any
application for a fishing permit (50 CFR 665.15(b)).

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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 (16 U.S.C. 1362 et seq.), and the Endangered Species Act (16 U.S.C. 1531 et seq.). 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 permit holders includes vessel owner contact
information, date of birth, Tax Identification Number, 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 within NMFS offices under the Privacy Act of 1974 (5 U.S.C. 552a) to coordinate monitoring and management 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/NOAA19, 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 INFORMATION
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 0648-0490. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 30 minutes per permit
application and 2 hours per permit denial appeal, 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 voluntary.
Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to
the NMFS Pacific Islands Regional Office at [email protected].