Mothership Permit Renewal Form

OMB Control No. 0648-0620; Expires 01/31/2026

MOTHERSHIP PERMIT
RENEWAL FORM

PACIFIC COAST GROUNDFISH
TRAWL RATIONALIZATION PROGRAM

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service, West Coast Region
Fisheries Permits Office
7600 Sand Point Way NE, Bldg. 1
Seattle, WA 98115-0070
Phone (206) 526-4353 Fax (206) 526-4461
www.westcoast.fisheries.noaa.gov

This form must be completed and submitted to the National Marine Fisheries Service (NMFS) at the address
given above to apply for the renewal of a mothership (MS) permit. To complete the renewal process, any
Economic Data Collection surveys due from the MS permit owner must be deemed complete by the
NOAA/Northwest Fisheries Science Center and the MS permit owner must submit a complete trawl identification
of ownership interest form. An MS permit renewal is effective upon approval by NMFS.
Please make any changes as appropriate to the business addresses, phone numbers, fax numbers and email
addresses listed below. Please respond to the mothership declaration question below. Sign, date, and return the
form with payment. Any changes in the vessel registered to the permit, or a change of permit or vessel owner will
require submission of a mothership permit change of vessel registration, permit owner, or vessel owner
application form.
Mothership Permit Owner
1. Permit Owner Name

2. Permit Number

MS
3. Business Mailing Address

4. Business Phone

(

Street or PO Box

)

5. Business Fax (optional)

(
City

State

Zip Code

)

6. Business Email (optional)

Mothership Vessel Owner
1. Vessel Owner Name

2. Vessel Name

3. Vessel Registration Number

3. Business Mailing Address

4. Business Phone

(

Street or PO Box

)

5. Business Fax (optional)

(
City

State

Zip Code

)

6. Business Email (optional)

Mothership Permit Renewal Form - Page 1 of 2

Mothership Declaration
As provided for at 660.150(f)(2)(i): If a vessel registered to the MS permit will operate as a mothership in the year
for which the permit is renewed, the permit owner must make a declaration as part of the permit renewal that while
participating in the whiting fishery it will operate solely as a mothership during the calendar year to which its limited
entry permit applies. Any such declaration is binding on the vessel for the calendar year, even if the permit is
transferred during the year, unless it is rescinded in response to a written request from the permit owner. Any
request to rescind a declaration must be made by the permit holder and granted in writing by the Regional
Administrator before any unprocessed whiting has been taken on board the vessel that calendar year.
Will the vessel registered to this mothership permit operate solely as a mothership in the Pacific
Coast groundfish fishery for calendar year 2017?

 YES

 NO

Please sign below to certify that the above information is true, correct and complete (edit if necessary) to the best
of your knowledge and return with: (1) a check or money order in the amount of $135.00 made payable to
U.S. Department of Commerce/NOAA and (2) a complete, notarized trawl identification of ownership
interest form.

__________________________________________________________________________________________
Date
Signature of Authorized Representative
Title (If corporate officer)
____________________________________
Printed Name of Authorized Representative

WARNING STATEMENT: A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under 15
CFR Part 904, a civil penalty up to $100,000 under 16 USC 1858, and/or criminal penalties including, but not limited to, fines or imprisonment
or both under 18 USC 1001.
PRIVACY ACT STATEMENT: Some of the information collection described above is confidential under section 402(b) of the MagnusonStevens Act and under NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. Business phone number, fax
number, and email are not released to the public. The information collected is part of a Privacy Act System of Records, COMMERCE/NOAA
#19, Permits and Registrations for United States Federally Regulated Fisheries. An amended notice was published in the Federal Register on
August 7, 2015 (80 FR 47457) and became effective on September 15, 2015 (80 FR 55327).
PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 0.33 hours 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 suggestions for reducing this burden to
NOAA/National Marine Fisheries Service, West Coast Region, Attn: Assistant Regional Administrator, 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 a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction
Act, unless that collection of information displays a currently valid OMB Control Number.

Mothership Permit Renewal Form - Page 2 of 2