Mothership Cooperative Permit Application Form

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

MOTHERSHIP
COOPERATIVE PERMIT
APPLICATION 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

INSTRUCTIONS
This form must be completed and submitted to the National Marine Fisheries Service (NMFS) at the address
given above to apply for a mothership (MS) cooperative permit. To be an eligible MS cooperative (coop) entity, a
group of mothership catcher vessel (MS/CV) endorsed limited entry permit owners (coop members) must be a
recognized entity under the laws of the United States or the laws of a State and represent all of the coop
members. The coop must include at least 20 percent of all MS/CV-endorsed permits as members. This
application must be postmarked no later than March 17 of the year in which the coop intends to fish. An MS
cooperative permit is effective upon approval by NMFS.
Section A – Cooperative Contact Information
Please provide the cooperative entity name, tax identification number (TIN), and state that the entity is registered
in, as well as the business mailing address, phone number, fax number, and email address. Also provide the
name of the cooperative manager and their date of birth (DOB).
Section B – Mothership Catcher Vessel Permits Obligated to Cooperative and Processor Obligation
The applicant must provide the permit number for each coop member’s MS/CV-endorsed limited entry permit, the
MS/CV endorsement and catch history assignment (CHA) ID number, and the associated CHA amount
(expressed as a percentage) as given on the permit. Also indicate the MS permit that each MS/CV-endorsed
limited entry permit is obligated to. Please note that if one MS/CV-endorsed limited entry permit has multiple
MS/CV-CHAs, you will need to list and obligate each separately. Please indicate the total whiting catch history
allocation that will accrue to the coop based on the sum of the individual MS/CV permits obligated to the coop. If
Section B does not provide sufficient space to list all permits, copy this section, add the additional information and
append to the application.
Section C – Catcher Vessel Information
Please provide the vessel name and USCG vessel documentation number for each catcher vessel fishing for the
coop. If Section C does not provide sufficient space to list all catcher vessels, copy this section, add the additional
information and append to the application.
Section D – Certification of Applicant
The applicant or authorized representative must sign and date the form. By signing and dating the form, the
applicant or authorized representative certifies that all information set forth in the form is true, correct and
complete to the best of the applicant’s knowledge or belief. The form will not be considered without the authorized
representative’s signature. NMFS may request that the authorized representative for a business entity include a
copy of the corporate resolution or other document authorizing the individual to sign and certify on behalf of the
business entity.

Supplemental Documentation
The applicant must provide a copy of the cooperative agreement and any inter-coop agreement entered
into at the time of the application submission, consistent with the regulations given at 50 CFR 660.150.

Mothership Cooperative Permit Application Form – Page 1 of 5

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

MOTHERSHIP
COOPERATIVE PERMIT
APPLICATION 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

Section A – Cooperative Contact Information
1. Name of Cooperative Entity

2. Cooperative TIN

3. State Cooperative Entity Registered In

4. Business Mailing Address

5. Business Phone Number

(

Street or PO Box

)

6. Business Fax Number (optional)

(
City

State

8. Name of Cooperative Manager

Zip Code

)

7. Business Email (optional)

9. Cooperative Manager DOB

Mothership Cooperative Permit Application Form – Page 2 of 5

Section B – MS/CV Permits Obligated to Cooperative and Processor Obligation
MS/CV-Endorsed
Permit Number

MS/CV Endorsement
and CHA ID Number

Catch History
Assignment

Obligated to
MS Permit Number

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS

GF

% MS
Total This Page

%

Total From Other Pages

%

Total Coop Whiting Allocation (sum of all MS/CVendorsed permit whiting catch history assignments)

Mothership Cooperative Permit Application Form – Page 3 of 5

%

Section C – Catcher Vessel Information

Vessel Name

USCG Vessel Documentation Number

Mothership Cooperative Permit Application Form – Page 4 of 5

Section D – Certification of Applicant

Under penalties of perjury, I hereby declare that I, the undersigned, am authorized to certify this application on behalf of the applicant and
completed this form, and the information contained herein is true, correct, and complete to the best of my knowledge and belief.
Signature of Authorized Representative

Date

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. TIN, DOB, business phone
number, fax number, email and contents of the cooperative agreement 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 4.00 hours per response (with
coop agreement), 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 Cooperative Permit Application Form – Page 5 of 5