Vessel Account Renewal Form

OMB Control No. 0648-0620; Expires 1/31/2025

VESSEL ACCOUNT
RENEWAL FORM
PACIFIC COAST GROUNDFISH
INDIVIDUAL FISHING QUOTA

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 vessel account. If the vessel owner has changed, the new vessel owner must
request a new vessel account. To complete the renewal process, any Economic Data Collection surveys due from the
vessel owner must be deemed complete by the NOAA/Northwest Fisheries Science Center and the vessel owner must
submit a complete trawl identification of ownership interest form. A vessel account renewal is effective upon approval
by NMFS.
1. Vessel Name

2. USCG or State Registered Vessel Number

3. Legal Name of Vessel Owner

4. Business Mailing Address

5. Business Phone

(

Street or PO Box

)

6. Business Fax (optional)

(
City

□

State

Zip Code

)

7. Business Email

By checking this box, I certify that the vessel owner listed above is the current vessel owner, as documented
by the US Coast Guard or state agency with which the vessel is registered.

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 a complete vessel ownership interest form.
______________________________________________________________________________________________
Signature of Authorized Representative
Title (If corporate officer)
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 Magnuson-Stevens 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 0.25 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.