DSBG OI App WORKING

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UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service (NMFS)
West Coast Region, Long Beach Fisheries Permits Office
501 W Ocean Blvd., Suite 4200
Long Beach, CA 90802
[email protected] (562)980-4238

OMB Control No. 0648-0204
Expires XX/XX/20XX

Federal Limited Entry Deep-Set Buoy Gear Permit
Identification of Ownership Interest Application Form
Please apply online directly at http://fisheriespermits.noaa.gov.
Fill this section out with your Initial Qualification Application, Annual Renewal Application, or Transfer Application as needed.

SECTION A- PERMIT APPLICANT IDENTIFICATION
Name of Point of Contact for Business

USCG Documentation or State Registration Number

Vessel Name (if unidentified, leave blank)

Business Entity Name

Tax Identification Number (TIN)

Business Mailing Address (Street or PO Box)

Business Phone (required)

(

)

Business Fax (optional)

(

City

Zip Code

State

)

Business Email (required)

SECTION B- IDENTIFICATION OF SHAREHOLDERS AND PARTNERS
NAME
(Last, First, Middle Initial)

DATE OF BIRTH
(mm/dd/yyyy)

BUSINESS MAILING ADDRESS
(Street or PO Box, City, State, Zip Code)

When renewing, you will have the opportunity to review Ownership Interest information on the National Permits System website
(http://fisheriespermits.noaa.gov). Please include any changes in shareholders that have occurred in the corporation, business,
or entity since the previous application was submitted, including any additions or divestments. Ownership interest is not
transferable, except for certain exceptions detailed in the Instructions Section of this form.*
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SECTION C- CERTIFICATION OF APPLICANT
Under penalties of perjury, I hereby declare that I, the undersigned, completed this application, and the information contained herein is true, correct, and complete
to the best of my knowledge and belief.
Date

Signature of Authorized Representative

Printed Name of Authorized Representative

INSTRUCTIONS
IMPORTANT- This application must be submitted by legally recognized corporations, partnerships and other business entities who own
or hold a Federal Limited Entry Deep-Set Buoy Gear Permit. This form must be submitted by the permit applicant with the annual permit
renewal (due by March 30) and with any transfer request, when the resulting Federal Limited Entry Deep-Set Buoy Gear Permit will list a
business entity as either the permit applicant or vessel owner. A Federal Limited Entry Deep-Set Buoy Gear Permit that lists a business
entity will not be renewed until such time that NMFS receives an ownership interest form from the permit applicant that identifies all
shareholders.
Note- A person is defined as any individual, corporation, partnership, association, any Federal, state, or local gov, or any entity that is
eligible to own a documented vessel. A “partnership” is defined as two or more individuals, partnerships, or corporations, or combinations
thereof, who have ownership interest in a permit, including married couples and legally recognized partnerships, such as limited
partnerships (LP), general partnerships (GP), and limited liability partnerships (LLP).
*Transfer Exceptions- Federal Limited Entry Deep-Set Buoy Gear Permits are not transferable, except for a one-time transfer to a family
member upon the death or legal incapacitation of the permit holder. A family member would be defined as spouse, domestic partner,
cohabitant, child, stepchild, grandchild, parent, stepparent, mother-in-law, father-in-law, son-in-law, daughter-in-law, grandparent, great
grandparent, brother, sister, half-brother, half-sister, step-sibling, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, or first cousin.
One-time transfers would also apply to the member of a partnership, corporation, or other entity. For example, if John Doe is a member
of a partnership with John Smith, and John Doe died, John Doe’s ownership interest could pass to a family member while John Smith’s
ownership interest remains unchanged. Changes to ownership, including the addition of individuals or entities as owners of the permit,
would otherwise not be allowed. NMFS would not consider it an ownership change if shares among the existing owners changes, or if a
member of a partnership, corporation, or other entity leaves and is not replaced.
The purpose of this form is to provide NMFS with information to ensure the number of Federal Limited Entry Deep-Set Buoy Gear Permits
owned or held by an individual does not exceed the designated limit (one permit or one portion of ownership interest per person), and to
determine if any change in ownership has occurred to corporations and partnerships since the control date.

SECTION A- PERMIT APPLICANT/VESSEL OWNER IDENTIFICATION:
Name of Point of Contact for Business/Vessel Name/Vessel Registration Number: List the name of the point of contact for the business,
the name of the vessel registered to the permit, and the U.S. Coast Guard documentation or state vessel registration number.
Name/TIN: Enter the name of the business entity that owns or holds the permit and its tax identification number (TIN).
Business Mailing Address: Enter the business mailing address, including street or PO Box number, state, and zip code, where the item(s)
should be sent.
Business Phone, Fax and Email: List the business email, telephone and fax numbers including the area codes; email is required.
SECTION B- IDENTIFICATIONS OF SHAREHOLDERS AND PARTNERS: List each individual shareholder or partner name (Last, First,
Middle Initial) and their business address. The date of birth is required for each individual. If the shareholder/partner is a corporation/
partnership, list the individual names of all shareholders/partners of that entity. NMFS may request further documentation as proof of
ownership.
SECTION C- CERTIFICATION OF APPLICANT: The authorized agent must sign and date the application. By signing and dating the
application, the authorized agent certifies that all information set forth in the application is true, correct, and complete to the best of the
applicant's knowledge and belief. The application will not be considered without the authorized agent’s signature.

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WARNING STATEMENT- A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under
15 CFR 904, a civil penalty of up to $100,000 under 16 USC 1858, and as a federal crime under 18 USC 1001.
PAPERWORK REDUCTION ACT - 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 0648-0204. 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.
Some of the information collection described above is confidential under section 402(b) of the Magnuson-Stevens Act. It is also
confidential under NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. Phone number, fax and email
information and TIN are not released to the public. All responses to this information collection are mandatory/required to obtain benefits
pursuant to 50 CFR 660. Send comments regarding this burden estimate or any other aspect of this information collection, including
suggestions for reducing this burden to the National Marine Fisheries Service at: 501 W. Ocean Blvd., Suite 4200, Long Beach, CA 90802,
Attn: Permits Office, [email protected]

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 High Seas Fishing Compliance Act, the Tuna Conventions Act of 1950, the Antarctic Marine Living Resources
Convention Act, the Western and Central Pacific Fisheries Convention Implementation Act
(WCPFCIA; 16 U.S.C. 6901 et seq), the Marine Mammal Protection Act, the Endangered Species Act and the Fur Seal Act. The authority for
the mandatory collection of the Tax Identification Number (TIN) is 31 U.S.C. 7701. Your date of birth and TIN are confidential and
protected under the Privacy Act. Provision of your date of birth and TIN is mandatory as part of this collection. The primary purpose for
requiring the date of birth is to verify the identity of individuals/entities doing business with the government to provide a unique
identification for assistance to comply with the Debt Collection Improvement Act of 1996. (Public Law 104-134) and for enforcement
activities.
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 holders includes vessel owner
contact information, date of birth, TIN and vessel descriptive information. Permit applicant information may be used as sampling frames
for surveys, as part of Fishery Management Council (FMC) analysis to support FMC decisions.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants. 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 voluntary; however, failure to provide complete and accurate information will prevent the
determination of eligibility for a permit.

This 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 XXXX (X FR XXXX) and
became effective on XXXX (X FR XXXX).

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