RFMC Nomination Application Kit

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Regional Fishery Management Councils Nomination Application Kit | Updated Aug. 2026

Part 1
Acknowledgement Statement, Resume, and Philosophy Statement
The Nomination Application Kit contains Parts 1-4. Please review each form prior to completing. You are ineligible for
appointment consideration if all qualification and nomination requirements of Section 302 of the Magnuson-Stevens
Act and other related requirements at 50 CFR 600.215 are not met.
Contact your Governor's office or State Agency if you have questions regarding the completion of the Nomination
Application Kit.
1. First name:

M.I.:

3. Sex:

Last name:

2. Council applying for:

4. Email address:

5. Is this a reappointment?
Yes

6. Have you been appointed to a seat on a
fishery council in the past?
Yes

If you checked Yes, which
council were you with

No

What years were your
previous term(s)?

No

7. Home phone:

Work phone:

Mobile phone:

8. Home address (number & street): Do not use a PO Box, if at all possible

City or town:

State:

Zip code:

State:

Zip code:

9. Current Employer:
Employer Address (number & street)

City or town:

For your nomination kit to be complete, you must provide:
1. An acknowledgement statement indicating why you want to be a Council member (Block 10)
2. A guiding philosophy statement on the conservation and management of living marine resources (Block 11)
3. A complete history detailing fisheries background and experience including information about your personal fisheriesrelated education, as well as information concerning awards and/or committee, board, or commission memberships,
authorship of publications, etc., or other related qualifications and interests (Block 12-14)
NOTE: You may either provide the above information on this form in Blocks 12-14, or you can attach an up to
date resume or document with your Nomination Kit. If you choose to attach a resume or document, please put
“See Attached” in Block 12-14 of this form.
PART 1 CONTINUED ON NEXT PAGE

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Regional Fishery Management Councils Nomination Application Kit | Updated Jan. 2025
10. Acknowledgment statement:

11. Guiding philosophy statement:

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Regional Fishery Management Councils Nomination Application Kit | Updated Jan. 2025
12. Work experience & education:

13. Committee, board, commission memberships:

14. Awards, publications, and any other related qualifications:

PART 1 COMPLETE. PROCEED TO PART 2
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Regional Fishery Management Councils Nomination Application Kit | Updated Jan. 2025

Part 2
Personal Fisheries Experience Form
The following information on your background and experience is requested to evaluate your qualifications for Council
membership. Members are categorized as coming from the commercial fishing sector, recreational fishing sector, or
“other” sector. The “other” sector consists of members with knowledge of and experience in biological, economic, or
social sciences; environmental or ecological matters; consumer affairs; and associated fields.
If you have experience in more than one sector please complete all relevant sections.
15. Which of the three primary fishing sectors does your experience most reflect?
Commercial

Recreational

Other

COMMERCIAL SECTOR
16. Do you have any current or past experience in any area related to a
commercial fishing sector?
Current experience

Previous experience

If so, for how many years?

None

If "Current" or "Previous", list and describe your experience, occupation or business to include, but not limited to, harvester,
processor, buyer/broker, retailer, supplier, or other and complete blocks 16-19. If "None", proceed to Block 20 of Part 2.

17. What species have you fished for commercially?

18. What fishing gear do you use commercially?

19. List any commercial fishing organizations/clubs you belong to:

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Regional Fishery Management Councils Nomination Application Kit | Updated Jan. 2025

RECREATIONAL SECTOR
20. Do you have any current or past experience in any area
related to the recreational fishing sector?
Current experience

Previous experience

If yes, for how many years?

None

If "Current" or "Previous", list and describe your experience, occupation, or business to include, but not limited
to, angler, supplier, outfitter, or other and complete blocks 20-23. If "None", skip to block 24 of Part 2.

21. What species do you target recreationally?

22. What type of fishing gear do you use
recreationally?

23. List any recreational anglers organizations/clubs you belong to:

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Regional Fishery Management Councils Nomination Application Kit | Updated Jan. 2025

CHARTER FISHING SECTOR
24. Do you have any current or past experience in any area
related to a charter fishing sector?
Current experience

Previous experience

If yes, for how many years?

None

If "Current" or "Previous", list and describe your experience, occupation, or business to include, but not limited to,
charter industry, charter captain or crew, or other and complete blocks 24-29. If "None", skip to block 30 of Part 2.

25. What type of charter fishing do you provide, captain, or crew?
Types and kinds to include: private fishing charter, walk-on fishing charters, inshore/offshore charters, or deep-sea
fishing charters.

26. What kind of charter fishing boat do you own, captain, or crew?
Kinds to include, but not limited to, six passenger, multi-passenger, party boat (vessel).

27. What species do you target when charter fishing?

28. What fishing gear do you use when charter fishing?

29. List any charter fishing organizations/clubs you belong to:

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OTHER SECTOR
30. Do you have any current or past experience related to biological, economic, or social
sciences; environmental or ecological matters; consumer affairs; and associated fields?
If Yes, please explain and complete blocks 30 - 33. If No, skip to block 34 of Part 2.

Yes

31. Describe your background and main areas of focus pertaining to fisheries.

32. Please list any of your publications/reports, related to this position:

33. List any related organizations/clubs you belong to:

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No

Regional Fishery Management Councils Nomination Application Kit | Updated Jan. 2025
PUBLIC PARTICIPATION
34. Have you attended previous federal/state fisheries meetings and/or public hearings?

Yes

No

If "Yes", list the meetings you have attended.

PART 2 COMPLETE
To complete your application, you must also fill out and sign the following documents:
Part 3: STATEMENT OF FINANCIAL INTERESTS FORM (NOAA Form 88-195) AND NATIONAL MARINE FISHERIES
SERVICE (NMFS) INTERGOVERNMENTAL PERSONNEL AGREEMENT (IPA):
Part 4: CERTIFICATION OF STATUS FORM:
For further guidance, please visit the Council Nomination Process & Guidance website.

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NOAA Form 88‐195

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Statement of Financial Interests
For Regional Fishery Management Council Voting Members, Nominees and
Members of a Scientific and Statistical Committee
Who needs to file
a financial
disclosure?

You, because you were nominated by the Governor of a state or appointed by the
Secretary of Commerce to serve as a voting member of a Regional Fishery
Management Council (Council); or you are a nominee to or a member of a Scientific
and Statistical Committee (SSC).

What is the
purpose of a
financial
disclosure?

The duties and responsibilities of your position require you to file the Statement of
Financial Interests to fulfill the requirements of the Magnuson‐Stevens Act. The
purpose of this report is to assist you and NMFS in avoiding conflicts between official
duties and private financial interests or affiliations. You may not vote on any Council
decision that would have a significant and predictable effect on a financial interest
disclosed in your report. Under penalty of law, please ensure that the information you
provide is complete and accurate.

What must I
disclose on this
form?

When do I need to
file my financial
disclosure?

The Magnuson‐Stevens Act requires the disclosure of any financial interest in
harvesting, processing, lobbying, advocacy, or marketing activity that is being, or will
be, undertaken within any fishery over which a Council has jurisdiction. This also
includes employment with an entity that provides consulting, legal, or
representational services relating to harvesting, processing, lobbying, advocacy, or
marketing activities. You must disclose such financial interest held by yourself; your
spouse, minor child, business partner; or any organization (other than the Council) in
which you are serving as an officer, director, trustee, business partner, or employee.
This does not include financial interests in entities engaging in scientific fisheries
research.
Nominees: This form must be filed by each nominee for Secretarial appointment with
the Assistant Administrator by April 15 or, if nominated after March 15, 1 month after
nomination by the Governor.
Members: A seated voting member appointed by the Secretary must file this form
with the Executive Director of the appropriate Council within 45 days of taking office;
and must file an update with the Executive Director of the appropriate Council within
30 days of the time any such financial interest is acquired or substantially changed.
All Council members must file this form annually by February 1st regardless of whether
any information on the form has changed.

Questions?

SSC Nominees and Members: Nominees to an SSC must file this form with the
Regional Administrator for the geographic area concerned within 45 prior to
appointment; and must file an update with the Regional Administrator for the
geographic area concerned within 30 days of the time any such financial interest is
acquired or substantially changed. All SSC members must file this form annually by
February 1st regardless of whether any information on the form has changed.
If you have any questions about how to complete this form, please contact your
Council Executive Director, NMFS Regional Office or the NOAA General Counsel for
your Council.

PENALTIES
Knowing and willful falsification of information required to be reported may subject you to criminal prosecution or subject
you to civil penalties. It is unlawful for an affected individual to knowingly and willfully fail to disclose, or to falsely
disclose, any financial interest as required by the Magnuson Stevens Act, or to knowingly vote on a Council decision in
violation of this Act. In addition to the criminal penalties applicable, a violation of this provision may result in removal
from Council or SSC membership.

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NOAA Form 88‐195

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STATEMENT OF FINANCIAL INTERESTS
Nominee or Member’s Name (Print last, first, middle initial) _____________________________________
Name of Council or Council Committee ____________________________________
Type of Appointment (list Nominee or Member) _________________________________
Type of Filing:

Annual

Supplemental

Nominee

Instructions
1. Carefully read the questions for Parts 1-3 on the following pages.
2. In Part 1, you must answer “yes” or “no” for each question provided. If you select “Yes,” check the box
by any applicable financial interest from the list below the question and provide the appropriate detail
explaining your selection. If you need more room to provide detail, please attach those pages to this
form.
3. In Part 2, you must answer “yes” or “no” for each question provided. If you select “Yes,” check the box
by any applicable financial interest from the list below the question and provide the appropriate detail
explaining your selection. If you need more space to provide detail, please attach those pages to this
form.
4. In Part 2, if you select “I have no spouse, business partner, or minor children,” you may skip the rest of
Part 2 and move to Part 3. Answer Part 3, if necessary.
5. After you have completed the form, sign and date the form on the last page.
6. Submit the completed form to NMFS for Council nominees; to your Council Executive Director for
seated Council members; or to the Regional Administrator for the geographic area concerned for SSC
members or nominees.

Paperwork Reduction Act
Notwithstanding any other provision of law, no person is required to respond to nor shall a person be subject 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. The public reporting burden for this information, on this NOAA Form 88-195, is estimated to
average 35 minutes per response, including time for reviewing 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 aspect of
this collection of information, including suggestions for reducing this burden to the National Marine Fisheries Service, Office of the Chief
rd
Information Officer (F/CIO), 1315 East-West Highway, SSMC #3, 3 Floor, Silver Spring, Maryland 20910.
Public Access to Information
This form, as completed by seated members of the Regional Fishery Management Councils, will be retained by the Council, made available
on the Council’s websites, and made available for public review at reasonable hours at the Council’s Office and at each public hearing or
public meeting.

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Part 1: Personal Financial Interest
Section 1.1: Assets and Ownership
Question 1.1.1
Do you have any stock, equity or ownership interest (whole or partial ownership) in a company or business engaged in
any of the following activities in any fishery under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the company or business. Please include
company or business name, date the interest began, and fishery or fisheries of interest.

Question 1.1.2

Do you have any stock, equity or ownership interest (whole or partial ownership) in any fishing vessel engaged
in any of the following activities in any fishery under the jurisdiction of the Council concerned?

 No
 Yes

Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the vessel. Please include vessel name,
company or business name, date the interest began, gear type and fishery or fisheries of interest.

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NOAA Form 88‐195

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Question 1.1.3

Do you have any stock, equity or ownership interest (whole or partial ownership) in any other entity engaged in any of
the following activities in any fishery under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.

Question 1.1.4

Do you have any stock, equity or ownership interest (whole or partial) in a company, business, or other entity that
provides any of the following services for any fishery under the jurisdiction of the Council concerned?

 No
 Yes

Check all that apply:
 Lobbying
 Advocacy

 Consulting
 Legal
 Representational Services

Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.

Question 1.1.5

Do you have any stock, equity or ownership interest in any entity that either owns (wholly or partially) or is owned by
(wholly or partially) another entity that is engaged in or that provides any of the following activities or services for any
fishery under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Consulting
 Legal
 Representational Services
 Lobbying
 Advocacy







Harvesting
Processing
Marketing
Provides equipment essential to any of the listed activities
Provides other services essential to any of the listed activities

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NOAA Form 88‐195

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Expiration Date 3/31/17
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include company or business
name, date the interest began, and fishery or fisheries of interest.

Section 1.2: Employment
Question 1.2.1

Do you have employment with any company or business engaged in any of the following activities in any fishery
under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting  Provides equipment essential to any of the listed activities
 Processing  Provides other services essential to any of the listed activities
 Marketing
 Provides equipment essential to any of the above activities
Please list and describe each applicable interest, as indicated above. Please include beginning date of
 Provides other services essential to any of the above activities
employment, company or business name, and fishery or fisheries of interest.

Question 1.2.2

Do you have employment with a fishing vessel engaged in any of the following activities in any fishery under the
jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include beginning date
of employment, vessel name, gear type, and fishery or fisheries of interest.

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NOAA Form 88‐195

OMB NO 0648 0192
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Question 1.2.3

Do you have employment with any other entity engaged in any of the following activities in any fishery under the
jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include beginning date
of employment, entity name, and fishery or fisheries of interest.

Question 1.2.4

Do you have employment with any company, business, or other entity that provides any of the following services for any
fishery under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Consulting
 Lobbying
 Legal
 Advocacy
 Representational Services
Please list and describe each applicable interest, as indicated above. Please include beginning date
of employment, entity name, and fishery or fisheries of interest.

Question 1.2.5
Do you have employment with any entity that either owns (wholly or partially) or is owned by (wholly or partially)
another entity that is engaged in or that provides any of the following activities or services for any fishery under the
jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Consulting
 Processing
 Legal
 Representational Services  Marketing

 Lobbying
 Advocacy

 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities

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NOAA Form 88‐195

OMB NO 0648 0192
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Please list and describe each applicable interest, as indicated above. Please include beginning date
of employment, entity name, and fishery or fisheries of interest.

Question 1.2.6
Do you have employment with an association or organization whose members include companies, vessels, or
other entities that are engaged in any of the following activities or services for any fishery under the jurisdiction
of the Council concerned?
No
 Yes
Check all that apply:
 Harvesting
Consulting
 Processing
Legal
 Lobbying
Representational Services
 Advocacy
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include beginning date
of employment, association name, and fishery or fisheries of interest.

Section 1.3: Other Service with an association or organization
Question 1.3.1
Are you serving as an officer, director, or trustee of any organization or association whose members include companies,
vessels, or other entities that are engaged in or provide any of the following activities or services for any fishery under
the jurisdiction of the Council concerned?
No

 Yes
Check all that apply:
 Harvesting
Consulting
Legal
 Processing
Representational Services
 Lobbying
 Advocacy
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include beginning date of service,
entity name, and fishery or fisheries of interest.

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NOAA Form 88‐195

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Part 2: Financial Interest of Spouses, Business Partners, and Minor Children
If you have no spouse, business partner, or minor children, check the box below and proceed to Part 3.
 I have no spouse, business partner, or minor children

Section 2.1: Assets and Ownership
Question 2.1.1

Does your spouse, business partner, or minor child have any stock, equity or ownership interest (whole or partial
ownership) in a company or business engaged in any of the following activities for any fishery under the jurisdiction of
the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the company or business. Please include
company or business name, date the interest began, and fishery or fisheries of interest.

Question 2.1.2

Does your spouse, business partner, or minor child have any stock, equity or ownership interest (whole or
partial) in any fishing vessel engaged in any of the following activities for any fishery under the jurisdiction of the
Council concerned?
No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the vessel. Please include vessel name,
company or business name, date the interest began, gear type, and fishery or fisheries of interest.

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NOAA Form 88‐195

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Question 2.1.3

Does your spouse, business partner, or minor child have any stock, equity or ownership interest (whole or partial)
in any other entity engaged in any of the following activities for any fishery under the jurisdiction of the Council
concerned?
No

 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.

Question 2.1.4

Does your spouse, business partner, or minor child have any stock, equity or ownership interest (wholly or
partially) in a company, business, or other entity that provides any of the following services for any fishery under
the jurisdiction of the Council concerned?

 No
 Yes

Check all that apply:
 Consulting
 Legal
 Representational Services
 Lobbying
 Advocacy
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.

Question 2.1.5

Does your spouse, business partner, or minor child have any stock, equity or ownership interest in any entity that
either owns (wholly or partially) or is owned by (wholly or partially) another entity that is engaged in or that
provides any of the following activities or services for any fishery under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Consulting
 Legal
 Representational Services
 Lobbying
 Advocacy

 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list and describe each applicable interest, as indicated above. Please include the percentage ownership or
share holdings or any other monetary or in‐kind enumeration of the entity. Please include entity name, date the
interest began, and fishery or fisheries of interest.

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NOAA Form 88‐195

OMB NO 0648 0192
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Section 2.2 Employment of Spouse, Business Partner, or Minor Child
Question 2.2.1

Does your spouse, business partner, or minor child have employment with any company or business engaged in any
of the following activities for any fishery under the jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, company or business name, and fishery or fisheries of interest.

Question 2.2.2

Does your spouse, business partner, or minor child have employment with a fishing vessel engaged in any of the
following activities for any fishery under the jurisdiction of the Council concerned?

 No
 Yes

Check all that apply:
 Harvesting
 Processing
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, vessel name, gear type, and fishery or fisheries of interest.

Question 2.2.3

Does your spouse, business partner, or minor child have employment with any other entity engaged in any of the
following activities for any fishery under the jurisdiction of the Council concerned?
 No

 Yes

Check all that apply:
Harvesting Processing
Marketing
Provides equipment essential to any of the listed activities
Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, entity name, and fishery or fisheries of interest.

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NOAA Form 88‐195

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Question 2.2.4

Does your spouse, business partner, or minor child have employment with any company, business, or other entity that
provides any of the following services for any fishery under the jurisdiction of the Council concerned?
 No

 Yes

Check all that apply:
 Lobbying
 Advocacy

 Consulting
 Legal
 Representational Services

Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, entity name, and fishery or fisheries of interest.

Question 2.2.5

Does your spouse, business partner, or minor child have employment with any entity that either owns (wholly or
partially) or is owned by (wholly or partially) another entity engaged in or that provides any of the following activities
or services for any fishery under the jurisdiction of the Council concerned?
 Harvesting
 No
 Processing
 Yes
 Lobbying
Check all that apply:
 Advocacy
 Consulting
 Marketing
 Legal
 Provides equipment essential to any of the listed activities
 Representational Services  Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, entity name, and fishery or fisheries of interest.

Question 2.2.6

Does your spouse, business partner, or minor child have employment with an association or organization whose
members include companies, vessels, or other entities engaged in any of the following activities in any fishery under the
jurisdiction of the Council concerned?

 No
 Yes
Check all that apply:
 Harvesting  Consulting
 Processing  Legal
 Lobbying
 Representational Services
 Advocacy
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of employment, association name, and fishery or fisheries of interest.

OMB Control No.: 0648-0314
Expiration Date: 10/31/20XX 11

NOAA Form 88‐195

OMB NO 0648 0192
Expiration Date 8/31/26

Section 2.3: Service with an association or organization by Spouse, Business Partner, or
Minor Child
Question 2.3.1

Does your spouse, business partner, or minor child serve as an officer, director, or trustee of any organization or
association whose members include companies, vessels, or other entities engaged in any of the following activities in any
fishery under the jurisdiction of the Council concerned?

No
Yes
Check all that apply:
 Harvesting
 Consulting
 Processing
 Legal
 Lobbying
 Representational Services
 Advocacy
 Marketing
 Provides equipment essential to any of the listed activities
 Provides other services essential to any of the listed activities
Please list person and relationship and describe each applicable interest, as indicated above. Please include
beginning date of service, entity name, and fishery or fisheries of interest.

Part 3: Information Requested of Other Persons
In the event any of the required information, including holdings placed in trust or percentage
ownership, is not known to you but is known to another person, you should request that other
person to submit the information on your behalf and should report such request in the space
below.
Please report to whom you have requested information for Part 3. When available, have that person please list
and describe each applicable interest. Please include the percentage ownership or share holdings or any other
monetary or in‐kind enumeration. Please include entity name, date the interest began, and fisheries of interest.

Signature
I certify that the statements I have made on this form and all attached statements are true, complete, and
correct to the best of my knowledge.

Signature_____________________________________

Date (mm/dd/yyyy)_________________________
OMB Control No.: 0648-0314

Expiration Date: 10/31/20XX 12

Part 3
Intergovernmental Personnel Agreements (IPAs)
Please mark the appropriate box and sign/date the appropriate blank line that may be applicable
to your nomination if:
a) you, your spouse, general partner, and/or any organization in which you are serving as an
officer, director, trustee, general partner, or employee, are currently participating as a principal
investigator for a National Marine Fisheries Service study grant(s);
b) if you, your spouse general partner, and/or any organization in which you are serving
as an officer, director, trustee, general partner, or employee, are currently detailed to the
NMFS on a full- part-time basis under an IPA:

□ a) above, is applicable: ____________________________________
(sign and date)

□ b) above, is applicable: ____________________________________
(sign and date)

:

□ neither a) nor b) above, is applicable to my nomination:
____________________________________
(sign and date)

INFORMATION REQUIRED TO BE REPORTED must be DISCLOSED on NOAA FORM
88-195, “STATEMENT OF FINANCIAL INTERESTS FOR USE BY VOTING MEMBERS
OF, AND NOMINEES TO, THE REGIONAL FISHERY MANAGEMENT COUNCILS”
Individuals nominated for appointment to a Regional Fishery Management Council must provide
financial disclosure information pursuant to section 302(j) of the Magnuson-Stevens Act, and
financial disclosure regulations at 50 CFR 600.235. The form must be filled out by each
nominee for Secretarial appointment.
Disclosure must be made on NOAA Form 88-195. In all instances, the form must be signed and
dated.

OMB Control No.: 0648-0314
Expiration Date: 10/31/20XX

Part 4
MEMORANDUM FOR:

Assistant General Counsel for Administration
U.S. Department of Commerce
Office of General Counsel
Washington, DC 20230

SUBJECT:

Certification of Status Statement

I, _________________________________________________________________________,
(Name)
currently residing at __________________________________________________________
(Street Address)
_______________________________________________________________________
(State)
(Zip)
(City)
hereby certify the following:
I am  / I am not  currently an agent of a foreign principal required to register pursuant to the
Foreign Agents Registration Act of 1938, as amended (at 22 U.S.C. § 611, et seq);
I am  / I am not  currently a lobbyist required to register under the Lobbying Disclosure Act
of 1995, as amended.
My signature below affirms that the information conveyed on this form is true, complete, and
correct to the best of my knowledge and belief, and is made in good faith; and that I understand
that knowing and willful false information on this form can be punished by fine or imprisonment
or both.

________________________________________
(Signature)

________________________
(Date)

OMB Control No.: 0648-0314
Expiration Date: 10/31/20XX

OMB Control No.: 0648-0314
Expiration Date: 10/31/2026
PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average 80 hours per nomination
package and 16 hours for background documentation per nominee, including time for reviewing 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 aspect of this collection of
information, including suggestions for reducing this burden, to: NOAA Fisheries, 1315 East-West Highway, Silver
Spring, MD 20910.

PRIVACY ACT STATEMENT
Authority: The collection of this information is authorized under Section 302 of the Magnuson-Stevens
Fishery Conservation and Management Act (16 U.S.C. 1852).
Purpose: Information is collected to evaluate qualifications and backgrounds of candidates nominated for
appointment to the Regional Fishery Management Councils.
Routine Uses: NOAA Fisheries uses this information to conduct background checks, assess qualifications, and
ensure balanced council representation. Nominee names are posted publicly via the NOAA Fisheries website.
Disclosure: Furnishing this information (including personal contact details, qualifications, and background
information) is required to be considered for appointment. Failure to provide complete information will render the
candidate ineligible for appointment consideration.

Public Burden Statement
0648-0314: 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 0648-0314. Without this approval, we could not
conduct this information collection. Public reporting for this information collection is estimated to be approximately
80 hours for a nomination for Council appointment; 16 hours for background documentation for nominees; 1 hour to
designate a principal state fishery official(s) or for a request to reinstate authority, 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 required to obtain benefits
pursuant to Magnuson-Stevens Act Section 302(b), Section 306(b)(2), and 50 CFR 600.215.he information collected
with these actions is used to ensure that the requirements of the Magnuson-Stevens Act are being met in regards to
Council membership and state authority.
Send comments regarding this burden estimate or any other aspect of this information collection, including
suggestions for reducing this burden to the Sean Lawler, Policy Analyst (Contractor), (301) 427-8561, and
[email protected].

0648-0192: 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 0648-0192. Without this approval, we could not
conduct this information collection. Public reporting for this information collection is estimated to be approximately
45 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. All responses to this
information collection are mandatory to obtain benefits pursuant to 50 CFR 600.235. Council members appointed by
the Secretary of Commerce, Scientific and Statistical Committee (SSC) members appointed by a Council, or
individuals nominated by the State Governor, Territorial Governor or Tribal Government for possible appointment as a
Council member must disclose their financial interest in any Council fishery. Send comments regarding this burden
estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Sean
Lawler, Policy Analyst (Contractor), (301) 427-8561, and [email protected].

OMB Control No.: 0648-0314
Expiration Date: 10/31/20XX