National Marine Sanctuaries Permit Application

NOAA NATIONAL MARINE SANCTUARIES
PERMIT APPLICATION

OMB # 0648-0141
Expires: 06/30/2008

Refer to “Instructions for Submitting Applications for National Marine Sanctuary Permits and Authorizations” for
guidance on how to properly complete this application. Applicants are responsible for reviewing the instructions in
their entirety to ensure are all application requirements are met.
Note: for certain activities, completion of this application may not be required. Consult the guidelines and the Office
of National Marine Sanctuaries (ONMS) website (http://www.sanctuaries.noaa.gov/) prior to completing and
submitting this application to see if this is the case for your proposed activity.

Section A – General
Sanctuary(s) in which you are applying to work:
Monterey Bay
Gray’s Reef
Channel Islands
Olympic Coast
Gulf of the Farallones
Cordell Bank
Stellwagen Bank
Hawai’ian Islands Humpback Whale
Fagatele Bay
Thunder Bay
Monitor
Florida Keys
Flower Garden Banks
For permit renewals or modifications only, enter the
Select one of the following:
✔
previously issued ONMS permit number:
New application
Renewal of previously issued permit
Change or modification to previously issued permit
(Note: expired permits cannot be renewed or modified)

Section B – Applicant Information

Dr.
Honorific
First Name
Mailing address:
Address Line 1:

Last Name

Middle Initial
Phone:

Address Line 2:
City:

Fax:

State:

Email:

Zip Code:
Institution represented (if applicable):

Title or Department:

Co-applicant or additional investigator authorized to conduct activities (if applicable):

First Name

Last Name

Institution

Section C – Project Information
Project title (maximum 300 characters):

Project dates (mm/dd/yyyy format):
Requested permit start date:
Requested permit end date:

Does this activity involve collections?
✔

No – If checked, no collection of sanctuary resources are allowed
Yes – Complete Collections Data Form and submit with application

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Section C – Project Information (Continued)
Project abstract (maximum 3000 characters):

Methods and protocols to be employed in the field (maximum 10000 characters):

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Proposed location of activities:
✔
Throughout sanctuary(s) or

Section C – Project Information (Continued)
If activities are to be conducted in specific locations within sanctuary, describe
where: See instructions for details. Coordinate data may also be required.

Specific locations within a sanctuary
Will this activity occur within any special sanctuary
zone (such as marine reserves, research-only areas,
sanctuary preservation areas, or state preserves)?
✔
No
Yes – Provide justification in Section E

Section D – Environmental Impacts
Answer the following questions as accurately as possible to assist in the consideration of this application. Maximum 1000 characters
per question. See instructions for additional guidance on how to complete these fields.
Describe any direct impacts on sanctuary resources that would result from this activity:

Describe any indirect impacts on sanctuary resources that would result from this activity:

Select if, to your knowledge, any of the following have been completed (or are being completed) for this proposal:
Federal environmental impact statement, analysis, or review
State or local environmental impact statement, analysis, or review
Other analysis of the environmental effects of this activity

Section E – Rationale
Answer the following questions as accurately as possible to assist in the consideration of this application. Maximum 1000 characters
per question. See instructions for additional guidance on how to complete these fields.
Describe why this activity needs to be conducted within the sanctuary(s):

If this activity is proposed to occur in any special sanctuary zone (e.g., marine reserves, research-only areas, sanctuary preservation
areas, state preserves), explain why this is necessary and how it will further the understanding of the zone:

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Section E – Rationale (Continued)
Describe how the proposed methods are appropriate for this activity:

Describe how the permit duration requested is appropriate for this activity:

Provide a statement explaining applicant qualifications and financial ability to complete the project (include project funding source):

Section F – Other Information
Requests for ONMS assistance (see instructions before completing):

Other permits, authorizations, or approvals obtained or required:
Check the boxes as appropriate, provide copies of any already received, and notify ONMS staff of the status of pending requests.
Coastal Zone Management Act (Federal Consistency)
Marine Mammal Protection Act
U.S. Army Corps of Engineers permit
Endangered Species Act
Other Federal, state, or local permit(s)
National Historic Preservation Act

Section G – Certification
I certify that this application is accurate and complete. I understand that incomplete applications will not be acted upon until any
required additional information is provided. I further understand that applications not received within the timelines outlined in the
instructions may not be processed in time for my activity to begin as planned. I authorize the ONMS to seek peer reviews of my
proposal, if deemed necessary.

Signature of applicant: __________________________________________________

Date: ______________________

(If providing application via electronic means, you may acknowledge this certification via email)
Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a valid OMB control number. Public reporting for this collection of information is estimated
to average 1.5 hours per response for most activities, including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing this application. See the instructions for details regarding this burden estimate.

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NOAA NATIONAL MARINE SANCTUARIES
COLLECTIONS DATA FORM

OMB # 0648-0141
Expires 06/30/2007

Collections Data
Complete this section only if requesting collections or samples as part of this activity. Describe the type, size, and
quantity of specimens or materials to be collected, sampled, or captured. Provide scientific nomenclature where
possible. Complete/attach additional pages if necessary.
Species

Qty

Sample Limits (max/min size, etc)

Location

Justification and Disposition
If specimens of the proposed types already exist in a repository, explain why additional collecting is necessary:

Summarize any mitigations associated with these collections:

Indicate the final disposition of these collections (select all that apply):
Temporarily captured or handled and then released undamaged in place
Will be destroyed through analysis or discarded after analysis
Permanently retained (Provide repository information. Unless deaccession agreement is reached, NOAA retains
ownership of retained specimens.)

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