Special Coral Reef Ecosystem Fishing Permit Application

OMB Control No. 0648-0463
Expiration Date: 02/08/2009

NOAA National Marine Fisheries Service
Pacific Islands Regional Office ATTN: SFD Permits
1601 Kapiolani Blvd. Suite 1110
Honolulu, HI 96814-4700
Ph: (808) 944-2200; FAX: (808) 973-2940

Special Coral Reef Ecosystem Fishing Permit Application Form
Applicant Information (Please print legibly)
Full Name or Business Name:
Taxpayer Identification Number (TIN):
Business Mailing Address:
Street

Date:

/

/

Date of Birth/Incorporation:
Apt.#

City

State

ZIP

Phone:
Cell:
Fax:
Email:
Vessel Name:
Home Port:
Length (ft):
Net Tonnage:
Gross Tonnage:
Vessel: (check one) USCG Documentation___; State License___; Vessel Registration Number:
Vessel Operator:
Name:
Phone:
Fax:
Address:
Street

Apt.#

City

State

ZIP

Privacy Act Statement: Federal Regulations (at 50 CFR Part 665) authorize collection of this information. This information is used to verify the identity of the
applicant(s) and to accurately retrieve confidential records related to federal commercial fishery permits. The primary purpose for requesting the TIN is for the
collection and reporting on any delinquent amounts arising of such person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996
(Public Law 104-134). Personal information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be disclosed to the public.

Is this permit solely to transship coral reef ecosystem taxa received from another vessel around the EEZ of the Northwest Hawaiian Islands, the
Pacific Remote Island Areas, or any other MPA? ________
Do you agree to accommodate an observer on board while fishing, if required?_______
Does vessel have an individual Vessel Monitoring System?______
Does vessel have insurance covering removal/clean-up in event of a grounding?_____ Name of Insurer: __________________________
Do you agree to submit daily log data within 30 days of returning to port?_____ or transshipment log data within 7 days of returning to port? _____
Check any special exemption for which you qualify and would like to be eligible for under this permit application (attach description of
conditions under which you apply):
Other FMP ____
Scientific Bioprospecting ___
General Indigenous ____
Indigenous use of live rock/coral ____
Aquaculture seed stock of coral ____
In which EEZ Management Subarea will fishing be conducted? (check only one)
Main Hawaiian Islands ____
American Samoa ____
Guam ____
Guam’s Southern Banks ____
CNMI ____
PRIA (specify) _________________________________________
Describe your intended fishing effort, general fishing grounds, gear to be used and methods of collection
Target Species or Taxa
Species Name

Expected Catch
(lb) (#, wt.)

How will it be
processed?1

Expected Incidental Species or Taxa
Why
harvested? 2

Species Name

Expected Catch
(lb) (#, wt.)

Keep?

1

Live, fresh, frozen, preserved, other
Food, ornamental, research, other

2

Use back, if necessary; total expected catch during permit period for target species required for permit approval
Attach statement regarding objectives of fishing operation, estimated ecosystem, habitat and protected species impacts, and any additional
information to help support approval of this application. Attach copy of USCG vessel documentation or state/territory vessel registration.
It is prohibited to file false information on any application for a fishing permit (50 CFR ' 665.15(b)).

Signature:

Date:
Please return completed and signed application to: NMFS Pacific Islands Regional Office, ATTN: Permits
1601 Kapiolani Blvd., Suite 1110, Honolulu, HI 96814-4700

OMB Control No. 0648-0463
Expiration Date: 02/08/2009

Paperwork Reduction Act Information
Public reporting burden for this collection is estimated to average 120 minutes per response, including the 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 Regional Administrator, NMFS Pacific Islands Region, 1601 Kapiolani Blvd., Suite 1110,
Honolulu, Hawaii, 96814-4700.
This information is being collected to provide the information needed by NMFS to regulate and monitor the coral reef fisheries and
resources managed under the Fishery Management Plan for Coral Reef Ecosystems of the Western Pacific Region (FMP) and to
evaluate the effectiveness of management by assessing the status of stocks and the status of the fisheries. The information provides a
basis for determining whether changes in management are needed to sustain the productivity of the stocks or to respond to
interactions between fishing vessels and protected species and to address economic problems in the fishery. The information is also
used to provide a basis for evaluating the magnitude and distribution of impacts resulting from changes to the regulations. Responses
to the collection are required under 50 CFR 665.13. Proprietary data provided concerning the vessel and/or business of the
respondents are handled as confidential under the Magnuson-Stevens Fishery Conservation and Management Act (Sec.402(b)).
Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any 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.