Attachment B, sample of previous survey

Attachment B
OMB Control No. 0648-0369; Expiration Date: 07/31/2009

West Coast Limited Entry Trawl Survey
CONTACT INFORMATION FOR SURVEY RESPONDENT
1. Name: ___________________________________2. Email: _________________________
3. Date (Month/Day/Year): _________________

4. Telephone: (____)_______________

5. Mailing Address (Street, City, State, and Zip Code): _______________________________
____________________________________________________________________________
VESSEL OWNERSHIP AND CHARACTERISTICS
6. Please review the following information about the vessel’s owner. If the information on record is correct, please
place a check mark in the Corrections column. If any item is incorrect, please write the correct information in the
Corrections column.
Item
a. Owner’s Name
b. Owner’s Address

Information on Record
Charles Smith
333 1st Street, Waldport, OR 97005

Corrections

7. Please verify the following information on record about your vessel. If the information on record is correct,
please place a check mark in the Corrections column. If the information on record is incorrect, please provide the
correct information in the Corrections column.
Item
a. USCG Vessel ID
b. State Vessel ID
c. Home Port
d. Weight (gross tons)
e. Length (feet)
f. Fuel Capacity
g. Engine Make and Model

Information on Record
33221843
OR33214
Newport, OR
21
75
300
No Information on Record

Corrections

8. For each of the following activities, please provide this vessel’s average fuel consumption and speed. If this
vessel does not engage in an activity, please write “NA” in the Fuel Consumption and Speed columns for that
activity
Activity

Fuel Consumption
(Gallons Per Hour)

a. Trawling
b. Shrimping
c. Crabbing
d. Trolling
e. Steaming (fully loaded with fish)
f. Steaming (empty)

1

Speed
(Knots Per Hour)

REVENUE AND EXPENDITURES
Questions 9 and 10 collect information about this vessel’s revenue sources and expenditures while operating in all
fisheries (groundfish, crab, shrimp, salmon, etc.).
9. Information on revenue sources outside of landings in Washington, Oregon, and California is important for
understanding the fishing opportunities of the limited entry trawl fleet. We can not obtain this information from
existing data sources. For each of the revenue sources listed below, please indicate the revenue earned during
calendar year 2003.
Revenue Source

2003 Revenue ($)

a. Landings in Alaska
b. Landings in Hawaii
c. Landings outside of the United States
d. West Coast at-sea deliveries
e. Chartering/Tendering
f. Sale or leasing out of permits associated with this vessel.
g. Other (please specify)_____________________ ______________)
10. For each expense category below, please provide total annual expenditures during calendar year 2003. If you
do not have separate data on expenditures for captain (part a) and crew (part b), please put a “NA” for 2003 Captain
expenditures in part a and put the combined Captain and Crew expenditures in part b.
Expense Category

2003 Expenditure ($)

a. Captain (including bonuses and payroll taxes)
b. Crew (including bonuses and payroll taxes)
c. Fuel and Lube
d. Food and crew provisions.
e. Ice
f. Bait
g. Purchase or lease of permits
h. Repair, maintenance, and improvements for vessel, gear, and equipment.
Please include expenditures on maintaining this vessel, expenditures on
repairing mechanical and physical problems with the vessel and equipment,
expenditures on new equipment, and expenditures on improvements to
existing equipment.

If you reported expenditures of over $1,000 on repair, maintenance, and improvements for
vessel, gear, and equipment in question 10h, please answer question 11. If you reported
expenditures of less than $1.000 in question 10h, please write “NA” in the response for question
11 and proceed to question 12.
11. Please describe the major causes of expenditures on repair, maintenance, and improvements for vessel, gear,
and equipment during 2003. _____________________________________
__________________________________________________________________________
__________________________________________________________________________

2

CREW COMPENSATION
Questions 12 through 15 collect information about crew payments when this vessel is participating in the West
Coast (Washington, Oregon, and California) groundfish fishery.
12. Does this vessel use a crew share system to pay its crew when operating in West Coast groundfish fisheries?
a. Yes (proceed to question 8).
b. No (proceed to the Survey Conclusion after question 10).

13. Which of the following expenses were deducted from total revenue before calculating the crew share when this
vessel operated in West Coast groundfish fisheries?
Deducted Before Calculating Crew Share?
a. Fuel and lube.
Yes
No
b. Food and other crew provisions.
Yes
No
c. Landing taxes.
Yes
No
d. Other. Please specify ____________.
Yes
No

14. On trips when the vessel owner serves as captain, please indicate the share of net revenue (revenue minus the
deductions listed in question 8) going to the vessel/captain and crew. If the vessel owner does not serve as captain
on any trips, please mark “NA”.
Vessel/captain share ________% Crew share________%
15. On trips when the vessel owner does not serve as captain, please indicate the share of net revenue (revenue
minus the deductions listed in question 5) going to the vessel, captain, and crew. If the vessel owner always serves
as captain, please mark “NA”
Vessel share_______% Captain share________% Crew share________%
SURVEY CONCLUSION
Thank you for participating in this survey. The information you have provided will improve studies of the economic
performance and economic impact of the West Coast limited entry trawl fishery.
Public reporting burden for this collection of information is estimated to average 1 hours 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
suggestions for reducing this burden to Carl Lian, NOAA Fisheries, Carl.Lian@noaa.gov, 206-302-2414.
Confidential name and address information will be released via a NOAA Fisheries website for informational
purposes. All other data submitted will be handled as confidential material in accordance with NOAA
Administrative Order 216-100, Protection of Confidential Fishery Statistics. 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.