Observer notification form

OMB Control No. 0648-xxxx Expires xx/xx/2012
Highly Migratory Species Observer Notification Form
This form is provided for your response. Please provide the information requested below and
at least 5 days prior to your estimated departure. The mailing address and FAX number you
should use are on the back of this form. If the vessel is not fishing or is involved in another
fishery during the selection period, please indicate this under Vessel Fishing Status.
Captain's Name: _____________________ Vessel Name: _____________________________
Documentation/Vessel Number: __________________________ Overall Length: ________(ft)
Crew Size: ______ (include skipper) Bunk Capacity: ______Life Raft Capacity: _______
Contact Person/Telephone Number(s): _________________________________
Communication Equipment (please
check)
Cellular phone:
VHF:
Single Side Band:
Call sign:

Commercial Fishing Vessel
Safety Examination Decal
Serial Number:
Date of issuance:
________/________
Month
Year

Vessel Fishing Status:
Port of Departure:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________ State: ___________________________
Telephone Number: ( ) Departure Date: ____________ Departure Time: ________ (AM or PM)
Expected Landing Port:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________ State: ____________________
Telephone Number: ( ) _______________________
Anticipated Landing Date: _____________

I certify under penalty of perjury under the laws of the United States of America that the
information given on this form is true and correct, and that I have full authority to execute this
form.

___________________________________ ____________
Signature
Date

For the Pelagic Observer Program, please return by mail to SEFSC Pelagic Observer Program,
75 Virginia Beach Dr. Miami, FL 33149 or fax to 305-361-4282. For questions, call 800-8580624.
For the Shark Observer Program, please return by mail to SEFSC Shark Bottom Longline
Observer Program, 3500 Delwood Beach Rd, Panama City, FL 32408-7403 or fax to (850) 2353559. For questions, call (850) 234-6541.

PAPERWORK REDUCTION ACT STATEMENT: The information provided on this form will
be used by the National Marine Fisheries Service to ensure that observers can be deployed
effectively, efficiently, and safely on fishing vessels in order to collect information that is used in
analyses that support the conservation and management of living marine resources and that are
required under the Magnuson-Stevens Fishery Conservation and Management Act (MSA), the
Endangered Species Act (ESA), the Marine Mammal Protection Act (MMPA), the National
Environmental Policy Act (NEPA), the Regulatory Flexibility Act (RFA), Executive Order
12866 (EO 12866), and other applicable law. The public reporting burden for this form is
estimated to average 2 minutes per response, including the time for completing, reviewing, and
transmitting the information on the form. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing the burden to:
National Marine Fisheries Service, F/SF1, National Observer Program, 1315 East West
Highway, Silver Spring, MD 20910. Providing the requested information is mandatory under
regulations at 50 C.F.R. 600.746 for the safety questions and at 50 C.F.R. Part 622.8, 50 C.F.R.
229.7, and 50 C.F.R. 222.401 for the other questions. The information on this form will be kept
confidential as required under Section 402(b) of the MSA (18 U.S.C. 1881a(b)) and regulations
at 50 C.F.R. Part 600, Subpart E. Notwithstanding any other provision 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. This is an approved
information collection under OMB Control No. 0648-xxxx through xx/xx/2012.