Observer notification form_shripm

June 2009

OMB Control #0648-xxxx.
Expires xx/xx/xxxx
Shrimp - Observer FAX Notification Form

This form is provided for your response. Please complete and return this form at least 48 hours prior to your
estimated departure. Fax to (409-766-3489) ATTN: MIKE HARRELSON and/or PAT CRYER. If the
vessel is not fishing or is involved in another fishery during the selection period, please state in the comment
section of this form which fishery and the gear to be used.
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 list)
Cellular / SAT phone:
VHF:
Single Side Band:
Call sign:

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

Port of Departure: Dock Facility: ____________________________ Street: ___________________________
City: ______________ State: _____ Phone Number: (
Departure Date: __/__/__

Time: __:__ (AM or PM)

) _____-_____
Anticipated Landing Date: __/__/__

Expected Landing Port: (if different from port of departure) Dock Facility: ____________________________
Street: _______________________________ City: ________________________ State: ____
Phone Number: (

) _____-________ Primary Language: (if other than English) ______________________

Comments:________________________________________________________________________________
__________________________________________________________________________________________
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 15
minutes, 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, Shrimp and Reef Fish Observer
Programs, 4700 Avenue U, Galveston, Texas 77551. 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. 222.401, 50 C.F.R. 229.7, and 50
C.F.R. 622.8 for all 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.