Broken trip adjustment sheet

Broken Trip Adjustment Sheet
SUBMIT TO:
NATIONAL MARINE FISHERIES SERVICE
SUSTAINABLE FISHERIES DIVISION
55 GREAT REPUBLIC DRIVE, GLOUCRSTER, MA 01930
FAX: (978) 281-9135
Information:
Owner name/corporation:
Vessel name:
Permit #:
USCG doc/State reg #:
Vessel operator:
Reason for broken trip:
Date VMS Broken Trip Notification Form sent to NMFS:
Pounds of scallops landed:
Access Area fished:
Broken trip departure date:
Broken Trip landing date:
Vessel owner signature: ____________________________ Date: __________________
This form is required under 50 CFR § 648.60 to monitor the days-at-sea allocation and usage for limited
access scallop permit holders. Signature of this form certifies that permit holder requirements specified in
50 CFR § 648.60, and that the information provided on this form is true, complete and correct to the best
of their knowledge, and made in good faith (18 U.S.C. 1001). Making false statement on this form is
punishable by law.
Notwithstanding any 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.
Public Reporting burden for this collection of information is estimated to average 5 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining data
needed, and completing and reviewing the information. Send comments regarding this burden estimate or
suggestions for reducing this burden to NMFS, 55 Great Republic Drive, Gloucester, MA 01930; and to
OMB, Paperwork Reduction project, Washington, DC 20509.
OMB Approval No. 0648-0491
Expires 03/31/2011