Landing Transaction Request Form

0MB Control No. 0648-0551 Exp. Date 08/31/2011

Incorrect Price:
Incorrect Price:
Incorrect Price:
$_______

$_______

$_______

duplicate entry, wrong amount of pounds, etc):

Correct Pounds:
Correct Pounds:
Correct Pounds:

IFQ Fisherman:
Approval Code from Transaction to be Corrected:

Correct Price:

Correct Price:
Correct Price:

$_______

$_______

$_______

Date:

Date:

Rev. 8/9/2011

Underthe provisions ofthe Paperwork Reduction Act of1995 (PL 104-13) and the Privacy Act of 974 (PL 93-579). you are advised thatdisclosure ofihe requested information is mandatory for the
purpose of managing the Gulf of Mexico Reef Fish fishery. The requested information is used to ensure proper compliance with Gulf reef fish TFQ programs Confidentiality of the information
provided will be treated in accordance with NOAA Administrative Order 216-100. The public reporting burden for this collection of information is estimated to be 5 minutes The estimate of public
reporting burden for this collection of information includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Written comments regarding the burden-hour estimate or other aspects of the collection-of-information requirements, or suggestions for reducing this burden, should be
th
3
Avenue South. St Petersburg, FL 3370 1-5505
sent to PRA Officer, NMFS, Southeast Regional Office. 263 j

Signature of IFQ Fisherman:

hereby declare under penalty of pen ury that the foregoing. information is true and correct.
I,
1001).
18
U.S.C.
18
U.S.C.
1621;
(28 U.S.C. § 1746;
§
§

Signature of IFQ Dealer

hereby declare under penalty of perjury that the foregoing information is true and correct.
1,
(28 U.S.C. § 1746; 18 U.S.C. § 1621; 18 U.S.C. § 1001).

Incorrect Pounds:
Species
Incorrect Pounds:
Species
Incorrect Pounds:
Species
Other Correction (please describe):
Reason for the Landing Transaction Correction (e.g.

IFQ Dealer:
Date of Transaction to be Corrected:

Instructions: Please complete this form if you have a landing transaction that should be corrected. This form must be completed and signed by
the IFQ dealer and the IFQ Fisherman and received by NOAA Fisheries Service within 15 days of the original transaction. By completing
and signing this form, both the IFQ dealer and fisherman acknowledge the information below is accurate. Please mail this form to: NOAA
Fisheries Service, Sustainable Fisheries Division, Attn: IFQ Program, 263 13th Avenue South, St. Petersburg, Florida 3370 1-5505. Any other
corrections to landing transactions should be reported via the IFQ Customer Service phone line at 1-866-425-7627.

LANDING TRANSACTION CORRECTION REQUEST

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