Reef Fish VMS certification and checklist

OMB No. 0648-0544
Approval Expires 06/30/2009

Vessel Monitoring System (VMS) Installation and Activation Certification
For the Reef Fish Fishery of the Gulf of Mexico
PLEASE COMPLETE THIS FORM BY
PROVIDING ALL REQUESTED INFORMATION
Fishing Vessel (F/V) Name:
Vessel state registration number or U.S. Coast Guard documentation number:

Installing marine electrician or dealer (name, address, and telephone number):

Date of Installation (mm/dd/yyyy):
VMS Mobile Transceiver Unit (MTU)
Manufacturer name:
Model:
Manufacturer serial number (S/N):
Communication network serial number (ISN):
VMS Mobile Communications Service Provider (MCSP)
Communications provider name:
Communications ID number assigned by service provider:
Did the manufacturer/vendor provide VMS MTU operating instructions? Yes  No 
Did the manufacturer/vendor provide training on the use of the VMS MTU? Yes  No 
Once the VMS MTU was installed, did the electrician/dealer, or the owner and/or operator of the
vessel verify with NOAA OLE VMS Program personnel that position data was being received?
Yes  No 
In accordance with 50 C.F.R. §622.9(a)(2), as the owner or operator of a vessel participating in the Gulf of Mexico
Reef Fish fishery, I hereby certify that the VMS unit on my vessel has been installed and the communication
services activated, and receipt of position data has been verify by NOAA OLE VMS Program personnel, in
compliance with the applicable procedures of this installation and activation form.

Vessel owner name:
Vessel owner signature:

Date:

Vessel operator name:
Vessel operator signature:

Date:

Submit this certification, when completed, to the NOAA/NMFS, Office for Law Enforcement, Southeast Division
VMS Program, 263 13th Avenue South, Suite 109, St. Petersburg, FL 33701.
Under the provisions of the Paperwork Reduction Act of 1995 (PL 104-13) and the Privacy Act of 1974 (PL 93-579), you are advised that
disclosure of the requested information is mandatory for the purpose of managing the Gulf of Mexico Reef Fish fishery. The requested
information is used to ensure proper operation of the VMS unit. Confidentiality of the information provided will be treated in accordance with
NOAA Administrative Order 216-100. The public reporting burdens for this collection of information are estimated as follows 15 minutes for
completion and submission of the statement certifying compliance with the installation and activation checklist. The estimates of public reporting
burdens for these collections of information include 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 estimates
or other aspects of the collection-of-information requirements, or suggestions for reducing this burden, should be sent to Jason Rueter, NMFS,
Southeast Regional Office, 263 13th Avenue South, St. Petersburg, FL 33701.