Certification for Broodstock and Juveniles

OMB Control No. 0648-XXXX

Expiration Date:

CERTIFICATION FOR BROODSTOCK AND JUVENILES

This form must be submitted to NMFS each time broodstock are acquired by a hatchery or used for spawning. Form must be received by NMFS at least 30 days prior to stocking juveniles in offshore systems.

Provide a separate form for each species being cultured.

For questions, contact the Regional Aquaculture Coordinator at (727) XXX-XXXX or email XXXXXXXX@noaa.gov.

FOR OFFICE USE ONLY
Date Received
Gulf Aquaculture Permit Number
Reviewer Initials and Date

(Permittee Name and Gulf Aquaculture Permit Number)

(Genus/Species and Common Name)

I certify that all _______________________________ broodstock used to provide juveniles to ______________________________________ were originally harvested from U.S. waters of

the Gulf of Mexico and have originated from the same population or sub-population of fish where the aquaculture facility is located or are progeny of such wild broodstock. I also certify that all broodstock animals have been individually marked or tagged (e.g., via a Passive Integrated Transponder (PIT), coded wire, dart, or internal anchor tag) to allow for identification of those individuals used in spawning.

Further, I certify that no transgenic or genetically modified organisms (GMOs) are used or possessed in the aquaculture facility and no transgenic or GMOs were used in the production of the juveniles or associated broodstock. I also certify that fin clips or other genetic information have been submitted for each individual broodstock animal in accordance with procedures specified by NMFS¹.

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

HATCHERY OWNER SIGNATURE PRINT NAME

POSITION IN COMPANY BUSINESS PHONE NUMBER CELL PHONE NUMBER

HATCHERY NAME AND MAILING ADDRESS DATE (MM/DD/YYYY)

/ /

Mail the completed form to:

NMFS (F/SER), Attn: Regional Aquaculture Coordinator, 263 13^th Avenue South, St. Petersburg, FL 33701.

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or other suggestions for reducing this burden to PRA Officer, National Marine Fisheries Service. F/SER26, 263 13th Avenue South, St. Petersburg, FL 33701.

The National Marine Fisheries Service requires this information for the conservation and management of marine fishery resources. The data reported will be used to develop, implement, and monitor fishery management activities for a variety of other uses. Responses to this collection are required to obtain or retain a fisheries permit under the Magnuson-Stevens Act. Name and address information will be released via a NMFS website. All other data submitted will be handled as confidential material in accordance with NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected 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.

1 Associated guidance for this requirement can be found at: (website TBD). Fin clip samples must be received at least 30 days prior to stocking juveniles in offshore aquaculture systems.

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