Reimbursement for equipment expenses

OMB Control #0648-0593 Expires 09/30/2012

NMFS/SEFSC/POP

REIMBURSEMENT INVOICE FOR CONTRACT OBSERVERS
VESSEL NAME

TRIP NUMBER

ORGANIZATION CODE

TASK NUMBER

DATES OF TRIP
TO

RATE

DAYS AT SEA

MEAL EXPENSES
$25 / DAY
RATE

X

SUBTOTAL
Days At Sea

EQUIPMENT EXPENSES

Company Name

Agent Name

Phone
CORPORATION / OWNER NAME

TIN (Taxpayer Identification Number)

MAILING ADDRESS

PHONE

DATE

SIGNATURE

TOTAL

PAPERWORK REDUCTION ACT STATEMENT: The information provided on this form will be used to reimburse
you for specific expenses during the observed trip identified on the form. That trip was observed 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 10 minutes per response, 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, F/
SF1, National Observer Program,1315 East West Highway,Silver Spring, MD20910. Providing the requested
information is required to have the Central Administrative Support Center (CASC) and United States Treasury process
and pay the reimbursement. The information on this form will be kept confidential as required under Section 402(b) of
theMSA (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. This is an approved information collection under OMB
Control No. 0648-xxxx through xx/xx/2012.