Observer Notification Form

April 1 – June 30, 2012

Highly Migratory Species Observer Notification Form
This form is provided for your response. Please provide the information requested below and return by mail or e-mail
(popobserver@noaa.gov) at least 5 days prior to your estimated departure. If the vessel is not fishing or is involved in another fishery
during the selection period, please indicate this under Vessel Fishing Status.

Captain's Name: _____________________ Vessel Name: _____________________________
Documentation/Vessel Number: __________________________ Overall Length: ________(ft)
Crew Size: ______ (include skipper) Bunk Capacity: ______Life Raft Capacity: _______
Contact Person/Telephone Number(s): _________________________________
Communication Equipment (please check)

Commercial Fishing Vessel Safety
Examination Decal

Cellular phone:

Serial Number:

VHF:
Date of Expiration: _____/_____ Month/Year

Single Side Band:
Call sign:

Vessel Fishing Status:
Port of Departure:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________ State: ___________________________
Telephone Number: (

) _________________________

Departure Date: ____________ Departure Time: ________ (AM or PM)
Dock Facility: _______________________________________________________________

Expected Landing Port:
Street: ______________________________________________________________________
City: ______________________________ State: ____________________
Telephone Number: (

) _______________________

Anticipated Landing Date: _____________

I certify under penalty of perjury under the laws of the United States of America that the information given on
this form is true and correct, and that I have full authority to execute this form.

Signature

Date

For the Pelagic Observer Program, please return by mail to SEFSC Pelagic Observer Program, 75
Virginia Beach Dr. Miami, FL 33149 or e-mail (popobserver@ noaa.gov). For questions call 800-8580624.
For the Shark Observer Program, please return by mail to SEFSC Shark Bottom Longline Observer
Program, 3500 Delwood Beach Rd, Panama City, FL 32408-7403 or fax to (850) 235-3559. For questions
call (850) 234-6541.
PAPERWORK REDUCTION ACT STATEMENT: Collection of information through the
observerprogram provides data for stock assessments and estimates of bycatch. Public
reporting burdenfor completing the vessel information form above is estimated at 2 minutes
per response. Sendcomments 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/SF1,1315 East West Highway, Silver Spring, MD 20910. Providing the
requested information ismandatory for managing HMS fisheries under the Magnuson-Stevens
Fishery Conservation andManagement Act (16 U.S.C. 1801 et seq.) In accordance with NOAA
Administrative Order 216-100,it is agency policy not to release confidential information,
other than in aggregate form.Notwithstanding any other provision of the law, no person is
required to respond to, nor shallany person be subject to a penalty for failure to comply
with a collection of informationsubject to the requirements of the Paperwork Reduction Act,
unless that collection ofinformation displays a currently valid OMB Control Number. This is
an approved informationcollection under OMB Control No.: 0648-0593 and expires September 30,
2012.