Certification for Broodstock and Juveniles

OMB Control No. 0648-0703

Expiration Date:

CERTIFICATION FOR BROODSTOCK AND JUVENILES

This form must be received by NOAA Fisheries at least 30 days prior to stocking juveniles in offshore systems. A separate form must be provided for different each species stocked.

For questions, contact the Regional Aquaculture Coordinator at (727) 551-5755 or email nmfs.ser.aquaculture@noaa.gov.

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

(Facility’s Gulf Aquaculture Permit Number)

(Genus/Species)

(Permittee name)

I __________________________________certify that all ___________________________ broodstock, or progeny of such broodstock, used to provide juveniles to __________________________________­ were originally harvested from U.S. waters of

the Gulf of Mexico, and will be or were from the same population or sub-population where the aquaculture facility is located. I also certify that each individual brood animal has been marked or tagged (e.g., via a Passive Integrated Transponder (PIT), coded wire, dart, or internal anchor tag) at the hatchery to allow for identification of those individuals used in spawning.

I certify that no genetically engineered or transgenic animals are used or possessed for culture purposes at the aquaculture facility.

I also certify that fin clips from each individual brood animal have been submitted to NOAA Fisheries in accordance with specified procedures at http://sero.nmfs.noaa.gov/sustainable_fisheries/gulf_fisheries/aquaculture/.

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 REPRESENTATIVE 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 Permits Office (F/SER14), Attn: Regional Aquaculture Coordinator, 263 13th 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. Non-confidential information may be released via a NOAA Fisheries website. Non-confidential information means: Name, Street Address, City, State, Zip Code, Effective Date of Permit, Permit Types, Vessel Name, Vessel Identification Number, and in the case of a “for hire” vessel the Passenger Capacity, or individual, corporate and lease holders of permits. 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.

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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	OMB 0648-XXXX Form
Author	jess.beck
File Modified	0000-00-00
File Created	2021-01-24