Amendment 80 cooperative permit and cooperative quota ap

Revised: 11/13/2015 OMB Control No. 0648-0565 Expiration Date: 01/31/2016

A80

Application for Amendment 80 Cooperative Quota (CQ) Permit

U.S. Dept. of Commerce/NOAA National Marine Fisheries Service (NMFS) Restricted Access Management (RAM) P.O. Box 21668 Juneau, AK 99802-1668 (800) 304-4846 toll free / 586-7202 in Juneau (907) 586-7354 fax

This application must be submitted annually and received by NMFS no later than 1700 hours A.l.t. on November 1 of the year prior to the year for which the applicant wishes to participate in an Amendment 80 fishery, or if sent by U.S. mail, the application must be postmarked by that time.

ATTACHMENT: A copy of the cooperative membership agreement or contract must be provided with this application.
BLOCK A – AMENDMENT 80 COOPERATIVE IDENTIFICATION
1. Cooperative's Legal Name:		2. Type of Business Entity under which the Amendment 80 Cooperative is Organized:
		3. State in which the Amendment 80 Cooperative is Legally Registered as a Business Entity:
4. Business Address; indicate whether [__] Permanent [__] Temporary
5. Business Telephone Number:	6. Business Fax Number:		7. E-mail Address:
8. Printed name of Amendment 80 Cooperative’s Designated Representative:

BLOCK B – MEMBERS OF THE AMENDMENT 80 COOPERATIVE
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:	2. NMFS Person ID:
	3. Amendment 80 QS Permit Number(s):
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:	2. NMFS Person ID:
	3. Amendment 80 QS Permit Number(s):
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:	2. NMFS Person ID:
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)

Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:	2. NMFS Person ID:
	3. Amendment 80 QS Permit Number(s):
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:	2. NMFS Person ID:
	3. Amendment 80 QS Permit Number(s):
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:	2. NMFS Person ID:
	3. Amendment 80 QS Permit Number(s):
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)

BLOCK C – IDENTIFICATION OF AMENDMENT 80 COOPERATIVE MEMBER VESSELS AND AMENDMENT 80 LLP LICENSES
Vessel Name	ADF&G Number/USCG Documentation Number	Amendment 80 LLP Number

BLOCK D -- IDENTIFICATION OF VESSELS ON WHICH THE CQ ISSUED TO THE AMENDMENT 80 COOPERATIVE WILL BE USED
Vessel Name	ADF&G Number/ USCG Documentation Number

BLOCK E -- EDR SUBMISSION

Has each member of the Amendment 80 cooperative submitted a timely and complete EDR (retitled in 2016 as Trawl Catcher/Processor Economic Data Report) for each Amendment 80 QS permit held by that person as required under § 679.94?

[__] YES [__] NO

BLOCK F – CERTIFICATION OF COOPERATIVE AUTHORIZED REPRESENTATIVE
The Cooperative Authorized Representative must sign and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. Attach explicit authorization to complete the application on behalf of the members of the cooperative.
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, the information presented here is true, correct, and complete.
1. Signature of Cooperative Authorized Representative	2. Date Signed
3. Printed Name of Cooperative Authorized Representative

Application for

Amendment 80 Cooperative Quota (CQ) Permit

A copy of the cooperative membership agreement or contract must be attached to this application.

A Cooperative Quota (CQ) permit is issued annually to an Amendment 80 cooperative that submits a complete and timely application for CQ that is subsequently approved by the Regional Administrator.

A CQ permit authorizes an Amendment 80 cooperative to participate in the Amendment 80 Program. NMFS will issue a CQ permit annually to an Amendment 80 cooperative if that Amendment 80 cooperative has submitted:

♦ A timely and complete application for Amendment 80 CQ.

Deadline: This completed application must be received by NMFS no later than 1700 hours A.l.t. on November 1 of the year prior to the year for which the applicant wishes to participate in an Amendment 80 fishery, or if sent by U.S. mail, the application must be postmarked by that time.

♦ A timely and complete Economic Data Report (EDR) for each member of the Amendment 80 cooperative holding Amendment 80 QS as described under § 679.94 that is subsequently approved by the Regional Administrator.

Deadline: The annual EDR submission deadline is June 1.

The Amendment 80 EDR is renamed in 2016 as Trawl Catcher/Processor Economic Data Report. Pacific States Marine Fisheries Commission (PSMFC) has been designated by NMFS to be the Data Collection Agent (DCA) for the Amendment 80 EDR program. PSMFC mails EDR announcements and filing instructions to Amendment 80 QS permit holders by April 1. You may also use the web based EDR form or download the EDR form in fillable PDF format. To request that a printed EDR be mailed to you, please call 1-877-741-8913, or email your request to edr@psmfc.org.

NOTE that the Amendment 80 regulations published at 50 CFR 679.94 direct EDR submitters to mail or fax completed EDR forms to the Alaska Fisheries Science Center. The updated submission address and fax number are listed below:

Pacific States Marine Fisheries Commission

NMFS Economic Data Reports

205 SE Spokane St., Suite 100

Portland, OR 97202

PH: (877) 741-8913

FX: (503) 595-3450

Email: am80edr@psmfc.org

An Amendment 80 CQ Permit is valid until:

The end of the year for which the Amendment 80 CQ fishery permit is issued;

The Amendment 80 CQ fishery is closed by the Regional Administrator; or

The permit is revoked, suspended, or modified pursuant to § 679.43 or under 15 CFR part 904.

A legible copy of the Amendment 80 CQ Permit must be carried on board the Amendment 80 vessels assigned to the Amendment 80 Cooperative.

To request that a printed EDR be mailed to you (at no cost), contact

Pacific States Marine Fisheries Commission

205 SE Spokane, Suite 100

Portland, OR 97202

Telephone: 1-877-741-8913

e-mail: info@psmfc.org

If the Amendment 80 QS Permit Holder is a non-individual (i.e., a corporation, partnership or other entity), provide the names of, and the percentage of ownership held by, all of its owners. Information should be provided to the individual level. See example below:

Name of Owner	% Interest
Joe Potpuller	25%
Alice Potpuller	25%
LLP Family Holdings, Inc.	50%
C. A80QSholder	25% (of 50%)
R. A80QSholder	25% (of 50%)
A. A80QSholder	25% (of 50%)
B. A80QSholder	25% (of 50%)

Duplicate the form, or attach a separate sheet of paper if necessary to display all of the Applicant’s owners (and owners of the Applicant’s owners to the individual level).

Type or print legibly in ink; retain a copy of completed application for your records.

When application is complete, submit

By mail to: NMFS Alaska Region

Restricted Access Management

P.O. Box 21668

Juneau, AK 99802-1668

By Fax to: (907) 586-7354

If you need additional information, contact Restricted Access Management (RAM) as follows:

Website: http://www.alaskafisheries.noaa.gov/ram/default.htm

Telephone (toll free): 800-304-4846 (press “2”)

Telephone (in Juneau): 907-586-7202 (press “2”)

e-Mail: RAM.Alaska@noaa.gov

Please allow at least 10 working days for your application to be processed. Items will be sent by first class mail, unless you provide alternate instructions and include a prepaid mailer with appropriate postage or corporate account number for express delivery.

COMPLETING THE APPLICATION

BLOCK A -- AMENDMENT 80 COOPERATIVE IDENTIFICATION

1. Cooperative's legal name

2. Type of business entity under which the Amendment 80 Cooperative is organized.

Each Amendment 80 cooperative must be formed as a partnership, corporation, or other legal business entity that is registered under the laws of one of the 50 states or the District of Columbia;

3. State in which the Amendment 80 Cooperative is legally registered as a business entity

4. Business address; indicate whether permanent or temporary

5-7. Business telephone number, business fax number, and e-mail address

8. Printed name and signature of Amendment 80 designated representative and date signed

BLOCK B – MEMBERS OF THE AMENDMENT 80 COOPERATIVE -- Amendment 80 QS Permit Holder and Ownership Documentation (complete for all members of the Amendment 80 cooperative)

1. Full name

2. NMFS Person ID

3. Amendment 80 QS Permit Number(s)

4. Names of all persons, to the individual level, holding an ownership interest in the

Amendment 80 QS Permit Number(s) assigned to the Amendment 80 cooperative

5. The percentage ownership each person and individual holds in the Amendment 80 QS Permit(s).

BLOCK C – IDENTIFICATION OF AMENDMENT 80 COOPERATIVE MEMBER VESSELS AND AMENDMENT 80 LLP LICENSES

Identify the Amendment 80 vessels held by all members of the Amendment 80 Cooperative

Name

Alaska Department of Fish & Game (ADF&G) vessel registration number

United States Coast Guard (USCG) documentation number

Amendment 80 License Limitation Program (LLP) numbers

BLOCK D -- IDENTIFICATION OF VESSELS ON WHICH THE CQ ISSUED TO THE AMENDMENT 80 COOPERATIVE WILL BE USED

Identify the Amendment 80 vessels on which the CQ issued to the Amendment 80 Cooperative will be used.

Name

ADF&G vessel registration number

USCG documentation number

BLOCK E – EDR SUBMITTAL

Indicate (YES or NO) whether the each member of the Amendment 80 cooperative has submitted an Amendment 80 Economic Data Report (EDR) as required under § 679.94. Note: The Amendment 80 EDR is renamed in 2016 as Trawl Catcher/Processor Economic Data Report.

BLOCK F – CERTIFICATION OF COOPERATIVE AUTHORIZED REPRESENTATIVE

The Cooperative Authorized Representative must print name, sign, and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. Attach explicit authorization to complete the application on behalf of the members of the cooperative.

_____________________________________________________________________________________________________________

PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average 2 hours 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 any other aspect of this collection of information, including suggestions for reducing the burden, to NOAA, National Marine Fisheries Service, Alaska Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, P.O. Box 21668, Juneau, AK 99802-1668.

ADDITIONAL INFORMATION

Before completing this form please note the following: 1) 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; 2) This information is mandatory and is required to manage the commercial fishing effort of the CDQ program in the BSAI and the Amendment 80 Program under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.); 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act as amended in 2006. It is also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.

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Application for

Amendment 80 Cooperative Quota Permit

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