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U.S. DEPARTMENT OF COMMERCE |
NOAA FORM 88-164 |
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NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION |
Revised 10-2014 |
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FISHERMEN'S CONTINGENCY FUND CLAIM APPLICATION |
OMB APPROVED NO. 0648-0082 |
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EXPIRES 02-28-2018 |
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INFORMATION |
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Claimant’s Name |
SSN |
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Business Name |
Tax ID # |
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Mailing Address |
Citizenship |
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City |
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State |
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Zip |
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Occupation |
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Email Address |
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Cell |
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Vessel Name |
Vessel # |
Phone |
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Home Port |
Vessel Type |
Tonnage |
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Locational coordinates of obstruction (GPS) |
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Date 15-day Report filed |
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Did you recover the obstruction? (Y/N) If yes, keep it as evidence. |
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Was a Surface marker attached to or near the obstruction? (Y/N) |
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If obstruction dragged, at what location was it left? |
Do you have photos of obstruction &/or damage? (Y/N) If yes, attach. |
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Describe obstruction and include if surface marker was attached or near the obstruction. State why you believe the obstruction is associated with oil and gas activities on the Federal Outer Continental Shelf.
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Circumstances of Casualty (Damage or Loss) |
Amount Claimed |
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Date of Casualty |
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Gear Loss (from page 3) |
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Time of Day |
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Gear Damage (from page 3) |
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Water Depth |
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Vessel Damage (from page 3) |
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Visibility |
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Vessel Loss |
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Vessel’s Speed |
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Economic Loss (from page 3) |
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Vessel’s Direction |
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Fuel (from page 3) |
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How much time did casualty involve? |
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Other Expenses (from page 4) |
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How many fishing days did you lose due to casualty? |
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Total |
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Explain the Vessel's activity at the time of casualty.
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Explain how the captain and crew responded.
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Explain any attempts to retrieve gear. State the number of gear units deployed and the number lost.
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Explain the extent of damage.
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Explain what captain and crew did after casualty. For example, did the vessel continue to fish or return to port?
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If returned to port, why?
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How much time did the casualty involve?
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Names of other vessels in the vicinity at the time of casualty.
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Witnesses |
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Each claim must contain notarized statements from any material witnesses to the casualty. Statements must describe the basic circumstances (i.e. who, when, what was lost/damaged, etc.) under which the casualty occurred and any knowledge as to cause of the casualty. Statements must include the occupational status (i.e. vessel owner, vessel operator, crew, etc.). Provide the following information and attach the notarized statements. Attached additional sheets if more than 3 witnesses. |
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Name 1 |
Street Address |
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City |
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State |
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Zip |
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Phone |
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Name 2 |
Street Address |
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City |
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State |
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Zip |
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Phone |
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Name 3 |
Street Address |
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City |
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State |
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Zip |
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Phone |
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Fuel – Complete this section if you are claiming for extra fuel consumed as a result of the casualty. |
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List the dollar amount for fuel you are claiming for extra fuel consumption. Explain how you calculated this amount.
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How many days had you been fishing when the casualty occurred? |
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On the casualty trip, how many hours (total) of running time was used to go to/from your port to casualty fishing site? |
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How many extra hours of running time are you claiming because of casualty? |
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What was the price per gallon (receipts must be submitted) did you pay for the fuel burned on the casualty trip? |
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Economic Loss Claimed |
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Provide the data for the following five (5) fishing trips: (a) three (3) trips prior to the casualty; (b) the casualty trip; and (c) the post-casualty trip. Attach copies of the fish trip tickets. |
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Date of Trip Ticket To From |
Number of Pounds of Fish Caught |
Number Days Spent Fishing |
Dollar Value of Catch |
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1 |
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2 |
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3 |
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Total |
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Average |
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Take number of days lost fishing due to casualty and multiply by Average Dollar Value of Catch |
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Then multiply it by .50 for maximum amount economic loss allowed |
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Date of Trip Ticket To From |
Number of Pounds of Fish Caught |
Number Days Spent Fishing |
Dollar Value of Catch |
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Casualty Trip |
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Post-Casualty |
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Claimed Gear – Lost or Damaged List each gear item for which you seek compensation. Describe item and include quantity and size. |
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Item |
Lost or Damaged |
Date of Purchase |
Purchase Price |
Replacement or Repair Date |
Replacement or Repair Cost |
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Total |
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Attach additional sheet(s) if needed. Submit proof of purchase (i.e. sales receipts, affidavits, etc.), an estimate for repair or replacement, and documentation for the date repair began and ended or date the replacement gear ordered and received. |
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Other Expenses List any other expenses you have incurred as a result of the casualty for which your claim is filed. Submit receipts. |
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Amount |
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Other Information |
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Provide a statement on the amount of time lost from fishing because of the damage or loss and a full explanation of why the time period is reasonable.
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Remarks and additional information.
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Statements and Signatures |
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CRIMINAL PENALTY FOR FRAUDULENT CLAIM. Any person who files a fraudulent claim is subject to criminal prosecution under 18 U.S.C. Section 284 and 1001, each of which, upon conviction, imposes a penalty of not more than a $10,000 fine and 5 years imprisonment, or both.
Privacy Act Statement. Authority: The collection of this information is authorized by Title 45 U.S.C. 1177 and CFR Part 259. The data is for the evaluation of eligibility for compensation from the Fishermen’s Contingency Fund. Compensation will not be considered unless all requested information is furnished. Purpose: In order to determine eligibility for the Fishermen’s Contingency Fund, the NOAA National Marine Fisheries Service (NMFS) requires financial information, vessel owner contact data, vessel and licensing information, damage estimates, replacement invoices, verification of payments, fish ticket data, economic and fuel loss estimates, snag information, and other data as relevant. Routine Uses: NMFS will use this information to determine eligibility for compensation from the Fishermen’s Contingency Fund. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within NMFS’ Financial Services Division. Disclosure of this information is also subject to all of the published routine uses as identified in Commerce/NOAA-21, Financial Services Division. Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of eligibility and compensation from the program.
Public reporting burden for this collection of information for a complete FCF claim (both forms 88-164 and 88-166) is estimated to average 8 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 suggestions for reducing this burden to National Marine Fisheries Service (NMFS or NOAA Fisheries), Financial Services Division, F/MB5 FCF, 1315 East West Hwy, 13th Floor, Silver Spring, MD 20910. The information collected is confidential under the Magnuson-Stevens Conservation and Management Act, as amended in 2006, NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics and 15CFR259.38 (b). Confidential name and address information will be released via a NOAA Fisheries website for informational purposes. All other data submitted will be handled as 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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SURROGATION AGREEMENT. I, ____________________________________(name) , on behalf of individual/corporation, in consideration of the compensation received pursuant to the provisions of the Outer Continental Shelf Lands Act Amendments of 1978, Title IV, from the United States of America, represented by the Secretary of Commerce, acting by and through the Administrator for the National Oceanic and Atmospheric Administration (the Secretary) on the date hereof, I do hereby subrogate, assign, transfer and set over to the Secretary and the Secretary’s successors and assigns, any and all rights and remedies, sums of money now due or owing to and nature, which I have had, or now have, or may have arising out of the loss, damage or destruction to our fishing vessel or gear for which the compensation has been granted. I hereby appoint the Secretary, the Secretary’s successors and assigns, myself true and lawful attorney and attorneys, with full power of substitution and revocation, for me and in my name, or otherwise, but for the sole use benefit of the said Secretary, the Secretary’s successors and assigns, to ask, demand, sue for the said claim or claims, or any part thereof.
I agree to provide the Secretary with all available and relevant information concerning the circumstances surrounding the events leading to the loss, damage or destruction for which the aforementioned compensation has been received. I also undertake to furnish the Secretary with such affidavits or declarations and to give such oral evidence as the Secretary may, in his/her discretion, deem necessary for the lawful pursuit of any claim arising from the aforementioned subrogated rights.
In witness whereof, I have hereunto set my hand on the date indicated below.
__________________________________________________ ____________________ Signature Date |
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I, ______________________________________ (name), a U.S. citizen, am the _____ Owner _______ Operator of the
________________________________________ (vessel) and have read all of the foregoing statements and supporting documents relating to this claim, and to the best of my knowledge all statements and documents are true and correct. No portion of the claimed loss and/or damage may be recoverable through an insurance claim. I also agree to repay all or any part of the award if the award should for any reason be subsequently reduced.
__________________________________________________ ____________________ Signature Date |
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INSTRUCTIONS TO CLAIMANTS |
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I. GENERAL. The Fishermen's Contingency Fund (FCF) is authorized by Title IV of the Outer Continental Shelf (OCS) Lands Act Amendments of 1978. Its purpose is to compensate commercial fishermen for damage or loss caused by obstructions associated with OCS oil and gas activities in U.S. Federal waters. The Program is administered by the NMFS FCF, Financial Services Division F/MB5, 1315 East-West Hwy, 13th Floor, Silver Spring, MD 20910.
II. WHAT CAN BE CLAIMED. You may file for actual and consequential damages as follows:
III. NEGLIGENCE CLAIMANT. An award will be reduced to the extent that the damage or loss was caused by your negligence or fault. Basic grounds for finding a claimant negligent or at fault are listed in the FCF Regulations. Negligence of the owner or operator of fishing gear will affect crew member awards.
IV. INSURANCE PROCEEDS. An FCF award will be reduced by the amount of any compensation you are entitled to receive from insurance.
V. PENALTY FOR FALSE CLAIMS. Any person who files a fraudulent claim is subject to prosecution under 18 USC sections 2187 and 1001, each of which, upon conviction, imposes a penalty of not more than $10,000 fine and 5 years imprisonment, or both.
VI. REQUIRED DOCUMENTATION. Documents which must be submitted with your claim are:
VII. NMFS PROCESSING OF CLAIMS.
VIII. PAYMENT OF AWARD FOR CLAIM. When an initial determination becomes final, NMFS FCF shall disburse the amount awarded.
IX. SUBROGATION. NMFS must obtain a subrogation agreement signed by you which assigns to the NMFS your rights against third parties and provides that you will assist NMFS in any reasonable way to pursue those rights.
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Authority: Public Law 97-212 (43 USC 1841 et seq.). Regulations: 50 CFR Part 296. |
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Contact information: NMFS F/MB5 FCF, 1315 East West Highway, 13th Floor, Silver Spring, MD 20910. Telephone: 301.427.8725. Fax: 301.713.1306. Additional information at www.nmfs.noaa.gov/mb/financial_services/fcf.htm |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Elaine.Saiz |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |