International Dolphin Conservation Program Vessel Operat

OMB Control No. 0648-0387
Expires: October 31, 2018

OPERATOR PERMIT APPLICATION - 2019
No Fee Required
The collection of information is mandated by the Marine Mammal Protection Act (16 U.S.C. 1371) and by implementing regulations contained at 50 CFR §216.24(b)(2). The
information supplied on this form will be used by the National Marine Fisheries Service to authorize the incidental take and to alert vessel owners of applicable rules and
regulations regarding the permit for the taking of marine mammals incidental to commercial purse seine fishing for yellowfin tuna in the eastern tropical Pacific Ocean. The
name of the operator supplied on this form may be released under the Freedom of Information Act. All other information supplied on this form are considered proprietary and
therefore subject to data confidentiality restriction of National Oceanic and Atmospheric Administration Administrative Order 216-100.

1. OPERATOR INFORMATION
OPERATOR NAME:
(First, Middle, Last)

HOME ADDRESS:
TELEPHONE:
FAX:
EMAIL:
2. PERMIT INFORMATION
VESSEL NAME(S):

DATE, LOCATION, AND PROVIDER OF MOST RECENT TUNA PURSE SEINE MARINE MAMMAL SKIPPER WORKSHOP:

OTHER FEDERAL, STATE, AND COMMERCIAL LICENSES HELD BY OPERATOR:
(include type, identification numbers, and expiration dates)

I declare that the information in this application is true and complete.

APPLICANT'S SIGNATURE

DATE

-or-

APPLICANT'S REPRESENTATIVE NAME (PLEASE PRINT)

SIGNATURE

DATE

Upon Completion, submit to: National Marine Fisheries Service, Attn: Permits, 501 West Ocean Blvd., Suite 4200, Long Beach CA 90802-4213
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 any other
aspect of this collection of information, including suggestions for reducing this burden, to Regional Administrator, West Coast Region, National Marine Fisheries Service, 501
West Ocean Boulevard, Suite 4200, Long Beach, California, 90802-4213, (562) 980-4000
The collection of this information is authorized under the Marine Mammal Protection Act. In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service
(NMFS) requires the use of permits or registrations by participants in the United States. Information on NOAA Fisheries permit applicants and renewing holders includes vessel
owner contact information, date of birth, and vessel descriptive information. Permit holder information may be used as sampling frames for surveys, as part of Fishery
Management Council (FMC) analysis to support FMC decisions. The Department will use this information to determine permit eligibility and to identify fishery participants.
Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within NMFS offices, in order to coordinate monitoring and
management of sustainability of fisheries and protected resources, as well as with the applicable State or Regional Marine Fisheries Commissions and International
Organizations. Disclosure of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/NOAA-19,
Permits and Registrations for the United States Federally Regulated Fisheries. Furnishing this information is voluntary; however, failure to provide complete and accurate
information will prevent the determination of eligibility for a permit.
The National Marine Fisheries Service may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current and valid
OMB Control number.