Leasing Downgrade Request Form

APPLICATION TO DOWNGRADE

NE MULTISPECIES DAYS-AT-SEA (DAS)

LEASING BASELINE

Provide all information requested.

Provide all information requested.

SUBMIT TO

NE MULTISPECIES DAS LEASING PROGRAM

US DEPARTMENT OF COMMERCE, NOAA

NATIONAL MARINE FISHERIES SERVICE

55 GREAT REPUBLIC DRIVE, GLOUCESTER, MA 01930

ONe

ONE BLACKBURN DRIVE, GLOUCESTER, MA 01930

Owner Name: Permit #:

Vessel Name: Official #:

(or state registration #)

Current Vessel Specifications: Length Overall: ______

Horsepower: ________

Check One:

____ Downgrade DAS Leasing baseline of above vessel to the

specifications on verified documents that have been previously

submitted.

____ Downgrade DAS Leasing baseline of above vessel to the

specifications on verified documents that I am currently submitting

with this application.

Signed: _______________________ Dated: _____________________

(Vessel Owner)

By signing this application you agree to downgrade the vessel specifications Length Overall (LOA) and Horsepower (HP) for DAS Leasing purposes only. This is a one-time DAS Leasing baseline downgrade for this permit that can not be reversed for this vessel and can not be applied for again in the future, even if the current vessel baseline specifications change through modification or replacement. If a vessel replacement occurs after a DAS Leasing baseline downgrade has occurred the DAS Leasing baseline will revert to the original DAS Leasing baseline specifications for that permit.

This form is required to obtain approval for the downgrade of DAS leasing baseline specifications under 50 CFR 648.82(k)(4)(xi) for NE multispecies permit holders. Signature of this form certifies that permit holders comply with limited access permit requirements specified in 50 CFR 648.4 and that information provided on this form is true, complete and correct to the best of their knowledge, and made in good faith (18 U.S.C. 1001). Making a false statement on this form is punishable by law.

Information obtained from the lease application is held confidential as required by NOAA Administrative Order 216-100, Confidentiality of Fisheries Statistics, and would be used only in summarized form (without identifying the source of data, i.e., vessel name, owner, etc.) for management of the fishery in the future.

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.

Public reporting burden for this collection of information is estimated to average 1 hour per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. Send comments regarding this burden estimate or suggestions for reducing this burden estimate or any other aspect of this collection of information to NMFS, 55 Great Republic Drive, Gloucester MA 01930.

OMB Approval No. 0648-0605

Expires 1/31/2019

Privacy Act Statement

Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and Management Act, 16 U.S.C 1801 et seq., the High Seas Fishing Compliance Act, the Tuna Conventions Act of 1950, the Antarctic Marine Living Resources Convention Act, the Western and Central Pacific Fisheries Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq), the Marine Mammal Protection Act, the Endangered Species Act and the Fur Seal Act. The authority for the mandatory collection of the Tax Identification Number (TIN) is 31 U.S.C. 7701.

Purpose: 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, TIN 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.

Routine Uses: 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.

Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of eligibility for a permit.