Application for Limited Access Fishery

Revised: 11/06/2018 OMB Control No. 0648-0565 Expiration Date: 03/31/2019

Application for Amendment 80 Limited Access Fishery Permit

U.S. Dept. of Commerce/NOAA National Marine Fisheries Service (NMFS) Restricted Access Management Program (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 Alaska local time (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. If sent by U.S. mail, the application must be postmarked by that time.

BLOCK A -- APPLICANT IDENTIFICATION
1. Applicant Name:		2. Tax ID Number:		3. NMFS Person ID:
4. Permanent Business Mailing Address:
5. Business Telephone Number:	6. Business Fax Number:		7. E-mail Address (if available):
BLOCK B -- AMENDMENT 80 VESSEL IDENTIFICATION
1. Name of the Amendment 80 vessel owned by applicant:			2. ADF&G Number:
			3. USCG Number:
1. Name of the Amendment 80 vessel owned by applicant:			2. ADF&G Number:
			3. USCG Number:

BLOCK C – AMENDMENT 80 LLP IDENTIFICATION
List the Amendment 80 LLP license number(s) held by the applicant that will be used in Limited Access Fishery.

BLOCK D – AMENDMENT 80 QS PERMIT INFORMATION
List the Amendment 80 QS permit number(s) held by the applicant that will be used in Limited Access Fishery.

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BLOCK E -- AMENDMENT 80 QS OWNERSHIP DOCUMENTATION
Provide the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS Permit(s) held by the applicant and the percentage ownership each person and individual holds in the Amendment 80 QS Permit.
Name(s)		Percentage Ownership
BLOCK F -- EDR SUBMISSION
Indicate whether the applicant has submitted a timely and complete the Annual Trawl Catcher/Processor Economic Data Report for each Amendment 80 QS permit held by that person as required under § 679.94. YES NO
BLOCK G -- APPLICANT CERTIFICATION
The applicant must sign and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. If the application is completed by a designated representative, then explicit authorization signed by the applicant must accompany the application.
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.
Signature of Applicant (or Authorized Representative):	Date Signed:
Printed Name of Applicant (or Authorized Representative):

Instructions for

APPLICATION FOR AMENDMENT 80 LIMITED ACCESS FISHERY PERMIT

An Amendment 80 limited access fishery permit is required for an Amendment 80 Quota Share (QS) holder to catch, process, and receive Amendment 80 species assigned to the Amendment 80 limited access fishery, or use halibut and crab prohibited species catch (PSC) assigned to the Amendment 80 limited access fishery.

An Amendment 80 limited access fishery permit is issued annually to an Amendment 80 QS holder who has submitted:

• A timely and complete application for the Amendment 80 limited access fishery as described at § 679.91 that is approved by NMFS; and

• A timely and complete Annual Trawl Catcher/Processor Economic Data Report (EDR) for all Amendment 80 QS permits held by that person as described under § 679.94 that is subsequently approved by NMFS.

Pacific States Marine Fisheries Commission (PSMFC) has been designated by NMFS to be the Data Collection Agent 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 am80edr@psmfc.org.

An Amendment 80 limited access fishery permit is valid until whichever of the following occurs first:

• Until the end of the year for which the Amendment 80 limited access fishery permit is issued; or

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

Deadline: A completed EDR must be received by NMFS no later than 1700 hours A.l.t. on June 1 of the year following the calendar year during which the Amendment 80 CQ permit was held, or if sent by U.S. mail, postmarked by that date.

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 legible copy of the Amendment 80 limited access fishery permit must be carried onboard an Amendment 80 vessel assigned to the Amendment 80 limited access fishery when fishing in the BSAI or adjacent waters open by the State of Alaska for which it adopts a Federal fishing season.

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

When complete, submit application to NMFS:

♦	By mail to:	NMFS Alaska Region Restricted Access Management (RAM)
		P.O. Box 21668 Juneau, AK 99802-1668
♦	By fax to:	(907) 586-7354
♦	By delivery to:	709 West 9th Street, Room 713 Juneau, AK 99801

If you need additional information, contact Restricted Access Management at (800) 304-4846 (Option No. 2) or

(907) 586-7202 (Option No. 2).

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 -- APPLICANT IDENTIFICATION

1. Applicant name

2. Tax ID number

3. NMFS person ID

4. Permanent business mailing address

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

BLOCK B -- AMENDMENT 80 VESSEL IDENTIFICATION

1. Name of Amendment 80 vessel(s) owned by applicant to be used in the limited access fishery.

2. ADF&G vessel registration number

3. USCG documentation number

BLOCK C – AMENDMENT 80 LLP IDENTIFICATION

List the Amendment 80 LLP license number(s) held by the applicant that will be used in the limited access fishery.

BLOCK D – AMENDMENT 80 QS PERMIT INFORMATION

List the Amendment 80 QS permit number(s) held by the applicant that will be used in the limited access fishery.

BLOCK E – AMENDMENT 80 OWNERSHIP DOCUMENTATION

Names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS Permit(s) held by the applicant; and

Percentage ownership each person and individual holds in the Amendment 80 QS Permit.

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%)

BLOCK F – EDR SUBMISSION

Indicate (YES or NO) whether the applicant has submitted a timely and complete EDR for each Amendment 80 QS permit held by that person as required under § 679.94.

BLOCK G -- APPLICANT CERTIFICATION

Enter applicant or authorized representative printed name, signature, and date signed.

If completed by a designated representative, attach authorization.

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 the instructions, searching the existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Assistant Regional Administrator, Sustainable Fisheries Division, NOAA National Marine Fisheries Service, P.O. Box 21668, Juneau, AK 99802-1668.

ADDITIONAL INFORMATION

Before completing this form, please note the following: 1) Notwithstanding any other provision of 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 commercial fishing efforts under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.) as amended by Public Law 109-479; 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act. They are also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.

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.

Purpose: NMFS uses information provided in this application to determine eligibility for the applicant to receive an Amendment 80 (A80) limited access fishery permit and to assign the permit. This permit authorizes the QS holder to catch, process, and receive A80 species assigned to the A80 limited access fishery, or use halibut and crab prohibited species catch assigned to the A80 limited access fishery, for the specified fishing year. The primary purpose for requesting the SSN/TIN is for the collection and reporting on any delinquent amounts arising out of such person’s relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). Personal information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may be disclosed to the public.

Routing Uses: Disclosure of this information is subject to the published routine uses identified in the Privacy Act System of Records Notice COMMERCE/NOAA-19, Permits and Registrations for the United States Federally Regulated Fisheries. NMFS posts some information from this form on its public website (https://alaskafisheries.noaa.gov/). In addition, NMFS may share information submitted on this application with other State and Federal agencies or fishery management commissions, including staff of the North Pacific Fishery Management Council and Pacific States Marine Fisheries Commission.

Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent determination of eligibility for an A80 limited access fishery permit.

Application for A80 Limited Access Fishery Permit ― Page 2 of 9