Inspection Request Form (OBSERVER SAMPLE STATION, VIDEO,

Revised: 03/14/2019 OMB Control No. 0648-0330, Expiration Date: 11/30/2020

	INSPECTION REQUEST FORM (OBSERVER SAMPLE STATION, VIDEO, BIN MONITORING and AT-SEA SCALES)

Note: Inspections will be scheduled within ten (10) working days of receiving a request. Requests for inspections in Dutch Harbor and Kodiak will be scheduled within ten (10) days, but may be delayed several days due to weather or logistics.

VESSEL INFORMATION
Vessel Name:	Federal Fisheries Permit:		Vessel Contact Name:
Vessel Contact Phone:	Vessel Contact E-mail:
Address of Vessel Location for Inspection:		Phone on Vessel:

VIDEO SYSTEM SELECTION
Select Video Monitoring Systems To Be Inspected:(more than one may be selected) □Video Bin Monitoring Option □Chinook Salmon Bycatch □BSAI Longline C/Ps □Flow Scale □Deck Sorting
Name of Video Installer to install & maintain system:		Name of Video Installer to install & maintain system:
Will video installer be on site at inspection? □ Yes □ No	Requested Inspection Date:		Requested Inspection Time:

VIDEO MONITORING DIAGRAM ATTACHMENT

You must attach a diagram that is clearly labeled and drawn to scale showing:

• Location of each camera & its coverage area

• Location of any additional video equipment, including monitors & hard drives

• All locations where sorting occurs

• Location of motion-compensated flow scale

Chinook Salmon Bycatch Monitoring:

• Location of salmon storage container

OBSERVER SAMPLING STATION Observer Sampling Station and At-Sea Scale Inspections should be scheduled at least one hour apart.
Would you like your observer sampling station inspection on a different date and time than the video inspection? □ Yes □ No	If YES, what date and time?
Diagram for trawl C/Ps & motherships, clearly labeled and drawn to scale showing the location(s) where all catch will be weighed, the location where observers will sample unsorted catch, and the location of the observer sampling station, including the observer sampling scale and table. Diagram for all other vessels, to scale showing the location(s) where catch comes on board the vessel, the location where observers will sample unsorted catch, the location of the observer sampling station, including the observer sampling scale and table.

AT-SEA SCALES Observer Sampling Station and At-Sea Scale Inspections should be scheduled at least one hour apart.
Would you like your at-sea scale inspection on a different date and time than the video inspection? □ Yes □ No	If YES, what date and time?
Will repair company be on site at inspection? □ Yes □ No	Repair Company Name:
Prior to the at-sea scale inspection make sure: The scale is installed in a rigid and level manner The display & printer are connected and operational Belts leading to the scale are connected and operational (not applicable to platform and hanging scales) Test weights & test weight certification documents are available for inspection (platform scales only) A crew member will be available to help the inspector transport test materials and conduct the testing

At-sea Scales, BSAI Longline C/Ps Video, and Flow Scale:

Fax, mail, or email completed forms and diagrams to:

NOAA/NMFS, Alaska Region

PO Box 21668

Juneau, AK 99802-1668

Ph: 907-586-7228

Fax: 907-586-7465

Email: jennifer.watson@noaa.gov

Bin Monitoring, Chinook Salmon Bycatch Monitoring, and Observer Sample Station:

Fax, mail, or e-mail completed forms and diagrams to:

FMA Observer Program

7600 Sand Point Way NE, Bldg 4

Seattle, WA 98115

Ph: 206-526-4007

Fax: 206-526-4066

Email: station.inspections@noaa.gov

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 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 (Attn: Records Officer).

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 being used 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 in 2006; 4) Submission of this information is necessary for NMFS to approve electronic monitoring systems; 5) Responses to this information request are not confidential.

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: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service collects permit holder information forms for the At-Sea Scales Program, which was developed in response to the need for catch accounting methods that were more precise and verifiable at the level of the individual haul and less dependent on estimates generated by at-sea observers. This was necessary due to the implementation of large-scale catch share programs that required NMFS to provide verifiable and defensible estimates of quota harvest. NMFS also established a set of performance based standards to allow shoreside processors to describe how they will ensure that all delivered catch can be effectively monitored by NMFS-authorized personnel, and that all catch is accurately sorted and weighed by species.

Routine Uses: The Department will use this information to identify fishery participants and evaluate the qualifications of the applicants. 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 required to obtain or retain the benefit of participation in either an at-sea scales program or shore-based catch monitoring program; failure to provide complete and accurate information will prevent the determination of eligibility for registration in either of these programs.

Inspection Request Form

Page 2 of 3