General Permit Applications and Permit Reports (Scientific, Education, & Mgmt Activities)

Papahânaumokuâkea Marine National Monument Permit Applications and Reports for Permits

PMNM Compliance Information Sheet - Instructions

General Permit Applications and Permit Reports (Scientific, Education, & Mgmt Activities)

OMB: 0648-0548

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Papahānaumokuākea Marine National Monument
Compliance Information Sheet - Instructions

Papahānaumokuākea Marine National Monument
Compliance Information Sheet – INSTRUCTIONS
NOTE: Issuance of a Monument permit is dependent upon the completion and review of the
application and Compliance Information Sheet.

1. Updated list of personnel to be covered by permit. List all personnel names and their
roles here (e.g. John Doe, Diver; Jane Doe, Field Technician, Jerry Doe, Medical
Assistant):
List all personnel participating in the proposed activity. Include first and last name, position
(John Doe, Diver; Jane Doe, Field Technician; Jerry Doe, Medical Assistant, etc.), affiliation,
telephone number, and email address for each individual. If specific names of all participants are
not known at the time this form is submitted, then specific positions must be provided as
placeholders for numbers of persons requested to enter the Monument. The Application Review
Committee may request resumes, biographies, or CVs for any personnel listed, at a later date.
Attach additional information if necessary.
NOTE: It is the Applicant’s responsibility to keep Monument staff apprised of any proposed
personnel changes. Full names of personnel and roles will be required in the Monument
Compliance Information Sheet prior to issuance of a permit.
2. Specific Site Location(s): (Attach copies of specific collection locations):
Provide additional detail of on site locations here. Additional detail may include, but is not
limited to: specific lat/long coordinates, habitat type, water depth, substrate type, etc. If
appropriate, attach an Excel spreadsheet or Shape file to this sheet. Contact the Monument
Permit Coordinator for additional information.
3. Other permits (list and attach documentation of all other related Federal or State
permits):
List permit numbers for all other related Federal or State Permits for which you have applied or
received. These may include, but are not limited to a Bird Banding Lab / Migratory Bird Permit,
State of Hawaii Department of Land and Natural Resources Division of Forestry and Wildlife
Permit, State Conservation District Use Permit, Endangered Species Act consultations, Marine
Mammal Protection Act Permit, International Animal Care and Use Committee, or any
University permits. Attach copies of permits already received. You will be required to provide
copies of all required permits to the Monument Permit Coordinator prior to departure for the
Monument.
List all permits you have received for the same or similar activities from any State or Federal
entity.
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Papahānaumokuākea Marine National Monument
Compliance Information Sheet - Instructions

3a. For each of the permits listed, identify any permit violations or any permit that
was suspended, amended, modified or revoked for cause. Explain the circumstances
surrounding the violation or permit suspension, amendment, modification or
revocation.
4. Funding sources (Attach copies of your budget, specific to proposed activities under this
permit and include funding sources. See instructions for more information):
Salary information and detailed program budgets are not necessary. List any in-kind
contributions awarded for the proposed activities.
5. Time frame:
The “Activity start” and “Activity completion” must include the entire span of the proposed
activity. In other words, these dates must specify if the proposed activity is a multi-year activity
and if so, the duration the proposed activity is expected to be conducted in the Monument.
NOTE: Multi-year projects do NOT guarantee the issuance of additional permits in subsequent
years.
If “Dates actively inside the Monument” cannot be determined at the time of application, explain
the reasons dates are pending (e.g., ship schedules, flight schedules). At minimum, describe the
intervals of time you propose to visit the Monument (e.g., during a specific nesting season or
quarterly), and the proposed duration of the proposal.
For Personnel Schedule, list those who will be in the Monument (specific locations) and for what
periods of time. Attach additional documentation if necessary.
6. Indicate (with attached documentation) what insurance policies, bonding coverage,
and/or financial resources are in place to pay for or reimburse the Monument trustees
for the necessary search and rescue, evacuation, and/or removal of any or all persons
covered by the permit from the Monument:
All persons covered under the permit are responsible for the cost of removing themselves from
the Monument at the conclusion of the term of the permit, revocation, or other enforcement
matters. Additionally, persons covered under the permit are responsible for the cost of removing
themselves from the Monument in the event of a necessary medical evacuation, emergency
evacuation, including weather, or for the cost of any necessary search and rescue operation.
Demonstrate that all persons covered under the permit have either insurance coverage, adequate
bond, or have other financial resources to pay Monument Co-Trustees for the cost of their
necessary search and rescue and/or removal from the Monument.
NOTE: The State of Hawaii requires permittees to carry general liability insurance.
7. Check the appropriate box to indicate how personnel will enter the Monument:
Check the appropriate box to indicate how personnel will enter the Monument. Note which
vessel(s) or aircraft(s) will be used to transport personnel. If entering by a vessel which is not
already permitted to enter the Monument in support of your proposed activity, you must include
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Papahānaumokuākea Marine National Monument
Compliance Information Sheet - Instructions

that respective vessel and its crew on this permit application. If entering by a vessel which is
already permitted to enter the Monument in support of your proposed activity, state the vessel’s
Monument Permit number here.
8. The certifications/inspections (below) must be completed prior to departure for vessels
(and associated tenders) entering the Monument. Fill in scheduled date (attach
documentation):
Check the relevant inspections that you will conduct prior to departure for the Monument.
Include the dates of scheduled inspections. Upon completion of the inspections and any required
cleaning operations, you will be required to provide proof of approved inspections / cleaning to
Monument permit coordination personnel.
All vessels must have at a minimum a Rodent Free Inspection, Hull Inspection, and Ballast
Water Record Inspection no more than 14 days prior to departure for the Monument. If any
small boat operations are proposed to occur within the Monument, then a Tender Vessel Fouling
Inspection must occur in this time frame as well. If any gear will be placed or used in the water
or on land, you must schedule an inspection of these items before departing for the Monument.
For more information on arranging these inspections contact the Monument Permit Coordinator
at (808) 725-5800, or nwhipermit@noaa.gov.
NOTE: Results of inspections may require cleaning operations such as rodent eradication, hull
cleaning, or ballast water maintenance at your own cost before departing for the Monument. If
proposed gear or materials are found to be contaminated with alien species you may be required
to conduct specific cleaning measures or complete replacement of contaminated items at your
own cost before departing for the Monument. Re-inspection may be required.
9. Vessel information (NOTE: if you are traveling aboard a National Oceanic and
Atmospheric Administration vessel, skip this question):
List all vessel information: Vessel name, owner, captain’s name, vessel type, length, gross
tonnage and vessel identification number. List vessel International Maritime Organization
Number (if applicable), flag of origin, call sign, port of embarkation, total ballast water capacity
volume (m3), total number of fuel tanks on ship, total number of ballast water tanks on ship, total
fuel capacity, and last port.
Indicate whether the vessel has a Marine Sanitation Device (MSD) and its type. Explain in detail
how you will comply with the regulations regarding discharge in the Monument. If applicable,
attach schematics of the vessel’s discharge and treatment systems.
List all types and amounts of hazardous materials to be carried on board for vessel or tender
vessel use.
Indicate that the vessel has a NOAA Office of Law Enforcement (OLE)-approved Vessel
Monitoring System (VMS). Provide the name and contact information of the contractor
responsible for installing the VMS system.

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Papahānaumokuākea Marine National Monument
Compliance Information Sheet - Instructions

For more information on NOAA OLE-approved VMS systems, refer to 71 FR 40080. This
information can be located at: http://hawaiireef.noaa.gov/PDFs/VMSfedreg.pdf or contact the
Monument Permit Coordinator.
List the make and model of the VMS to be used while conducting activities in the Monument.
NOTE: All vessels entering the Monument MUST have an NOAA OLE-approved VMS System
installed PRIOR to entering the Monument. “An owner or operator of a vessel that has been
issued a permit for accessing the Monument must ensure that such a vessel has an OLEapproved, operating vessel monitoring system (VMS) on board, when voyaging within the
Monument” (50 CFR 404.5).
Individuals MUST ENSURE that a type-approved VMS unit is installed and that the automatic
position reports are being properly received by the NOAA OLE system prior to the issuance of a
permit. To make sure your VMS is properly configured for the NOAA OLE system, please
contact NOAA OLE at (808) 725-6110 or (808) 725-6100.
10. Tender information:
This question is not required if you are traveling aboard a NOAA vessel.

Additional Information for Land Based Operations
11. Proposed movement of personnel, gear, materials, and, if applicable, samples:
Include answers to the following questions:
If personnel, gear and materials are to be transported to the Monument by vessel, how will
transportation of personnel, gear and materials occur between ship and shore?
If applicable, how will personnel be transported between islands within any one atoll?
Provide a time line of all significant transportation events for arrivals and departures.
12. Room and board requirements on island:
Describe where personnel will sleep/eat/bathe while on the island(s). Note how many personnel
will be using U.S. Fish and Wildlife Service and/or State of Hawaii supplied accommodations
and for how long.
13. Work space needs:
Describe office/desk/workbench/workshop/lab space you expect to use during the proposed
activity on the island(s). Describe all electrical and water needs you expect to use during the
proposed activity on the island(s). Describe what disposal route all water and hazardous
materials will take (e.g., laboratory sink, drains, flow-through aquaria) and where these materials
will ultimately end up.
NOTE: charging batteries, rinsing gear, cleaning tools, painting and maintaining equipment, etc.,
all take space and resources. Requesting use of these resources should be done in this section.
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File Typeapplication/pdf
Authorlasha-lynn.salbosa
File Modified2019-12-11
File Created2017-02-23

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