Change of MS/CV Endorsement and Catch History Assignment

OMB Control No. 0648-0620, Expires on: xx/xx/xxxx

Change of MS/CV Endorsement and Catch History Assignment Registration Application Form Pacific Coast Groundfish Trawl Rationalization Program

UNITED STATES DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration National Marine Fisheries Service, West Coast Region Fisheries Permits Office 7600 Sand Point Way NE, Bldg. 1 Seattle, WA 98115-0070 Phone (206) 526-4353 Fax (206) 526-4461 www.westcoast.fisheries.noaa.gov

INSTRUCTIONS

This form must be completed and submitted to the National Marine Fisheries Service (NMFS) at the address given above to apply for a change of mothership catcher vessel (MS/CV) endorsement and associated catch history assignment (CHA) registration. A separate form must be completed for each distinct MS/CV endorsement and assignment CHA registration change. To complete the application process, any Economic Data Collection surveys due from the MS/CV-endorsed trawl limited entry permit owner must be deemed complete by the NOAA/Northwest Fisheries Science Center. Please submit your current MS/CV-endorsed trawl limited entry permit with the completed application form.

Section A - Current Permit Information

Identify the current trawl limited entry permit and permit owner to which the MS/CV endorsement and CHA are registered to. List the MS/CV-endorsed permit number and the MS/CV endorsement and CHA ID number, found on the permit. List the permit owner name as given on the current permit, as well as the tax identification number (TIN) for business entities or date of birth (DOB) for individuals. Please provide the business mailing address, phone number, fax number and email address.

Section B - New Permit Information

Identify the new trawl limited entry permit number to which the MS-CV endorsement and CHA will be transferred. List the permit owner name as given on their current permit, as well as the tax identification number (TIN) for business entities or date of birth (DOB) for individuals. Please provide the business mailing address, phone number, fax number and email address.

Section C - Transaction Price Information for MS/CV Endorsement and Catch History Assignment

You must provide price information for the transaction, as specified at §660.140 (g)(2)(iv)(B). Please indicate whether the transaction was monetary or non-monetary. If this is a monetary transaction, please provide the price. If this is a non-monetary transaction, please provide further information describing the change in registration of the MS/CV endorsement and associated CHA.

Section D - Certification of Applicant

The applicant or authorized representative must sign and date the form to certify that all information set forth in the form is true, correct and complete to the best of the applicant’s knowledge or belief. The form will not be considered without the applicant or authorized representative’s signature. NMFS may request that the authorized representative for a business entity include a copy of the corporate resolution or other document authorizing the individual to sign and certify on behalf of the business entity.

Supplemental Documentation

• Submit your current MS/CV-endorsed limited entry trawl permit with this form.

OMB Control No. 0648-0620, Expires on: xx/xx/xxxx

Change of MS/CV Endorsement and Catch History Assignment Registration Application Form Pacific Coast Groundfish Trawl Rationalization Program

UNITED STATES DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration National Marine Fisheries Service, West Coast Region Fisheries Permits Office 7600 Sand Point Way NE, Bldg. 1 Seattle, WA 98115-0070 Phone (206) 526-4353 Fax (206) 526-4461 www.westcoast.fisheries.noaa.gov

Section A - Current Permit Information (Identify the current trawl limited entry permit and permit owner to which the MS/CV endorsement and catch history assignment are registered to)
1. Permit Number GF			2. MS/CV Endorsement and CHA ID Number
3. Current Permit Owner Name			4. TIN (if business) or DOB (if person)
5. Business Mailing Address Street or PO Box			6. Business Phone ( )
			7. Business Fax (optional) ( )
City	State	Zip Code	8. Business Email (optional)

Section B - New Permit Information (Identify the new trawl limited entry permit and permit owner to which the MS/CV endorsement and catch history assignment will be registered to)
1. Permit Number GF
2. Current Permit Owner Name			3. TIN (if business) or DOB (if person)
4. Business Mailing Address Street or PO Box			5. Business Phone ( )
			6. Business Fax (optional) ( )
City	State	Zip Code	7. Business Email (optional)

Section C – Transaction Price Information for MS/CV Endorsement and Catch History Assignment

(Mandatory field)

1. The nature of the transaction was:

□ Monetary □ Non-Monetary

2. If the transaction was monetary, please provide the selling price of the above listed MS/CV endorsement and catch history assignment:

$___________________________

3. If the transaction was non-monetary, please describe the nature of the transaction [i.e. registering the endorsement and catch history assignment to another trawl limited entry permit that I own, or trading it for shoreside IFQ quota shares or quota pounds (list species and amount), etc.]:

Section D – Certification of Applicant
Under penalties of perjury, I hereby declare that I, the undersigned, am authorized to certify this application on behalf of the applicant and completed this form, and the information contained herein is true, correct, and complete to the best of my knowledge and belief.
Signature of Applicant or Authorized Representative	Date
Printed Name of Applicant or Authorized Representative

WARNING STATEMENT: A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under 15 CFR Part 904, a civil penalty up to $100,000 under 16 USC 1858, and/or criminal penalties including, but not limited to, fines or imprisonment or both under 18 USC 1001.

PRIVACY ACT STATEMENT: Some of the information collection described above is confidential under section 402(b) of the Magnuson-Stevens Act and under NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. TIN, DOB, business phone number, fax number, email and transaction price information are not released to the public. The information collected is part of a Privacy Act System of Records, COMMERCE/NOAA #19, Permits and Registrations for United States Federally Regulated Fisheries. An amended notice was published in the Federal Register on August 7, 2015 (80 FR 47457) and became effective on September 15, 2015 (80 FR 55327).

PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 0.58 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 suggestions for reducing this burden to NOAA/National Marine Fisheries Service, West Coast Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected 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.