observer notification form

Reef Fish - Observer FAX Notification Form

This form is provided for your response. Please complete and return this form at least 48 hours prior to your estimated departure. The information can be mailed to: NOAA/NMFS, Galveston Laboratory, 4700 Avenue U, Galveston, TX 77551 or Faxed to (409-766-3489); ATTN: MIKE HARRELSON, PAT CRYER, JEFF PULVER and/or MATT DUFFY. If the vessel is not fishing or is involved in another fishery during the selection period, please state in the comment section of this form which fishery and gear used (include contact number).

Captain's Name: _______________________________ Vessel Name: ____________________________

Documentation/Vessel Number: _______________________________ Overall Length: __________ (ft)

Crew Size: _______ (include skipper) Bunk Capacity: _________ Life Raft Capacity: __________

Contact Person/Telephone Number(s): _____________________________________________________

Communication Equipment (please list)	Commercial Fishing Vessel Safety
	Examination Decal
Cellular / SAT phone:           	Serial Number: 
VHF: 	Date of issuance
	________/________ Month Year 
Single Side Band: 
Call sign: 

Vessel Fishing Status:

Port of Departure:

Dock Facility: _________________________________________________________________________ 

Street: _______________________________________________________________________________
City: ___________________________ State: _____ Phone Number: ( ) _______-____________ Departure Date: ___/___/___ Time: ___:___ (AM or PM) Anticipated Landing Date: ___/___/___

Expected Landing Port: (if different from port of departure)

Dock Facility: _________________________________________________________________________

Street: _______________________________________________________________________________
City: ____________________________ State: ______ Phone Number: ( ) ______-_____________

Primary Language: (if other than English) ________________________

Comments: __________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

PAPERWORK REDUCTION ACT STATEMENT: Collection of information through the observer program provides data for stock assessments and estimates of bycatch. Public reporting burden for completing the vessel information form above is estimated at 2 minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to: National Marine Fisheries Service, F/SF1, 1315East West Highway, Silver Spring, MD 20910. Providing the requested information is mandatory fisheries under the Magnuson-Stevens Fishery Conservation and Management Act (16U.S.C. 1801 et seq.) In accordance with NOAA Administrative Order 216-100, it is agency policy not to release confidential information, other than in aggregate form. 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. This is an approved information collection under OMB#0648-0593 and expires Nov 30, 2015.