Reimbursement Invoice for Contract Observers - Liability

NMFS/SEFSC/POP

OMB Control #0648-0593. Expires 12/31/2021

REIMBURSEMENT INVOICE FOR CONTRACT OBSERVERS
VESSEL NAME

TRIP NUMBER

ORGANIZATION CODE

TASK NUMBER

DATES OF TRIP
TO

RATE

DAYS AT SEA

MEAL EXPENSES
$25 / DAY
RATE

SUBTOTAL

X
DAYS AT SEA

LIABILITY INSURANCE
*ATTACH ENDORSEMENT AND BILLING STATEMENT

COMPANY NAME

AGENT NAME

PHONE
CORPORATION / OWNER NAME

TIN (Taxpayer Identification Number)

MAILING ADDRESS

PHONE

DATE

SIGNATURE

TOTAL

Public Burden Statement - Effective 4/30/2020
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork
Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0648-0593. Without this approval, we could not conduct this
information collection. Public reporting for this information collection is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are mandatory. Send comments regarding this burden estimate or any other aspect of this information
collection, including suggestions for reducing this burden to the NOAA/NMFS/SEFSC at: 75 Virginia Beach Drive, Miami, FL 33149, Attn: Fisheries Biologist Andy Davis, Andrew.Davis@noaa.gov