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pdfAugust 2020
OMB Control #0648-0593. Expires 4/30/2023
Shrimp - 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, ELLEN SIKES, KAYLA CHAPMAN and/or JASON WILLIAMS. 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)
Cellular / SAT phone:
VHF:
Commercial Fishing Vessel Safety
Examination Decal
Serial Number:
Date of issuance
________/________
Month
Year
Single Side Band:
Call sign:
Vessel Fishing Status:
Port of Departure:
Dock Facility: _________________________________________________________________________
Street: _______________________________________________________________________________
City: ___________________________ State: _____
Departure Date: ___/___/___
Phone Number: (
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: 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 65 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 to obtain benefits. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the National Marine Fisheries Service, Shrimp and Reef Fish Observer Programs at: 4700
Avenue U, Galveston, Texas 77551, Attn: Fisheries Administrator, Elizabeth Scott-Denton.
File Type | application/pdf |
File Title | Microsoft Word - SH_Obs_Notification_Form.doc |
Author | judy.gocke |
File Modified | 2020-08-24 |
File Created | 2020-08-24 |