Application for Amendment 80 Cooperative Quota (CQ) Perm

Revised: 02/15/2023

Application for
AMENDMENT 80
COOPERATIVE
QUOTA (CQ) PERMIT

OMB Control No. 0648-0565 Expiration Date: 04/30/2023
U.S. Dept. of Commerce/NOAA
National Marine Fisheries Service (NMFS)
Restricted Access Management (RAM)
P.O. Box 21668
Juneau, AK 99802-1668

(800) 304-4846 toll free / (907) 586-7202 in Juneau
(907) 586-7354 fax / ram.alaska@noaa.gov

This application is used by an Amendment 80 cooperative to request an Amendment 80 CQ permit.
This application must be submitted annually and received by NMFS no later than 1700 hours A.l.t. on
November 1 of the year prior to the year for which the applicant wishes to participate in an Amendment 80
fishery, or if sent by U.S. mail, the application must be postmarked by that time.
ATTACHMENT:
A copy of the cooperative membership agreement or contract must be provided with this application.
BLOCK A – AMENDMENT 80 COOPERATIVE IDENTIFICATION
1. Cooperative's Legal Name:

2. Type of Business Entity under which the Amendment
80 Cooperative is Organized:
3. State in which the Amendment 80 Cooperative is
Legally Registered as a Business Entity:

4. Permanent Business Address:

5. Business Telephone Number:

6. Business Fax Number:

7. Business E-mail Address:

8. Printed Name of Amendment 80 Cooperative’s Designated Representative:

Application for A80 CQ Permit ― Page 1 of 9

BLOCK B – MEMBERS OF THE AMENDMENT 80 COOPERATIVE
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full Name:
2. NMFS Person ID:
3. Amendment 80 QS Permit Number(s):
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS
permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds
in the Amendment 80 QS permit(s).

Name

1. Full Name:

% Ownership in Amendment 80 QS Permit(s)

Amendment 80 QS Permit Holder and Ownership Documentation
2. NMFS Person ID:
3. Amendment 80 QS Permit Number(s):

Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS
permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds
in the Amendment 80 QS permit(s).

Name

1. Full Name:

% Ownership in Amendment 80 QS Permit(s)

Amendment 80 QS Permit Holder and Ownership Documentation
2. NMFS Person ID:
3. Amendment 80 QS Permit Number(s)

Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS
permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds
in the Amendment 80 QS permit(s).

Name

% Ownership in Amendment 80 QS Permit(s)

Application for A80 CQ Permit ― Page 2 of 9

1. Full Name:

Amendment 80 QS Permit Holder and Ownership Documentation
2. NMFS Person ID:
3. Amendment 80 QS Permit Number(s):

Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS
permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds
in the Amendment 80 QS permit(s).

Name

1. Full Name:

% Ownership in Amendment 80 QS Permit(s)

Amendment 80 QS Permit Holder and Ownership Documentation
2. NMFS Person ID:
3. Amendment 80 QS Permit Number(s):

Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS
permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds
in the Amendment 80 QS permit(s).

Name

1. Full Name:

% Ownership in Amendment 80 QS Permit(s)

Amendment 80 QS Permit Holder and Ownership Documentation
2. NMFS Person ID:
3. Amendment 80 QS Permit Number(s):

Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS
permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds
in the Amendment 80 QS permit(s).

Name

% Ownership in Amendment 80 QS Permit(s)

Application for A80 CQ Permit ― Page 3 of 9

BLOCK C – IDENTIFICATION OF AMENDMENT 80
COOPERATIVE MEMBER VESSELS AND AMENDMENT 80 LLP LICENSES

Vessel Name

ADF&G Number/USCG
Documentation Number

Application for A80 CQ Permit ― Page 4 of 9

Amendment 80 LLP
Number

BLOCK D -- IDENTIFICATION OF VESSELS ON WHICH THE CQ ISSUED TO THE
AMENDMENT 80 COOPERATIVE WILL BE USED
ADF&G Number/
Vessel Name
USCG Documentation Number

BLOCK E -- EDR SUBMISSION
Has each member of the Amendment 80 cooperative submitted a timely and complete Annual Trawl
Catcher/Processor Economic Data Report for each Amendment 80 QS permit held by that person as
required under § 679.94?
YES

NO

BLOCK F – CERTIFICATION OF COOPERATIVE AUTHORIZED REPRESENTATIVE
The Cooperative Authorized Representative must sign and date the application certifying that all
information is true and correct to the best of their knowledge and belief; explicit authorization must
accompany the application on behalf of the members of the cooperative.
Pursuant to 28 U.S.C. § 1746, I declare under penalty of perjury that the foregoing is true and
correct.
1. Signature of Cooperative Authorized Representative:

2. Date:

3. Printed Name of Cooperative Authorized Representative; attach explicit authorization to complete the
application on behalf of the members of the cooperative:

Application for A80 CQ Permit ― Page 5 of 9

Application for
Amendment 80 Cooperative Quota (CQ) Permit
A copy of the cooperative membership agreement or contract must be attached to this application.
A Cooperative Quota (CQ) permit is issued annually to an Amendment 80 cooperative that submits a complete
and timely application for CQ that is subsequently approved by the Regional Administrator.
A CQ permit authorizes an Amendment 80 cooperative to participate in the Amendment 80 Program. NMFS
will issue a CQ permit annually to an Amendment 80 cooperative if that Amendment 80 cooperative has
submitted:
◆ A timely and complete application for Amendment 80 CQ.
Deadline: This completed application must be received by NMFS no later than 1700 hours A.l.t. on
November 1 of the year prior to the year for which the applicant wishes to participate in an Amendment
80 fishery, or if sent by U.S. mail, the application must be postmarked by that time.
◆ A timely and complete Annual Trawl Catcher/Processor Economic Data Report (EDR) for each
member of the Amendment 80 cooperative holding Amendment 80 QS as described under § 679.94
that is subsequently approved by the Regional Administrator.
Deadline: The annual EDR submission deadline is June 1 of the year following the year during which the
A80 QS permit was held.
Pacific States Marine Fisheries Commission (PSMFC) has been designated by NMFS to be the Data Collection
Agent for the Amendment 80 EDR program. PSMFC mails EDR announcements and filing instructions
to Amendment 80 QS permit holders by April 1. You may also use the web based EDR form or
download the EDR form in fillable PDF format. To request that a printed EDR be mailed to you, please
call 1-877-741-8913, or email your request to edr@psmfc.org.
An Amendment 80 CQ Permit is valid until:
The end of the year for which the Amendment 80 CQ fishery permit is issued;
The Amendment 80 CQ fishery is closed by the Regional Administrator; or
The permit is revoked, suspended, or modified pursuant to § 679.43 or under 15 CFR part 904.
A legible copy of the Amendment 80 CQ Permit must be carried on board the Amendment 80 vessels assigned
to the Amendment 80 Cooperative.
If the Amendment 80 QS Permit Holder is a non-individual (i.e., a corporation, partnership or other entity),
provide the names of, and the percentage of ownership held by, all of its owners. Information should be
provided to the individual level. See example below:
Name of Owner
% Interest
Joe Potpuller

25%

Alice Potpuller

25%

LLP Family Holdings, Inc.

50%

C. A80QSholder

25% (of 50%)

R. A80QSholder

25% (of 50%)

A. A80QSholder

25% (of 50%)

B. A80QSholder

25% (of 50%)

Application for A80 CQ Permit ― Page 6 of 9

Duplicate the form, or attach a separate sheet of paper if necessary to display all of the Applicant’s owners (and
owners of the Applicant’s owners to the individual level).
GENERAL INFORMATION
Please allow at least 10 working days for this application to be processed. It is important that all blocks are
completed and any required attachments are provided. Failure to answer any of the questions, provide any of the
required documents, or to have signatures could result in delays in the processing of your application.
Forms are available on the NMFS Alaska Region website at https://www.fisheries.noaa.gov/region/alaska.
Print information in the application legibly in ink or type information.
Retain a copy of completed application for your records.
When completed, submit the application —
By mail to:

NMFS Alaska Region
Restricted Access Management (RAM)
P.O. Box 21668
Juneau, AK 99802-1668

By delivery to: Room 713, Federal Building
709 West 9th Street
Juneau, AK 99801
Or, by fax to:

907-586-7354

If you need additional information:
Contact RAM at: (800) 304-4846 (Option #2) or (907) 586-7202 (Option #2)
E-mail address: ram.alaska@noaa.gov
Website: https://www.fisheries.noaa.gov/region/alaska
COMPLETING THE APPLICATION
BLOCK A -- AMENDMENT 80 COOPERATIVE IDENTIFICATION
1. Cooperative's legal name.
2. Type of business entity under which the Amendment 80 Cooperative is organized.
Each Amendment 80 cooperative must be formed as a partnership, corporation, or other legal business
entity that is registered under the laws of one of the 50 states or the District of Columbia.
3. State in which the Amendment 80 Cooperative is legally registered as a business entity.
4. Permanent business address.
5. Business telephone number.
6. Business fax number.
7. Business e-mail address.
8. Printed name and signature of Amendment 80 designated representative.

Application for A80 CQ Permit ― Page 7 of 9

BLOCK B – MEMBERS OF THE AMENDMENT 80 COOPERATIVE -- Amendment 80 QS Permit
Holder and Ownership Documentation (complete for all members of the Amendment 80 cooperative)
1.
2.
3.
4.

Full name.
NMFS Person ID.
Amendment 80 QS Permit Number(s).
Names of all persons, to the individual level, holding an ownership interest in the
Amendment 80 QS Permit Number(s) assigned to the Amendment 80
cooperative.
5. The percentage ownership each person and individual holds in the Amendment 80 QS Permit(s).
BLOCK C – IDENTIFICATION OF AMENDMENT 80 COOPERATIVE MEMBER VESSELS AND
AMENDMENT 80 LLP LICENSES
Identify the Amendment 80 vessels held by all members of the Amendment 80 Cooperative
Vessel Name
Alaska Department of Fish & Game (ADF&G) vessel registration number
United States Coast Guard (USCG) documentation number
Amendment 80 License Limitation Program (LLP) numbers
BLOCK D -- IDENTIFICATION OF VESSELS ON WHICH THE CQ ISSUED TO THE
AMENDMENT 80 COOPERATIVE WILL BE USED
Identify the Amendment 80 vessels on which the CQ issued to the Amendment 80 Cooperative will be used
Vessel Name
ADF&G vessel registration number
USCG documentation number
BLOCK E – EDR SUBMITTAL
Indicate (YES or NO) whether each member of the Amendment 80 cooperative has submitted the Annual
Trawl Catcher/Processor Economic Data Report EDR as required under § 679.94.
BLOCK F – CERTIFICATION OF COOPERATIVE AUTHORIZED REPRESENTATIVE
Enter the Cooperative Authorized Representative printed name, signature, and date signed.
The Cooperative Authorized Representative must sign and date the application certifying that all information is
true and correct to the best of their knowledge and belief; explicit authorization must accompany the application on
behalf of the members of the cooperative.
PUBLIC REPORTING BURDEN 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 0648-0565. Without this approval, we could not conduct this information
collection. All responses to this information collection are required to obtain or retain benefits and are required to manage
the commercial fishing effort of the CDQ program in the Bering Sea and Aleutian Islands management area and the
Amendment 80 Program under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801,
et seq.). Public reporting burden for this information collection is estimated to average 2 hours 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. Send comments regarding this burden estimate or any other aspect
of this information collection, including suggestions for reducing the burden, to NOAA, National Marine Fisheries
Service, Alaska Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, P.O. Box 21668, Juneau,
AK 99802-1668.

Application for A80 CQ Permit ― Page 8 of 9

PRIVACY ACT STATEMENT
Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and
Management Act, 16 U.S.C. 1801 et seq.
Purpose: NMFS uses information from this application to determine eligibility for a cooperative quota (CQ) permit, assign
CQ to Amendment 80 (A80) cooperatives, determine the A80 species initial total allowable catch assignments, determine
which vessels must be tracked for catch accounting, and review ownership and control information for various QS holders
to ensure that QS and CQ use caps are not exceeded. An A80 CQ permit authorizes the A80 cooperative and vessels
assigned to that cooperative to participate in the A80 CQ fishery.
Routing Uses: Disclosure of this information is subject to the published routine uses identified in the Privacy Act System
of Records Notice COMMERCE/NOAA-19, Permits and Registrations for the United States Federally Regulated
Fisheries. NMFS posts some information from this form on its public website (https://alaskafisheries.noaa.gov/). In
addition, NMFS may share information submitted on this application with other State and Federal agencies or fishery
management commissions, including staff of the North Pacific Fishery Management Council and Pacific States Marine
Fisheries Commission. Other information is confidential under section 402(b) of the Magnuson-Stevens Act and NOAA
Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will
prevent determination of eligibility for an A80 CQ permit.

Application for A80 CQ Permit ― Page 9 of 9

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