Federal Limited Entry Deep-Set Buoy Gear Permit Pre-fill

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service (NMFS)
West Coast Region, Long Beach Fisheries Permits Office
501 W Ocean Blvd., Suite 4200
Long Beach, CA 90802
wcr-permits@noaa.gov (562)980-4238

OMB Control No. 0648-0204
Expires XX/XX/20XX

PERMIT FEE:$101
DUE: MARCH 31

Federal Limited Entry Deep-Set Buoy Gear Permit
Pre-filled Renewal Application Form
Please renew annually online, directly at http://fisheriespermits.noaa.gov.

PERMIT APPLICANT INFORMATION
USCG DOCUMENTATION OR
STATE REGISTRATION NUMBER

VESSEL NAME
PERMIT APPLICANT NAME*
(individual or business)

DATE OF BIRTH OF PERMIT APPLICANT
(if individual)

TAX IDENTIFICATION NUMBER OF PERMIT APPLICANT
(if business)

ADDRESS
PHONE NUMBER
ALT PHONE NUMBER
EMAIL ADDRESS

VESSEL OWNERSHIP INFORMATION
VESSEL OWNER NAME
(individual or business)

DATE OF BIRTH OF PERMIT APPLICANT
(if individual)

TAX IDENTIFICATION NUMBER OF PERMIT APPLICANT
(if business)

ADDRESS
PHONE NUMBER
ALT PHONE NUMBER
EMAIL ADDRESS

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IDENTIFICATION OF SHAREHOLDERS AND PARTNERS
NAME
(Last, First, Middle Initial)

DATE OF BIRTH
(mm/dd/yyyy)

BUSINESS MAILING ADDRESS
(Street or PO Box, City, State, Zip Code)

When renewing, you will have the opportunity to review Ownership Interest information on the National Permits System website
(http://fisheriespermits.noaa.gov). Please include any changes in shareholders that have occurred in the corporation, business,
or entity since the previous application was submitted, including any additions or divestments. Ownership interest is not
transferable, except for certain exceptions detailed in the Instructions Section of this form.*

SIGNATURE
I certify that the above information is complete, true, and correct to the best of my knowledge and belief.
Name (Print legibly)

Signature

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Date

INSTRUCTIONS
Important - Please verify all information listed on the online application is correct, including Ownership Information and
vessel information associated with the permit. Update the application with any changes necessary to reflect current
ownership information via the National Permits System (NPS) website.
A complete renewal package consists of a complete Federal Limited Entry Deep-Set Buoy Gear Renewal Application Form, a
complete Federal Limited Entry Deep-Set Buoy Gear Identification of Ownership Interest Application Form, and payment of
required fees. Electronically sign and date this renewal form online to verify that all information is complete, true, and correct
to the best of your knowledge.
Federal Limited Entry Deep-Set Buoy Gear Permits expire April 30 of each year. Completed renewal packages must be
submitted online via the NPS website between February 1 and March 31 of each year to prevent a lapse in eligibility to fish.
Permits will permanently expire on April 30. A Federal Limited Entry Deep-Set Buoy Gear Permit that is allowed to expire will
not be issued unless the permit applicant requests re-issuance in the form of an appeal by June 30, and NMFS determines
that failure to renew was proximately caused by illness, injury, or death of the permit owner. Such medical evidence may
include a notice from a physician or any other documentation NMFS may require.
Failure to renew the Federal Limited Entry Deep-Set Buoy Gear Permit permit annually will result in this permit
becoming permanently expired and will not be available for any future use.
Transfers- Federal Limited Entry Deep-Set Buoy Gear Permit are not transferable, except for a one-time transfer to a family member
upon the death or legal incapacitation of the permit holder. A family member would be defined as spouse, domestic partner, cohabitant,
child, stepchild, grandchild, parent, stepparent, mother-in-law, father-in-law, son-in-law, daughter-in-law, grandparent, great
grandparent, brother, sister, half-brother, half-sister, step-sibling, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, or first cousin.
One-time transfers would also apply to the member of a partnership, corporation, or other entity. Changes to ownership, including the
addition of individuals or entities as owners of the permit, would otherwise not be allowed. NMFS would not consider it an ownership
change if shares among the existing owners changes, or if a member of a partnership, corporation, or other entity leaves and is not
replaced. A transfer may not occur if such a transfer will result in a person holding more than one Federal Limited Entry Deep-Set Buoy
Gear Permit.
For assistance, please contact the WCR Long Beach Permits Office at 562-980-4238 or e-mail wcr-permits@noaa.gov.
All forms associated with with the Deep-Set Buoy Gear Limited Entry Fishery can be found online, by registering for a permit
account at http://fisheriespermits.noaa.gov.

WARNING STATEMENT- A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under
15 CFR 904, a civil penalty of up to $100,000 under 16 USC 1858, and as a federal crime under 18 USC 1001.
PAPERWORK REDUCTION ACT - 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 0648-0204. Without this approval, we could not conduct this information collection. Public reporting for
this information collection is estimated to be approximately 20 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.
Some of the information collection described above is confidential under section 402(b) of the Magnuson-Stevens Act. It is also
confidential under NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. Phone number, fax and email
information and TIN are not released to the public. All responses to this information collection are mandatory/required to obtain benefits
pursuant to 50 CFR 660. 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 at: 501 W. Ocean Blvd., Suite 4200, Long Beach, CA 90802,
Attn: Permits Office, wcr-permits@noaa.gov

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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., the High Seas Fishing Compliance Act, the Tuna Conventions Act of 1950, the Antarctic Marine Living Resources
Convention Act, the Western and Central Pacific Fisheries Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq), the Marine
Mammal Protection Act, the Endangered Species Act and the Fur Seal Act. The authority for the mandatory collection of the Tax
Identification Number (TIN) is 31 U.S.C. 7701. Your date of birth and TIN are confidential and protected under the Privacy Act. Provision of
your date of birth and TIN is mandatory as part of this collection. The primary purpose for requiring the date of birth is to verify the identity
of individuals/entities doing business with the government to provide a unique identification for assistance to comply with the Debt
Collection Improvement Act of 1996 (Public Law 104-134) and for enforcement activities.
Purpose: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service (NMFS) requires the use of permits or registrations
by participants in the United States. Information on NOAA Fisheries permit applicants and renewing holders includes vessel owner contact
information, date of birth, TIN and vessel descriptive information. Permit holder information may be used as sampling frames for surveys,
as part of Fishery Management Council (FMC) analysis to support FMC decisions.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants. Disclosure of
this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within NMFS offices, in order to coordinate
monitoring and management of sustainability of fisheries and protected resources, as well as with the applicable State or Regional Marine
Fisheries Commissions and International Organizations. Disclosure of this information is also subject to all of the published routine uses as
identified in the Privacy Act System of Records Notice COMMERCE/NOAA-19, Permits and Registrations for the United States Federally
Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the
determination of eligibility for a permit.

This 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 XXXX (X FR XXX) and became
effective on XXXX (X FR XXX).

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