Electronic Monitoring Equipment Reimbursement Request

ATLANTIC STATES MARINE FISHERIES COMMISSION 1050 N. Highland
Street, Suite 200 A-N
Arlington, VA 22201
Tel: (703) 842-0740 Fax: (703) 842-0741
www.asmfc.org

ELECTRONIC MONITORING (EM) EQUIPMENT REIMBURSEMENT REQUEST FORM
Fishing vessel owners are eligible for reimbursement of one EM system every three years while funds last, including installation and
vessel monitoring plan development. In the event that a vessel requires an upgrade or replacement of its system, or a system
component, during the 3-year period, the vessel owner must apply for reimbursement approval prior to purchase. Hardware must be
procured from a NOAA-approved service provider and must meet program standards and requirements.
1.
2.
3.

Purchase and install a NOAA Approved EM unit.
Work with the EM service provider to complete and sign this reimbursement request form.
Submit the completed request form to your sector manager. The sector manager should aggregate the requests and submit
them to ASMFC on a monthly basis for reimbursement.

I. VESSEL INFORMATION
Vessel Name:
Hull Number:
Permit Number:

State Registration Number:

USCG Documentation Number:
II. SECTOR and SECTOR MANAGER INFORMATION
Sector
Sector Manager Name:
Phone Number:
III.

EM SYSTEM INFORMATION
Vendor:

Cost of Equipment:

$ 500.00

Installer:

VMP Development (Time):

$ 100.00

Equipment manufacturer:

Installation (Time):

$ 10,000.00

Equipment Model/Version number:

Installation (Travel):

$ 9,100.00

Total

$ 19,700.00

IV. Signature
Under penalties of perjury, I hereby declare that I, the undersigned, completed this application and the information contained herein
is true, correct, and complete to the best of my knowledge. I also declare that the EM equipment described above has been installed
on board the vessel listed above and is intended for use only on this vessel.
Applicant First Name:

MI:

Last Name:

Business Name:
Applicant Signature:
FMRD Form EMR-2021-1.0

Date:
Form Effective Date 6.2021 (Previous Versions Obsolete)

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