Pacific HMS Vessel Permit Application

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NATIONAL MARINE FISHERIES SERVICE
501 WEST OCEAN BLVD
SUITE 4200
Permit
LONG BEACH, CA 90802

OMB#: 0648-0204
APPROVAL EXPIRES: 04/30/2010

Application Fee: $30

Pacific Highly Migratory Species
Vessel Permit Application
SECTION 1 VESSEL INFORMATION (please print legibly or type)
USCG DOC. OR STATE REG. NO. VESSEL

VESSEL NAME

HULL IDENTIFICATION NUMBER

HOME PORT AND STATE

USCG DOCUMENTED HAIL PORT AND STATE

RADIO CALL SIGN

DOES THIS VESSEL HAVE AN OPERATIONAL VMS?

REGISTERED LENGTH (FT.)

YES_______

HOLD CAPACITY (SHORT TONS)

NO_______

REGISTERED DEPTH (FT.)

REGISTERED BREADTH (FT.)
HOLD CAPACITY (METRIC TONS)

GROSS TONS

NET TONS

HOLD CAPACITY (CUBIC METERS)

PROPULSION TYPE

REFRIGERATION TYPE

HORSEPOWER

HULL MATERIAL

YEAR BUILT

LOCATION BUIL

CREW SIZE (INCLUDING OFFICERS)

PASSENGER CAPACITY

VESSEL FLAG

PREVIOUS VESSEL NAMES

EFFECTIVE DATES

SECTION 2 SELECT THE TYPE OF GEAR TO BE AUTHORIZED BY THE HMS PERMIT
COMMERCIAL:

RECREATIONAL:

HARPOON

PURSE SEINE

TROLL/JIG

LONGLINE

DRIFT GILLNET

BAITBOAT

CHARTER VESSEL
No

SECTION 3 VESSEL OWNERSHIP INFORMATION
CORPORATION EIN

COMPANY NAME
BUSINESS ADDRESS
BUSINESS TELEPHONE

CITY
BUSINESS FAX

BUSINESS CELL PHONE

DATE CORPORATION FILED

DUNNS NO.

STATE

ZIP

BUSINESS E-MAIL

MANAGING OWNER NAME LAST FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

SECOND OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

THIRD OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

SECTION 4 SIGNATURE (All applications must be signed and dated)
I certify that the above information is complete, true, and correct to the best of my knowledge and belief.
OWNER'S SIGNATURE:

NAME: (Print legibly or type)

DATE:

General - This information is being collected by the National Marine Fisheries Service to ensure that timely and accurate records
are available concerning the fishing vessels of the U.S. that participate in Pacific Ocean fisheries for highly migratory species,
consistent with the requirements of the Fishery Management Plan for U.S. West Coast Fisheries for Highly Migratory Species.
The collection of information concerning U.S. fishing vessels harvesting tuna in the eastern Pacific Ocean is also necessary for
the U.S. to comply with its obligations as a member of the Inter-American Tropical Tuna Commission.
This permit is required for commercial fishing vessels and recreational charter vessels that harvest any of the species that are
included in the FMP. They are: Billfish/Swordfish: striped marlin (Tetrapturus audax); swordfish (Xiphias gladius). Sharks:
common thresher shark (Alopias vulpinus); pelagic thresher shark (Alopias pelagicus); bigeye thresher shark (Alopias
superciliosus); shortfin mako or bonito shark (Isurus oxyrinchus); blue shark (Prionace glauca). Tunas: north Pacific albacore
(Thunnus alalunga); yellowfin tuna (Thunnus albacares); bigeye tuna (Thunnus obesus); skipjack tuna (Katsuwonus pelamis);
northern bluefin tuna (Thunnus orientalis). Other: dorado or dolphinfish (Coryphaena hippurus).
Instructions Section 1 - Enter vessel information as it appears on the Coast Guard documentation or, if the vessel is not Coast Guard
documented, as it appears on the state registration certificate.
Hull Identification Number - If your vessel does not have a hull identification number leave the box blank.
Home Port - enter the city and state where the vessel is customarily kept, not necessarily the home port listed on the certificate
of documentation.
Hail Port - enter the city and state listed on the certificate of documentation.
Radio Call Sign - If your vessel has no radio, leave blank.
Operational VMS - Global positioning system using satellites to track vessel movements.
Hold Capacity - Cubic Meters is preferred; however, Short Tons or Metric Tons are acceptable.
Provide all other information required to the best of your ability.
Section 2 - For commercial fishing vessels, mark only gears that the vessel will use to harvest highly migratory species. Indicate
only whether a recreational vessel is a charter or commercial passenger fishing vessel (CPFV). It is not necessary to list any
gear for recreational vessels.
Section 3 - For a vessel owned by a company, enter an EIN (Employer Identification Number). The owner's date of birth will be
used as an additional identifier and to establish the two-year renewal date for the permit. Enter the month, day, and year. Contact
information for all owners of the vessel is required. If there are more than three owners, use an additional sheet. It is
recommended that vessel owners obtain a DUNNS Number by contacting Dunn and Bradstreet at their website: www.dnb.com.

Enclose a check in the amount of $30, payable to “US Department of Commerce - NOAA” for the
application fee. Please write your vessel number and name in the memo section of your check.
Warning: A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under 15
CFR part 904, a civil penalty up to $100,000 under 16 USC 1858, and as a federal crime under 18 USC 1001.
Paperwork Reduction Act - Public reporting burden for this collection is estimated to average 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 collection of information. Notwithstanding any other provision of the law, no person is required to
respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the
requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control
Number Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to Southwest Region, NMFS, 501 West Ocean Blvd., Suite 4200, Long Beach, California
90802-4213.
Privacy Act Statement
The EIN is collected under the authority of the Debt Collection Improvement Act of 1996 (Public Law 104-134).The primary
purpose for requesting the EIN is for the collection and reporting on any delinquent amounts arising out of such person’s
relationship with the government pursuant to the Debt Collection Improvement Act of 1996 (Public Law 104-134). Reporting of
the EIN is mandatory, and permit applications, renewals and transfer requests will not be processed without this information.
Personally identifiable information is confidential and protected under the Privacy Act (5 U.S.C. 552a). Business information may
be disclosed to the public.