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OMB
Control No. 0648-0618 Expiration Date: XXXXXX
Who is responsible for submitting: All owners of a quota share permit at any time in 2019.
Complete all questions. If a question is not applicable, write "NA" in the answer box. The survey will not be considered complete unless there is an answer to every question.
Submit by November 30, 2020.
Web form submission: Completed “West Coast Groundfish Quota Share Permit Owner” forms must be certified and submitted electronically no later than November 30, 2020.
Retain a copy. Retain a copy of the completed form.
More information: www.nwfsc.noaa.gov/edc.
Questions: Visit the website above or contact Erin Steiner at (866) 791-3726 or NWFSC.EDC@noaa.gov.
	Public Reporting Burden
	Statement 
	Public reporting burden for
	this collection of information is estimated to take 1 hour per
	response, including time for reviewing the instructions, searching
	existing data sources, gathering and maintaining the data needed,
	and completing and reviewing the collection of information. Send
	comments regarding this burden to Erin Steiner, National Marine
	Fisheries Service, Northwest Fisheries Science Center, 2725 Montlake
	Blvd E, Seattle, WA
	98112. 
	Additional Information 
	Before completing this form,
	please note the following: 1) 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; 2) This information is mandatory and is
	required to manage commercial fishing efforts under 50 CFR part 660
	and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C.
	1801, et seq.);
	3) Responses to this information request are confidential under
	402(b) of the Magnuson-Stevens Act (16 U.S.C. 1801, et
	seq.). They are
	also confidential under NOAA Administrative Order 216-100, which
	sets forth procedures to protect the confidentiality of fishery
	statistics. 
  
Contact Information
Provide the contact information for the Quota Share Permit Owner in 2019. Please make sure that the name provided matches the name of the holder of the quota share permit and account registered in 2019.
| Legal Name of Person, Company, Partnership, or Other Business Entity | Quota Share Permit Number QS | ||
| TIN (if business) or DOB ( if person) | |||
| Business Mailing Address Street or PO Box | Business Phone ( ) | ||
| Business Fax (optional) ( ) | |||
| City | State | Zip Code | Business Email (optional) | 
Quota Shares Information
Is this quota share account solely owned by a Not-for-Profit organization?
| 
				 | Yes | 
				 | Skip to Question 3 | 
				 | 
| 
				 | No |   
				 | Continue to Question 2 | 
				 | 
For each owner/partial owner of this quota share permit, check all that apply [system will prompt a response for each owner]:
 
Owner of a vessel that fished in the IFQ program in 2019
 
Owner of a vessel that fished on the West Coast in 2019
 
Vessel operator or crew member that fished in the IFQ program in 2019
 
Vessel operator or crew member that fished on the West Coast in 2019
 
Retired vessel operator or crew member
 
Owner of a fish dealer or fish processor
 
Employee of a fish dealer or fish processor
 
Employee of a fishing-related business1 (excluding fish dealers, processors, and quota share holders)
 
Family2 member of any of the above
 
Other, please specify____________________
How much was received for leasing quota from this quota permit in 2019?
$______________
Read the following statement, and sign and date the box below.
| I certify under penalty of perjury that I have reviewed all the information in this form and that it is true and complete to the best of my knowledge. | |
| Signature | Date signed 
				 _____/_____/_________ mm dd yyyy | 
| Print Name | |
Questionnaire Comments:
 
  
1 Fishing-related businesses include net suppliers, gear suppliers, equipment suppliers, fuel, shipyards, various repair services, etc.
2 Family is defined as spouse, party to a civil union, parents, children, and siblings (13 C.F.R. § 121.103(f))
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Colin Sayre | 
| File Modified | 0000-00-00 | 
| File Created | 2021-03-10 |