Observer notification form

Highly Migratory Species Observer Notification Form
This form is provided for your response. Please provide the information requested below and return by mail or FAX (305361-4282) at least 5 days prior to your estimated departure. If the vessel is not fishing or is involved in another fishery during the
selection period, please indicate this under Vessel Fishing Status.

Captain's Name: _____________________ Vessel Name: _____________________________
Documentation/Vessel Number: __________________________ Overall Length: ________(ft)
Crew Size: ______ (include skipper) Bunk Capacity: ______Life Raft Capacity: _______
Contact Person/Telephone Number(s): _________________________________

Communication Equipment (please check)

Commercial Fishing Vessel Safety
Examination Decal

Cellular phone:

Serial Number:

VHF:

Date of issuance:
Year

________/________ Month

Single Side Band:
Call sign:

Vessel Fishing Status:
Port of Departure:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________
Telephone Number: (

State: ___________________________

) Departure Date: ____________ Departure Time: ________ (AM or PM)

Expected Landing Port:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________
Telephone Number: (

State: ____________________

) _______________________

Anticipated Landing Date: _____________

I certify under penalty of perjury under the laws of the United States of America that the information given on
this form is true and correct, and that I have full authority to execute this form.

___________________________________
Signature

____________
Date

For the Pelagic Observer Program, please return by mail to SEFSC Pelagic Observer Program, 75
Virginia Beach Dr. Miami, FL 33149 or fax to 305-361-4282. For questions call 800-858-0624.
For the Shark Observer Program, please return by mail to SEFSC Shark Bottom Longline Observer
Program, 3500 Delwood Beach Rd, Panama City, FL 32408-7403 or fax to (850) 235-3559. For questions
call (850) 234-6541.
PAPERWORK REDUCTION ACT STATEMENT: Collection of information through the observer
program provides data for stock assessments and estimates of bycatch. Public reporting burden
for completing the vessel information form above is estimated at 2 minutes per response. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden to: National Marine Fisheries Service, F/SF1,
1315 East West Highway, Silver Spring, MD 20910. Providing the requested information is
mandatory for managing HMS fisheries under the Magnuson-Stevens Fishery Conservation and
Management Act (16 U.S.C. 1801 et seq.) In accordance with NOAA Administrative Order 216-100,
it is agency policy not to release confidential information, other than in aggregate form.
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. This is an approved information
collection under OMB Control No.: 0648-0374 and Expiration Date: 09/30/2008.