Electronic Monitoring (EM) Equipment Reimbursement Reque

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)
OMB Control No. 0648-0605
Expiration Date: 8/31/2026

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Public Burden Statement
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 0648-0605. Without this
approval, we could not conduct this information collection. Public reporting for the DAS Leasing Request Form information collection, the DAS
Transfer Program information collection, DAS Downgrade information collection, and Transfer of Annual Catch Entitlements information
collection, are estimated to be approximately 0.08 hours 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. Public reporting for the Electronic
Monitoring Program Requirements information collection is estimated to be approximately 0.5 hours 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. Responses to the Electronic Monitoring (EM) Equipment Reimbursement Request Form are voluntary to obtain benefits.
All other responses to these information collections are required to obtain benefits pursuant to 50 CFR 648. These forms are necessary to carry
out the requirements of the ground fish fishery as specified by the Northeast (NE) Multi-species Fishery Management Plan (FMP). 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 Greater Atlantic Regional Office at: 55 Great Republic Drive, Gloucester Massachusetts 01930, Attn: Heather
Nelson, heather.nelson@noaa.gov.
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).
Purpose: The information collected is necessary for NOAA to issue reimbursement for an upgrade or replacement of an electronic monitoring
system.
Routine Uses: The Department will use this information to determine eligibility for reimbursement of costs related to upgrade or replacement of
an electronic monitoring system. Disclosure of this information is permitted within NMFS offices under the Privacy Act of 1974 (5 U.S.C. 552a).
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. Failure to provide complete and accurate information will prevent the determination of
eligibility for reimbursement.

OMB Control No. 0648-0605
Expiration Date: 8/31/2026

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