+------+---------------------------------------------------------------+
| ![   | ##### **Florida Keys National Marine Sanctuary**              |
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| dia/ | **PERMIT APPLICATION FORM**                                   |
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The National Marine Sanctuaries Act (16 U.S.C. 1431 *et seq.*) directs
the Secretary of Commerce to designate and manage areas of the marine
environment with nationally significant aesthetic, ecological,
historical, or recreational values as national marine sanctuaries. The
National Marine Sanctuary Program has issued regulations to implement
this act (15 CFR Part 922). These regulations exist to safeguard
resources within sanctuary boundaries and include prohibitions on the
conduct some activities. Program regulations also give the NMSP
authority to issue permits to allow certain activities beneficial to
sanctuaries that would otherwise be prohibited.

Guidelines on applying for permits are given in "Guidelines For
Submitting Applications For National Marine Sanctuary Permits And
Authorizations," which may be found at
[**http://floridakeys.noaa.gov/research_monitoring/permit_guidelines.pdf**](http://floridakeys.noaa.gov/research_monitoring/permit_guidelines.pdf).
Applicants are responsible for reviewing and understanding the
guidelines in their entirety to ensure are all application requirements
are met. This form does not and is not meant to replace the guidelines,
but is instead provided to assist potential applicants in gathering and
submitting the information required for most permits. Some permits may
require more or less information; applicants should consult the
guidelines for details. This form is provided for the convenience of
applicants only and is not required.

Completed applications should be submitted in MS Word or Rich Text
Format to Ms. Joanne Delaney, Permit Coordinator, at
[Joanne.Delaney@noaa.gov]{.underline} and Dr. Brian D. Keller, Science
Coordinator, at <Brian.Keller@noaa.gov>. Questions may be addressed to
[Joanne.Delaney@noaa.gov.]{.underline}

Anyone conducting prohibited activities without a valid national marine
sanctuary permit or authorization may be subject to the penalties as
provided under Section 307 of the National Marine Sanctuaries Act.

#### [Public Reporting Burden]{.underline}

Submittal of the information requested in these guidelines is required
to obtain a permit pursuant to NMSP regulations (15 CFR part 922). This
data is to evaluate the potential benefits of the activity, determine
whether the proposed methods will achieve the proposed results, evaluate
any possible detrimental environmental impacts, and determine if
issuance of a permit is appropriate. It is through this evaluation that
the NMSP is able to use permitting as one of the management tools to
protect sanctuary resources and qualities.

Applicants are requested to indicate any information that is considered
proprietary business information. Such information is typically exempt
from disclosure to anyone requesting information pursuant to the Freedom
of Information Act (FOIA). NOAA will make all possible attempts to
protect such proprietary information, consistent with all applicable
FOIA exemptions in 5 U.S.C. 552(b). Typically exempt information
includes trade secrets, commercial and financial information (5 U.S.C.
552(b)(4)). Personal information affecting an individual's privacy will
also be kept confidential consistent with 5 U.S.C. 552(b)(6).

Public reporting burden for this collection of information is estimated
to average one (1) hour per response (e.g., initial application, cruise
log, final report), including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden, to National Permit Coordinator, NOAA National Marine Sanctuary
Program, 1305 East-West Highway (N/ORM6), 11th Floor, Silver Spring, MD,
20910.

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.

**A. APPLICANT AND PROJECT INFORMATION**

[Project Title:]{.underline}

[Sanctuary(s):]{.underline}

# [Applicant Information:]{.underline}

Name:

Affiliation:

Department:

Mailing address *(include street or post office box, city, state, and
zip code)*:

Phone number:

Fax number:

E-mail address:

[Secondary (co-applicant) information]{.underline} *(if applicable)*:

Name:

Affiliation:

Department:

Mailing address *(include street or post office box, city, state, and
zip code)*:

Phone number:

Fax number:

E-mail address:

[Name(s) of any other individuals authorized to conduct activities under
this permit:]{.underline}

Name(s):

Affiliation(s):

[Project summary:]{.underline} *(2-3 sentences)*

[Project abstract:]{.underline} *(approximately 250 words)*

*Include summary of objectives, methods, and project significance.*

[Project rationale:]{.underline}

## Describe the issue to be investigated, its importance and relevance to the sanctuary, and why it is necessary to be conducted in the sanctuary.

[Activity objectives:]{.underline}

*When appropriate, include the specific hypothesis to be tested.*

[Intended use of results:]{.underline}

**B. METHODS**

[Proposed location of activity:]{.underline}

*When appropriate, include geographic coordinates of activity in decimal
degrees or degrees, minutes, seconds. Explain whether coordinates notate
sampling point(s), boundary points, or a central point and associated
radius, and approximate area of location.*

*Check here if proposed activity will occur within one or more of the
Sanctuary zones (Sanctuary Preservation Areas, Special Use/Research-only
Areas, Ecological Reserves, Wildlife Management Areas, Key Largo
National Marine Sanctuary Existing Management Area, and Looe Key NMS
EMA). [Complete additional information in section G.]{.underline}*

[Procedures:]{.underline}

*Explain the methods and protocols to be employed in the field. Include
descriptions and diagrams of any instrumentation or equipment to be used
and deployment duration. Describe all phases of activity, including
equipment removal. Include activity frequency (e.g., daily, monthly) as
appropriate.*

[Collections:]{.underline} *(when applicable)*

*Describe the type, size, and quantity of specimens or materials to be
collected, sampled, or captured. Include collection methods, handling,
frequency, and replicates required for each experiment (use table if
necessary). If aware that specimens of the proposed types already exist
in a repository, explain why additional collecting is necessary. Provide
information on mitigation, if applicable. Provide scientific
nomenclature where possible. Provide information on all other applicable
federal or state permits where required.*

[Project schedule:]{.underline}

## Describe overall project schedule along with requested permit dates:

Requested permit start date:

Requested permit stop date:

[Project budget:]{.underline}

*Briefly outline expenses associated with this activity. Provide
contract number, performance period, and name of sponsoring agency, as
applicable.*

### **C. PRODUCTS**

*Describe expected publications or reports, proposed disposition of
collected specimens (note any specimens that will be destroyed and/or
those that will be maintained in possession), and any data to be
generated as part of this project.*

### **D. LITERATURE CITED IN THIS APPLICATION**

### **E. QUALIFICATIONS OF PERMITTED PERSONNEL**

### **F. ENVIRONMENTAL IMPACTS OF ACTIVITY**

### **G. SUPPORTING DOCUMENTATION AND SPECIAL CONCERNS**

[Coordination with other research/activities:]{.underline}

[Copies of other permits:]{.underline}

*List all permits required from other agencies for the proposed project.
Indicate date the permit was acquired or application was submitted.
Attach/submit other permits or applications.*

[Requests for NMSP assistance:]{.underline}

[Activities in marine zones:]{.underline}

*For any activity or portion of activity proposed to take place in
marine zones, describe why it is necessary to conduct this activity in a
particular zone and how it will further the scientific understanding
and/or management of the zone or sanctuary.*

[Proposed Locations (*Check all that apply and list names of every
applicable site. See map at
*]{.underline}*<http://floridakeys.noaa.gov/research_monitoring/map.html>
[for zone locations):]{.underline}*

Sanctuary Preservation Areas:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Special Use/Research Only Areas:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Ecological Reserves:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Wildlife Management Areas:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Key Largo NMS Existing Management Area

Looe Key NMS Existing Management Area

[Proposed Activity within Zones:]{.underline}

Extractive use:

diseased organisms

non-diseased organisms

both diseased and non-diseased

Non-extractive use

*Brief description of proposed activities within Sanctuary zone(s):*