View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
46 CFR 11
46 CFR 12
46 CFR 16
46 CFR 10
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CG-719B
Application for Merchant Mariner Credential
Application for Merchant Mariner Credential (Form CG-719B).pdf
Yes
Yes
Fillable Printable
Form and Instruction
CG-719C
Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions
Disclosure Statement for Narcotics, DWI_DUI, and_or Other Convictions (Optional Form CG-719C).pdf
Yes
Yes
Fillable Printable
Form and Instruction
CG-719K
Application for Medical Certificate
Application for Medical Certificate (Form CG-719K).pdf
Yes
Yes
Fillable Printable
Form and Instruction
CG-719K/E
Application for Medical Certificate, Short Form
Application for Medical Certificate, Short Form (Form CG-719K_E.pdf
Yes
Yes
Fillable Printable
Form
CG-719P
DOT/USCG Periodic Drug Testing Form
CG719P.pdf
Yes
Yes
Fillable Printable
Form
CG-719S
Small Vessel Sea Service Form
CG719S.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Transportation
Subfunction:
Water Transportation
Privacy Act System of Records
Title:
Merchant Seamen's Records
FR Citation:
74 FR 30308
Number of Respondents:
90,293
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
90 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
310,091
0
-513
0
0
310,604
Annual IC Time Burden (Hours)
61,850
0
-154
0
0
62,004
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.