REPORT OF PERSONAL INJURY OR LOSS OF LIFE

ICR 198207-2115-003

OMB: 2115-0004

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
172738 Migrated
ICR Details
2115-0004 198207-2115-003
Historical Active 198105-2115-003
DOT/USCG
REPORT OF PERSONAL INJURY OR LOSS OF LIFE
No material or nonsubstantive change to a currently approved collection   No
Emergency 07/12/1982
Approved with change 07/12/1982
Retrieve Notice of Action (NOA) 07/12/1982
  Inventory as of this Action Requested Previously Approved
05/31/1984 05/31/1984 05/31/1984
2,850 0 2,850
2,850 0 941
0 0 0

THE INFORMATION COLLECTED IS NEEDED TO INFORM THE COAST GUARD THAT DEATH OR INJURY HAS OCCURRED. THIS INFORMATION IS THEN USED BY THE COAST GUARD IN THE CONDUCT OF SUBSEQUENT INVESTIGATIONS REQUIRED BY 43 U.S.C. 1348.

None
None


No

1
IC Title Form No. Form Name
REPORT OF PERSONAL INJURY OR LOSS OF LIFE CG-924E

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,850 2,850 0 0 0 0
Annual Time Burden (Hours) 2,850 941 0 0 1,909 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/12/1982


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