Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical

Forms and Documents

Document Name	Status
Form CG-719K Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction	Modified
1625-0040_COI_SUPPORTING_STATEMENT 061609.doc Supporting Statement A	2009-06-17
1625-0040 46 USC 7302.pdf Supplementary Document	2009-03-17
1625-0040 46cfr10.202[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr10.209[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr10.207[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr12.15-5[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr10.205[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr12.02-9[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr10.211[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr12.02-17[1].pdf Supplementary Document	2009-03-17
1625-0040 46cfr12.05-5[1].pdf Supplementary Document	2009-03-17
1625-0040 30-day FRN.doc Supplementary Document	2009-03-17
1625-0040 60-day FRN.doc Supplementary Document	2009-03-17

IC Document Collections

IC ID	Document Title	Status
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction	Modified

ICR Details

OMB Control No: 1625-0040	ICR Reference No: 200803-1625-010
Status: Historical Active	Previous ICR Reference No: 200606-1625-001
Agency/Subagency: DHS/USCG	Agency Tracking No:
Title: Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/30/2009
	Date Received in OIRA: 04/08/2009
Terms of Clearance: USCG should continue working to maximize submitters ability to submit the instruments electronically (beyond the capacity to electronically fill out and email the documents.)

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved	07/31/2009
Responses	65,299	0	73,294
Time Burden (Hours)	10,885	0	329,356
Cost Burden (Dollars)	0	0	16,258,000

---

Abstract: IAW Title 46, US Code & Title 46, CFR the collection of this information is necessary to determine competency, character & physical qualifications for the issuance of USCG licenses, certificates of registry & merchant mariner documents.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 54842	09/23/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 9421	03/04/2009
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	CG-719K/E, CG-719B, CG-719K, CG-719P, CG-719S, CG-719A, CG-719K, and CG-719K//E	Merchant Mariner Credential Medical Evaluation Report ,   Merchant Mariner Evaluation of Fitness for entry Level Ratings ,   DOT/USCG Periodic Drug Testing Form ,   Small Vessel Sea Service Form ,   APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERATOR, AND MERCHANT MARINER'S DOCUMENT

---

ICR Summary of Burden

	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	65,299	73,294	0	0	-7,995	0
Annual Time Burden (Hours)	10,885	329,356	0	0	-318,471	0
Annual Cost Burden (Dollars)	0	16,258,000	0	-16,300,146	42,146	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The changed is due to an ADJUSTMENT to our program. Previous estimations in burden hours were an overestimate which erroneously considered travel time to and from Regional Exam Centers. Written applications may be mailed, and do not require travel time.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/08/2009

---