Information Collection

Adequacy Certification for Reception Facilities and Advance Notice - 33 CFR Part 158

IC 20537 under ICR 200804-1625-008 · OMB 1625-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CG-5401 Adequacy Certification for Reception Facilities and Advance Notice - - 33 CFR Part 158	Form
CG-5401 Certificate of Adequacy for Reception Facilty CG-5401.pdf This is a certificate that USCG personnel issue in the performance of their duties.	Form
CG-5401A Application for Certificate of Adequacy for Reception Fa CG-5401A.pdf www.uscg.mil/forms/cg.asp?files=280&id=	Form and Instruction
CG-5401B Application for Certificate of Adequacy for Reception Fa CG-5401B.pdf www.uscg.mil/forms/cg.asp?files=280&id=	Form and Instruction
CG-5401C Application for Certifiate of Adequacy for Reception Fac CG-5401C.pdf www.uscg.mil/forms/cg.asp?files=280&id=	Form and Instruction

IC Title:

Adequacy Certification for Reception Facilities and Advance Notice - - 33 CFR Part 158

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 33 CFR 158.140

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CG-5401	Certificate of Adequacy for Reception Facilty	CG-5401.pdf	This is a certificate that USCG personnel issue in the performance of their duties.	No		Paper Only
Form and Instruction	CG-5401A	Application for Certificate of Adequacy for Reception Facilities	CG-5401A.pdf	http://www.uscg.mil/forms/cg.asp?files=280&id=	Yes	Yes	Fillable Printable
Form and Instruction	CG-5401B	Application for Certificate of Adequacy for Reception Facilities FORM B	CG-5401B.pdf	http://www.uscg.mil/forms/cg.asp?files=280&id=	Yes	Yes	Fillable Printable
Form and Instruction	CG-5401C	Application for Certifiate of Adequacy for Reception Facilities FORM C	CG-5401C.pdf	http://www.uscg.mil/forms/cg.asp?files=280&id=	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 85

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	122	-4,060	4,182
Annual IC Time Burden (Hours)	227	-831	1,058
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.