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
PTA, USCG-STCW, 20100430, priv final.pdf Supplementary Document	2011-01-24
1625-0040_NoR_r2.doc Supplementary Document	2011-01-20
1625-0040_COI_SUPPORTING_STATEMENT_0616091_13Jan2011revision.doc Supporting Statement A	2011-01-20
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

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: 201009-1625-009
Status: Historical Inactive	Previous ICR Reference No: 201002-1625-001
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 08/12/2011
	Date Received in OIRA: 06/17/2011
Terms of Clearance: USCG has requested withdrawal of this revision request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved	01/31/2013
Responses	65,299	0	65,299
Time Burden (Hours)	10,885	0	10,885
Cost Burden (Dollars)	0	0	0

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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.

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Authorizing Statute(s): US Code: 46 USC 7302 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1625-AA16	Proposed rulemaking	74 FR 59354	06/17/2011

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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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	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

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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: A PROGRAM change will result from the SNPRM, "Implementation of the Amendments to the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, and Changes to Domestic Endorsements" (RIN 1625-AA16)( Docket No. USCG-2004-17914). The Coast Guard is amending its regulations governing requirements for credentialed mariners by adding the requirement that all credentialed mariners advise the US Coast Guard National Maritime Center (NMC) of any significant change in medical conditions as defined in proposed 46 CFR 10.307(b). As a signatory to the STCW Convention, this program change is necessary to demonstrate to the International Maritime Organization that the United States has in place certain specific regulations that implement the international requirements and related amendments to the STCW Convention.

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Annual Cost to Federal Government: $170,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 06/17/2011

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