Information Collection

Coast Guard Boating Accident Report Form (CG-3865)

IC 20444 under ICR 201106-1625-003 · OMB 1625-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0003 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CG-3865 Coast Guard Boating Accident Report Form (CG-3865)	Form
1625-0003 Instructions_r1.doc	Instruction
Snapshots2.doc	Other-Snapshot BARD
CG-3865 Boating Accident Report CG3865final.pdf www.uscg.mil/forms	Form

IC Title:

Coast Guard Boating Accident Report Form (CG-3865)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 33 CFR 173 33 CFR 174 33 CFR 173.55

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-3865	Boating Accident Report	CG3865final.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Instruction			1625-0003 Instructions_r1.doc		Yes	Yes	Printable Only
Other-Snapshot BARD			Snapshots2.doc		Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,000	0	5,000
Annual IC Time Burden (Hours)	2,500	0	2,500
Annual IC Cost Burden (Dollars)	2,200	150	2,050

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.