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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CG-719B APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERATOR, AND MERCHANT MARINER'S DOCUMENT	Form and Instruction	Modified	Available
Form CG-719S Small Vessel Sea Service Form	Form and Instruction	Modified	Available
Form CG-719P DOT/USCG Periodic Drug Testing Form	Form and Instruction	Modified	Available
Form CG-719K Merchant Mariner Credential Medical Evaluation Report	Form and Instruction	Modified	Available
Form CG-719K/E Merchant Mariner Evaluation of Fitness for entry Level Ratings	Form and Instruction	Modified	Available
SORN MMLD 65_FR_19476-01.pdf	Supplementary Document	Uploaded 2012-06-28	Available
30 Day Federal Register.docx	Supplementary Document	Uploaded 2012-06-14	Available
1625-0040_COI_SupportingStatement_28Jun12.docx	Supporting Statement A	Uploaded 2012-06-29	Available
1625-0040_NoR_18May12.docx	Supplementary Document	Uploaded 2012-05-24	Available
Title 46 Subtitle II Part E Chapter 91.txt	Supplementary Document	Uploaded 2012-05-24	Available
Title 46 Subtitle II Part E Chapter 87.txt	Supplementary Document	Uploaded 2012-05-24	Available
Title 46 Subtitle II Part E Chapter 75.txt	Supplementary Document	Uploaded 2012-05-24	Available
Title 46 Subtitle II Part E Chapter 73.txt	Supplementary Document	Uploaded 2012-05-24	Available
60 Day Federal Register.doc	Supplementary Document	Uploaded 2012-05-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERATOR, AND MERCHANT MARINER'S DOCUMENT
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	Small Vessel Sea Service Form
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	DOT/USCG Periodic Drug Testing Form
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	Merchant Mariner Credential Medical Evaluation Report
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	Merchant Mariner Evaluation of Fitness for entry Level Ratings

ICR Details

OMB Control No: 1625-0040	ICR Reference No: 201109-1625-003
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: 09/20/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/29/2012
Terms of Clearance: DHS is requesting the collection be withdrawn from OMB review.

table that charts list comparision

	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): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 17081	03/23/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 35701	06/14/2012
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

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: Yes

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: A program change will result from the Proposed Rules "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 an issuance of a medical certificate for STCW-endorsed mariners. 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 regulations that implement the international requirements and related amendments to the STCW Convention. This program change will increase the number of annual responses of the CG-719K or CG-719K/E by 3,201 and the total burden hours by 2,667. The proposed change will not require additional information to be collected; only increase the number of annual responses.

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Annual Cost to Federal Government: $14,729,656

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: 06/29/2012

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