Information Collection

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

IC 43932 under ICR 201109-1625-003 · OMB 1625-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CG-719K/E Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction
CG-719K Merchant Mariner Credential Medical Evaluation Report CG-719K_final draft to vendor_14Jun12.pdf Link will be provided upon OMB approval.	Form and Instruction
CG-719K/E Merchant Mariner Evaluation of Fitness for entry Level R CG719KE.pdf Link will be provided upon OMB approval.	Form and Instruction
CG-719P DOT/USCG Periodic Drug Testing Form CG719P.pdf www.uscg.mil/forms	Form and Instruction
CG-719S Small Vessel Sea Service Form CG719S.pdf www.uscg.mil/forms	Form and Instruction
CG-719B APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERA CG719B.pdf www.uscg.mil/forms	Form and Instruction

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 46 CFR 10.105(b)

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 and Instruction	CG-719K/E	Merchant Mariner Evaluation of Fitness for entry Level Ratings	CG719KE.pdf	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719B	APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERATOR, AND MERCHANT MARINER'S DOCUMENT	CG719B.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K	Merchant Mariner Credential Medical Evaluation Report	CG-719K_final draft to vendor_14Jun12.pdf	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719P	DOT/USCG Periodic Drug Testing Form	CG719P.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719S	Small Vessel Sea Service Form	CG719S.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title: Privacy Act of 1974: System of Records

FR Citation: 65 FR 19476

Number of Respondents: 68,500

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	68,500	3,201	65,299
Annual IC Time Burden (Hours)	57,083	46,198	10,885
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.