Information Collection

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

IC 43932 under ICR 201301-1625-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Merchant Mariner Medical Evaluation Report Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction
Form CG-719K/E Merchant Mariner Evaluation of Fitness for entry Level Ratings Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction
Form CG-719P DOT/USCG Periodic Drug Testing Form Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction
Form CG-719S Small Vessel Sea Service Form Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction
Form CG-719B APPLICATION FOR MERCHANT MARINER CREDENTIAL (MMC) Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction
CG-719K Merchant Mariner Medical Evaluation Report CG-719K_final draft to vendor OMB_6Dec12.pdf	Form and Instruction
CG-719K/E Merchant Mariner Evaluation of Fitness for entry Level R CG_719KE.pdf	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 MERCHANT MARINER CREDENTIAL (MMC) CG719B_vendor version_6Dec2012.pdf www.uscg.mil/forms	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CG-719K	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K/E	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719P	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719S	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719B	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 259,606

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	Previously Approved
Annual Number of Responses for this IC	56,500	56,500
Annual IC Time Burden (Hours)	44,258	44,258
Annual IC Cost Burden (Dollars)	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].