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

Application for Merchant Mariner Credential (MMC), Merchant Mariner Certificate Evaluation Report, Small Vessel Sea Service Form, DOT/USCG Periodic Drug Testing Form, Merchant Mariner Evaluation of Fi

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CG-719K 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 Link will be provided upon OMB approval. Form and Instruction
CG-719K/E Merchant Mariner Evaluation of Fitness for entry Level R CG_719KE.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 MERCHANT MARINER CREDENTIAL (MMC) CG719B_vendor version_6Dec2012.pdf www.uscg.mil/forms Form and Instruction

Information Collection (IC) Details

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:

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	CG_719KE.pdf	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719B	APPLICATION FOR MERCHANT MARINER CREDENTIAL (MMC)	CG719B_vendor version_6Dec2012.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K	Merchant Mariner Medical Evaluation Report	CG-719K_final draft to vendor OMB_6Dec12.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:	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 %

	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

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.