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

U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD

Application for Merchant Mariner Credential (MMC), Application for Merchant Mariner Medical Certificate, Application for Merchant Mariner Medical Certificate for Entry Level Ratings, Small Vessel Sea Service Form, DOT/USCG Periodic Drug Testing Form, Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions, Merchant Mariner Medical Certificate, Recognition of Foreign Certificate

OMB No. 1625-0040 Exp: 1/31/2016

Who must comply?	Applicants for Merchant Mariner Credentials (MMC), whether original, renewal, duplicate, raise of grade, or a new endorsement on a previously issued MMC. Applicants for Merchant Mariner Medical Certificates to include National and Standards of Training, Certification and Watchkeeping for Seafarers (STCW) credentialed mariners, and first-class pilots.
What is this collection about?	This information is used by the Coast Guard to evaluate information against applicable statutes, regulations, and policies solely for the purposes of determining eligibility for issuance and retention of an MMC or Merchant Mariner Medical Certificate.
Where do I find the requirements for this information?	Title 46 CFR Parts 10, 11, 12, 13, and 16, which can be obtained electronically at—http://ecfr.gpoaccess.gov. International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended (STCW Convention) and the STCW Code, including the STCW Final Rule (Docket No. USCG-2004-17914) published on December 24, 2013.
When must information be submitted to the Coast Guard?	An applicant must submit information to the Coast Guard before an MMC or Merchant Mariner Medical Certificate application can be evaluate for eligibility.
How is the information submitted?	Through one of 17 Regional Examination Centers (REC) located throughout the nation in written or e-mail form. REC contact and submission information can be found at http://www.uscg.mil/nmc/recs/default.asp .
What happens when complete information is received?	The Coast Guard will evaluate the information, and if the applicant establishes to the Coast Guard that he or she satisfies all the requirements for the MMC or Medical Certificate sought, the Coast Guard will issue the credential or certificate.
For additional information, contact--	The National Maritime Center http://www.uscg.mil/nmc/default.asp .

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the average burden for this report is about 47 minutes (9 minutes for CG-719B, 18 minutes for CG-719K, 15 minutes for CG-719S, and 5 minutes for CG-719P). You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commanding Officer, U.S. Coast Guard National Maritime Center, 100 Forbes Drive, Martinsburg, WV 25404 or Office of Management and Budget, Paperwork Reduction Project (1625-0040), Washington, DC 20503.