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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CG-719B Application for Merchant Mariner Credential (MMC)	Form and Instruction	Modified	Available
Form CG-719C (01/14) Disclosure Statement for Narcotics, DWI/DUI, AND/OR Other Convictions	Form and Instruction	Modified	Available
Form CG-719S (01/14) Small Vessel Sea Service Form	Form and Instruction	Modified	Available
Form CG-719P (01/14) DOT/USCG Periodic Drug Testing Form	Form and Instruction	Modified	Available
Form CG-719K/E (01/14) Application for Merchant Mariner Medical Certificate for Entry Level Ratings	Form and Instruction	Modified	Available
Form CG-719K (01/14) Application for Merchant Mariner Medical Certificate	Form and Instruction	Modified	Available
Emergency Request Justification.doc	Supplementary Document	Uploaded 2015-07-07	Available
1625-0040_Supporting_Statement_r2.docx	Supporting Statement A	Uploaded 2015-03-17	Available
1625-0040_NoR_23Jan2014.docx	Supplementary Document	Uploaded 2014-09-24	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 Merchant Mariner Credential (MMC)
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	Disclosure Statement for Narcotics, DWI/DUI, AND/OR Other Convictions
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	Application for Merchant Mariner Medical Certificate for Entry Level Ratings
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	Application for Merchant Mariner Medical Certificate
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Instruction	Modified

ICR Details

OMB Control No: 1625-0040	ICR Reference No: 201409-1625-011
Status: Historical Active	Previous ICR Reference No: 201301-1625-001
Agency/Subagency: DHS/USCG	Agency Tracking No:
Title: 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
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 04/30/2015
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/08/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/26/2015
Terms of Clearance: The Department of Homeland Security's U.S. Coast Guard is reminded to comply with all public comment procedures of 5 CFR 1320 to continue to collect this information.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2016	6 Months From Approved	01/31/2016
Responses	56,500	0	56,500
Time Burden (Hours)	47,444	0	44,258
Cost Burden (Dollars)	0	0	0

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Abstract: IAW Title 46 CFR Parts 10, 11, 12, 13, and 16, the collection of this information is necessary to determine competency, character & physical qualifications for the issuance of a Merchant Mariner Credential (MMC) or Medical Certificate.

Emergency Justfication: This request is being submitted in association with the Final Rule,RIN 1625–AA16, Implementation of the Amendments to the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978,and Changes to National Endorsements

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Authorizing Statute(s): US Code: 46 USC Subtitle II, Part E Name of Law: Mechant Seamen Licenses, Certificates, and Documents
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1625-AA16	Final or interim final rulemaking	78 FR 77796	12/24/2013

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Federal Register Notices & Comments

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-719P (01/14), CG-719C (01/14), CG-719K (01/14), CG-719K/E (01/14), CG-719S (01/14), CG-719B	Application for Merchant Mariner Medical Certificate ,   Application for Merchant Mariner Medical Certificate for Entry Level Ratings ,   DOT/USCG Periodic Drug Testing Form ,   Small Vessel Sea Service Form ,   Disclosure Statement for Narcotics, DWI/DUI, AND/OR Other Convictions ,   Application for Merchant Mariner Credential (MMC)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	56,500	56,500	0	0	0	0
Annual Time Burden (Hours)	47,444	44,258	0	0	3,186	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: There is an adjustment (increase) in the respondent's burden as a result of the 12,000 respondents (CG-719K & CG-719K/E) that were not accounted for in the last Supporting Statement, but were accounted for in the table above. . The optional form CG-719C will not contribute to a burden increase because the information was required to be provided previously by the applicant in a format of their choosing attached to the application. By instituting a form this will allow faster and more consistent processing and support the future movement to a wholly electronic application system.

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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: 03/26/2015

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