Information Collection

Coast Guard Auxiliary Safety Survey

IC 214651 under ICR 201501-1625-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CG-16798 (11/13) Coast Guard Auxiliary Safety Survey	Form
1625-NEW_Inst_r1_2014.docx	Instruction
CG-16798 (11/13) District Five Auxiliary Safety Survey USCG AUX Survey Draft8-03202013.doc surveys.uscg.mil/Community/se.ashx?s=6F20F77460608CE6	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	CG-16798 (11/13)	District Five Auxiliary Safety Survey	USCG AUX Survey Draft8-03202013.doc	https://surveys.uscg.mil/Community/se.ashx?s=6F20F77460608CE6	Yes	Yes	Fillable Fileable
Instruction			1625-NEW_Inst_r1_2014.docx		Yes	No	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title: Privacy Act of 1974; Department of Homeland Security United States Coast Guard - 024 Auxiliary Database

FR Citation: 76 FR 28795

Number of Respondents: 3,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	533	533
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.