Information Collection

Coast Guard Boating Accident Report Form (CG-3865)

IC 20444 under ICR 201512-1625-004 · OMB 1625-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0003 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1625-0003 Inst_r0_2015.doc	Instruction
CG-3865 (4/15) Recreational Boating Accident Report CG_3865.pdf	Form
CG-3865SP Reporte Del Accidente En Barcos De Recreacion CG_3865SP.pdf	Form

IC Title:

Coast Guard Boating Accident Report Form (CG-3865)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 33 CFR 174 33 CFR 173.55 33 CFR 173

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1625-0003 Inst_r0_2015.doc	Yes	Yes	Printable Only
Form	CG-3865 (4/15)	Recreational Boating Accident Report	CG_3865.pdf	Yes	Yes	Fillable Printable
Form	CG-3865SP	Reporte Del Accidente En Barcos De Recreacion	CG_3865SP.pdf	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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	Previously Approved
Annual Number of Responses for this IC	5,000	-94	5,094
Annual IC Time Burden (Hours)	2,500	-470	2,970
Annual IC Cost Burden (Dollars)	2,450	209	2,241

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.