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-719S Small Vessel Sea Service Form	Form	Modified	Available
Form CG-719P DOT/USCG Periodic Drug Testing Form	Form	Modified	Available
Form CG-719K/E Application for Medical Certificate, Short Form	Form and Instruction	Modified	Available
Form CG-719K Application for Medical Certificate	Form and Instruction	Modified	Available
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions	Form and Instruction	Modified	Available
Form CG-719B Application for Merchant Mariner Credential	Form and Instruction	Modified	Available
Narrative of Changes Table.8.23.16.docx	Supplementary Document	Uploaded 2018-02-27	Available
Narrative of Changes Table (3) 5.16.docx	Supplementary Document	Uploaded 2018-02-27	Available
Narrative of Changes Table (2).1.16.docx	Supplementary Document	Uploaded 2018-02-27	Available
1625-0040_Narrative of Change_12Sep11.docx	Supplementary Document	Uploaded 2018-02-27	Available
1625-0040 30-Day FR Notice_Volume 83_FR 3757_20180126.doc	Supplementary Document	Uploaded 2018-02-27	Available
1625-0040 30-Day FR Notice_Volume 81_FR 8085_February 17, 2016.doc	Supplementary Document	Uploaded 2018-02-27	Available
1625-0040 60-Day FR Notice_Volume 82_FR 49639_20171026.doc	Supplementary Document	Uploaded 2018-02-27	Available
1625-0040 60-Day FR Notice_Volume 80_FR 62079_October 15, 2015.doc	Supplementary Document	Uploaded 2018-02-27	Available
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308.doc	Supplementary Document	Uploaded 2018-02-27	Available
privacy-pia-uscg-015-MMLDS-2011.pdf	Supplementary Document	Uploaded 2018-02-27	Available
PTA, USCG - Form 719S, 20170908, PRIV Final.pdf	Supplementary Document	Uploaded 2018-02-27	Available
PTA, USCG - Form 719P, 20170908, PRIV Final.pdf	Supplementary Document	Uploaded 2018-02-27	Available
PTA, USCG - Form 719KE, 20170831, PRIV final.pdf	Supplementary Document	Uploaded 2018-02-27	Available
PTA, USCG - Form 719K, 20170831, PRIV Final.pdf	Supplementary Document	Uploaded 2018-02-27	Available
PTA, USCG - Form 719C, 20170908, PRIV Final.pdf	Supplementary Document	Uploaded 2018-02-27	Available
PTA, USCG - Form 719B, 20170908, PRIV Final.pdf	Supplementary Document	Uploaded 2018-02-27	Available
1625-0040_SS_r2_2017.doc	Supporting Statement A	Uploaded 2018-02-27	Available
CFR-2002-title46-vol1-part16.pdf	Supplementary Document	Uploaded 2016-01-28	Available
CFR-2002-title46-vol1-part13.pdf	Supplementary Document	Uploaded 2016-01-28	Available
CFR-2002-title46-vol1-part12.pdf	Supplementary Document	Uploaded 2016-01-28	Available
CFR-2014-title46-vol1-part11.pdf	Supplementary Document	Uploaded 2016-01-28	Available
CFR-2002-title46-vol1-part10.pdf	Supplementary Document	Uploaded 2016-01-28	Available
USCODE-2011-title46-subtitleII-partE.pdf	Supplementary Document	Uploaded 2016-01-28	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	Modified	Small Vessel Sea Service Form
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form	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 Medical Certificate, Short Form
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	Form and Instruction	Modified	Application for Medical Certificate
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	Application for Merchant Mariner Credential
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: 201601-1625-009
Status: Historical Active	Previous ICR Reference No: 201409-1625-011
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: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/13/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/01/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	36 Months From Approved
Responses	68,500	0	0
Time Burden (Hours)	47,444	0	0
Cost Burden (Dollars)	0	0	0

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 49639	10/26/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 3757	01/26/2018
Did the Agency receive public comments on this ICR? Yes

---

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-719B, CG-719C, CG-719K, CG-719P, CG-719S, CG-719K/E	Application for Merchant Mariner Credential ,   Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions ,   Application for Medical Certificate ,   Application for Medical Certificate, Short Form ,   DOT/USCG Periodic Drug Testing Form ,   Small Vessel Sea Service Form

---

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	68,500	0	0	0	12,000	56,500
Annual Time Burden (Hours)	47,444	0	0	0	0	47,444
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:

---

Annual Cost to Federal Government: $14,729,656

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

---

Common Form ICR:  No

---

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: 03/01/2018

---