1625-0040 Narrative of Revision

Narrative of Change

The purpose of the Narrative of Change is to clearly indicate changes to a collection since the previous approval

Collection Title: Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Level Physical

OMB Control No.: 1625-0040

Current Expiration Date: 6/30/2012

Collection Instrument: CG-719B

The following items listed below are changes to CG-719B as a result of the Coast Guard Authorization Act of 2010 and to align language with statutory and regulatory changes. See the enclosed CG-719B for further details:

1. Added the following to page 1 –

1. “See instructions at the end of the application for completing this form.” after Section I – Personal Data.

2. “Reference Number”

3. “Alien Registration Number (ARN)”

4. “Delivery/Mailing Address, if different (PO Box acceptable”

5. “Other” box after phone, alternate phone, and email address boxes

6. “(Please indicate best method(s) of contact by checking the appropriate box(es))” after Next of Kin/Emergency Contact

7. “Cell Phone (Optional)” under Next of Kin/Emergency Contact

8. “Endorsement Category” under Section II

9. “Transaction Type (Check All That Apply; See Instructions for Definitions and Additional Requirements for the transaction below)” under Section II

10. “ If I am not approved for the endorsement I have requested, I wish to be approved for the highest endorsement for which I am qualified (e.g. I want AB Limited if I am not approved for AB Unlimited).”

2. Added the following to page 2 –

1. “Transportation Worker's Identification Credential (TWIC)

I have previously enrolled for a TWIC with TSA and am exempt from holding a valid TWIC” to Section III

2. “ I understand that a Document of Continuity is not valid for use in accordance with 46 CFR 10.227(e)(2)(ii) and aware of the requirements to obtain an MMC.” to Section III.

3. “Third Party (Optional): By checking the following boxes, I am authorizing release of information to the third party as indicated below. If a selection is made, please provide the Name of the Organization or Third Party, Address, and Phone Number. Additional Third Party release information can be attached separately.” to Section III.

4. “ Safety and Suitability” to Section III.

5. “ Medical” to Section III

6. “ Professional qualifications, certification records, or Sea Service” to Section III

7. “ Merchant Mariner Credential” to Section III

8. “ Act on my behalf in all matters pertaining to the processing of my current USCG credential application” to Section III

9. “Name of Organization or Third Party” to Section III

10. “Organization Point of Contact (if applicable)” to Section III

11. “Address” to Section III

12. City, State, Zip Code” to Section III

13. “Phone Number” to Section III

3. Added the following to page 3 –

1. “Signature of Witness to the Oath” and “Date” to Section III

4. Added 2 pages of instructions for further guidance regarding information that may be required to be submitted with the application.

5. Added “Figure 1” to assist applicants in determining what attachments to include with applications (according to endorsement categories and transaction types).

6. Changed the following to page 1 –

1. Header for all pages – changed “Application for License as an Officer, Staff Officer, or Operator and for Merchant Mariner’s Document” to “Application for Merchant Mariner Credential (MMC)”

2. Changed Section I – Personal Data:

1. Name section to “Legal Name (Last, First, Middle, Suffix) [Alias(es) or Maiden Name(s) if applicable]”

2. Date of Birth section to “DD/MM/YYYY”

3. “Country of Citizenship” to “Citizenship/Nationality”

4. Removed “Color of Eyes”

5. Removed “Color of Hair”

6. Removed “Height”

7. Removed “Weight”

8. Changed “PO Boxes are acceptable” to “PO Boxes NOT acceptable”

9. Changed “FAX Number” to “Alternate Phone”

10. Changed title of Section II to “Requested Coast Guard Credential(s) See instructions at the end of the application for completing this form.”

11. Removed “*If requesting a duplicate for a lost or stolen License/MMD attach a signed statement explaining how, when and where your credentials were lost or stolen and your efforts to recover them.”

12. Removed “State Current or Previous License/Merchant Mariner’s Document”

13. Removed “Description of License/Merchant Mariner’s Document”

14. Removed “Place of Issue”

15. Removed “Date of Issue”

7. Changed the following to page 2 –

   1. Removed “Narcotics, DWI/DUI, and Conviction Record” in Section III and replaced with “Mariner’s Consent/Certification” Section III Change “MMD #” box to “MMC #”

   2. C hanged “Conviction means found guilty by judgment..” under “Narcotics, DWI/DUI, and Conviction Record” in Section III to “ I have attached a signed statement of explanation…” in box 4 of Section III.

   3. Removed the following from Section III:

1. “Indicate your answers…”

2. “Have you ever been convicted of violating...”

3. “Have you ever been convicted by any court…”

4. “Have you ever been convicted of a traffic…”

5. “Have you ever had your driver’s license revoked…”

6. “Have you ever been given a Coast Guard letter…”

7. “Have you ever had any Coast Guard license…”

8. “I have attached a statement of explanation for all areas marked “yes” above…”

9. “Signature of Applicant agreeing to the above statement”

10. “Date”

4. Removed “Section IV – Character References (For Original License Applicants Only)”

5. Removed “I am an Original License Applicant…”

6. Removed “Section V - Mariner’s Consent”

7. Revised language in “National Driver Registry (NDR)…” and moved to Section III, box 5.

8. Removed “Signature of Applicant” from NDR

9. Removed “Date” from NDR

10. Revised language in “Mariner’s Tracking System…” and moved to Section III, box 2.

11. Removed “Signature of Applicant” from Mariner’s Tracking System

12. Removed “Date” from Mariner’s Tracking System

8. Changed the following to page 3 –

1. Removed “Section VI – Certification and Oath”

2. Changed “Certification (Mandatory)” to “Certification”

3. Revised language in “Certification” and moved to Section III, box 9.

4. Removed “Signature of Applicant…” under Section VI

5. Removed “Date” under Section VI

6. Revised “Oath (For originals only. Coast Guard official must witness applicant signature.)” to “Oath (For originals only.)”

7. Revised language in “Oath…” and moved to Section III, box 10.

8. Removed “Signature of Coast Guard Official ________________ Date”

9. Removed entire Section VII

10. Removed entire Section VIII

11. Removed entire Section IX

9. Changed the following to page 4 –

1. Revised language in the Privacy Act and moved to bottom of page 3.