Employer documentation of refusal to provide blood, breath urine specimens for chemical test

Report of Marine Casualty & Chemical Testing of Commercial Vessel Personnel

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0001 can be found here:

Documents and Forms

Document Name Document Type
1625-0001_Inst_r5_2016-inv.doc Instruction

Information Collection (IC) Details

IC Title:	Employer documentation of refusal to provide blood, breath urine specimens for chemical test	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 46 CFR 4.06

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1625-0001_Inst_r5_2016-inv.doc		Yes	Yes	Printable Only

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 40 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.