Information Collection

Adequacy Certification - Application for Certificate of Adequacy (COA)

IC 20537 under ICR 201808-1625-006 · OMB 1625-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1625-0045_Inst_r4_2018-fac.doc	Instruction
CG-5401A (04/15) Application for Certificate of Adequacy (COA) for Recept CG-5401A_04-15_w-exp-date.pdf www.uscg.mil/forms	Form and Instruction
CG-5401B (04/15) Application for Certificate of Adequacy (COA) for Recept CG-5401B_04-15_w-exp-date.pdf www.uscg.mil/forms	Form and Instruction
CG-5401C (04/15) Application for a Reception Facility Certificate of Adeq CG-5401C_04-15_w-exp-date.pdf www.uscg.mil/forms	Form
CG-5401D (04/15) Application for a Reception Facility Certificate of Adeq CG-5401D_04-15_w-exp-date.pdf www.uscg.mil/forms	Form

IC Title:

Adequacy Certification - Application for Certificate of Adequacy (COA)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 33 CFR 158.140

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
Instruction			1625-0045_Inst_r4_2018-fac.doc		Yes	Yes	Printable Only
Form and Instruction	CG-5401A (04/15)	Application for Certificate of Adequacy (COA) for Reception Facilities Form A	CG-5401A_04-15_w-exp-date.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Fileable
Form and Instruction	CG-5401B (04/15)	Application for Certificate of Adequacy (COA) for Reception Facilities Form B	CG-5401B_04-15_w-exp-date.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Fileable
Form	CG-5401C (04/15)	Application for a Reception Facility Certificate of Adequacy for Garbage Form C	CG-5401C_04-15_w-exp-date.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Fileable
Form	CG-5401D (04/15)	Application for a Reception Facility Certificate of Adequacy for Ozone Depletion Substances and Exhaust Gas Cleaning System Residue Form D	CG-5401D_04-15_w-exp-date.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title: DHS/USCG - 013 MISLE

FR Citation: 74 FR 30305

Number of Respondents: 420

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	420	13,962	-13,944	402
Annual IC Time Burden (Hours)	660	3,576	-3,486	570
Annual IC Cost Burden (Dollars)	0	0	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.