Form CGHQ-3923 (01/19) CGHQ-3923 (01/19) State Registration Data

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1625-New
Expires: mm/dd/yyyy

U.S. Coast Guard
STATE REGISTRATION DATA

Instructions: This form references data outlined in 33 CFR 174.19. Section 1 represents administrative information. Section 2 represents recreational vessel
registration where the primary operation was "pleasure", "rent or lease", or "dealer or manufacturer demonstration". Section 3 represents commercial vessel
registration where the primary operation was "charter fishing", "commercial fishing", "commercial passenger carrying", or "other commercial operation". Section
4 provides tallies. Section 5 represents the scope of your registration system. Please fill in these sections for the calendar year. Direct form questions to CG­
BSX-21 at 202-372-1103. By transmitting this form to CG-BSX, you hereby certify the information contained herein to be accurate to the best of your knowledge.

SECTION 1 * ADMINISTRATIVE
STATE

POINT OF CONTACT

AGENCY

PHONE

CALENDAR YEAR REPRESENTED

EMAIL

DATE SUBMITTED

SECTION 2 * RECREATIONAL VESSELS REGISTERED BY LENGTH CATEGORY
LENGTH CATEGORY (ft)
MOTORIZED VESSEL TYPES

<16

16 to <26

26 to <40

40 to 65

>65

All Lengths

>65

All Lengths

Airboat
Auxiliary sail
Cabin motorboat
Houseboat
Inflatable boat
Open motorboat
Personal watercraft
Pontoon boat
Other

NON-MOTORIZED VESSEL TYPES

<16

16 to <26

LENGTH CATEGORY (ft)
26 to <40
40 to 65

Inflatable boat
Paddlecraft
Rowboat
Sail only
Other

SECTION 3 * COMMERCIAL VESSELS REGISTERED

SECTION 4 * TALLIES
TOTAL

Charter fishing
Commercial fishing
Commercial passenger carrying
Other commercial operation

Total Registration
Recreational
- Motorized
- Non-motorized
Commercial

SECTION 5 * SCOPE OF REGISTRATION SYSTEM (what vessels your State registers. Examples: all watercraft, all motorboats, etc.)

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 45 minutes. You may submit any comments concerning the accuracy of this burden
estimate or any suggestions for reducing the burden to: Commandant (CG-BSX), U.S. Coast Guard, Washington, DC 20593-7501, or Office of Management
and Budget, Paperwork Reduction Project (1625-XXX), Washington, DC 20503.
Privacy Act Notice
Authority - 46 U.S.C. 6016, 12303.
Purpose - To obtain statistical data on State-registered recreational and commercial vessels.
Routine Uses - USCG personnel will use this information in an annual statistical publication and to calculate rates (i.e. fatality rate expressed by the number of
deaths per 100,000 registered vessels). Privacy Impact Assessment coverage is provided by DHS/USCG/PIA-008 MISLE, which outlines the risks of capturing
information required to support the Coast Guard's marine safety, security, environmental protection and law enforcement programs.
Disclosure - Mandatory; States are required to report this information before March 1 of each year to the Coast Guard in accordance with 33 CFR 174.123.
CGHQ-3923 (01/19)

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