Information Collection

State Registration Data

IC 236013 under ICR 201905-1625-001 · OMB 1625-0131.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CGHQ-3923 (01/19) State Registration Data	Form
Form CGHQ-3923 (01/19) State Registration Data State Registration Data	Form
1625-NEW_Instruction_r2.docx	Instruction
1625-NEW_Instruction_r2.docx	Instruction
CGHQ-3923 (01/19) State Registration Data CGHQ-3923_01-19.pdf	Form
CGHQ-3923 (01/19) State Registration Data CGHQ-3923_01-19.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 33 CFR 174.123

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
Form	CGHQ-3923 (01/19)				Yes	Yes	Fillable Printable
Instruction					Yes	Yes	Printable Only

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title: USCG - 013 MISLE

FR Citation: 74 FR 30305

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	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.

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