Application for Merchant Mariner Credential (MMC), Merchant Mariner Certificate Evaluation Report, Small Vessel Sea Service Form, DOT/USCG Periodic Drug Testing Form, Merchant Mariner Evaluation of Fi

Forms and Documents

Document Name	Status
1625-0040_SS_r0_2020_calc-sheet_App_A-to-B.pdf Supplementary Document	2021-02-24
1625-0040 30-day FR Notice 86FR2429 20210112.docx Supplementary Document	2021-02-24
1625-0040 60-day FR Notice 85FR66573 20201020.docx Supplementary Document	2021-02-24
CG719S.pdf Supplementary Document	2021-02-24
CG719B.pdf Supplementary Document	2021-02-24
CG719C (002).pdf Supplementary Document	2021-02-24
CG719K.pdf Supplementary Document	2021-02-24
CG719KE (002).pdf Supplementary Document	2021-02-24
CG719P.pdf Supplementary Document	2021-02-24
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308.doc Supplementary Document	2018-02-27
privacy-pia-uscg-015-MMLDS-2011.pdf Supplementary Document	2018-02-27
1625-0040_SS_r0_2020 (002).pdf Supporting Statement A	2021-02-24
CFR-2002-title46-vol1-part16.pdf Supplementary Document	2016-01-28
CFR-2002-title46-vol1-part13.pdf Supplementary Document	2016-01-28
CFR-2002-title46-vol1-part12.pdf Supplementary Document	2016-01-28
CFR-2014-title46-vol1-part11.pdf Supplementary Document	2016-01-28
CFR-2002-title46-vol1-part10.pdf Supplementary Document	2016-01-28
USCODE-2011-title46-subtitleII-partE.pdf Supplementary Document	2016-01-28

IC Document Collections

IC ID	Document Title	Status
43932	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Instruction	Modified

ICR Details

OMB Control No: 1625-0040	ICR Reference No: 202102-1625-008
Status: Received in OIRA	Previous ICR Reference No: 201601-1625-009
Agency/Subagency: DHS/USCG	Agency Tracking No:
Title: Application for Merchant Mariner Credential (MMC), Merchant Mariner Certificate Evaluation Report, Small Vessel Sea Service Form, DOT/USCG Periodic Drug Testing Form, Merchant Mariner Evaluation of Fi
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/11/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2021
Responses	310,604	68,500
Time Burden (Hours)	62,004	47,444
Cost Burden (Dollars)	0	0

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Abstract: IAW Title 46 CFR Parts 10, 11, 12, 13, and 16, the collection of this information is necessary to determine competency, character & physical qualifications for the issuance of a Merchant Mariner Credential (MMC) or Medical Certificate.

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Authorizing Statute(s): US Code: 46 USC Subtitle II, Part E Name of Law: Mechant Seamen Licenses, Certificates, and Documents
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 66573	10/20/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 2429	01/12/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	CG-719B, CG-719C, CG-719K, CG-719P, CG-719S, CG-719K/E	DOT/USCG Periodic Drug Testing Form ,   Small Vessel Sea Service Form ,   Application for Merchant Mariner Credential ,   Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions ,   Application for Medical Certificate ,   Application for Medical Certificate, Short Form

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	310,604	68,500	0	0	242,104	0
Annual Time Burden (Hours)	62,004	47,444	0	0	14,560	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The change in burden is an ADJUSTMENT due to the change (i.e., increase) in the estimated annual number of responses. There is no proposed change to the reporting or recordkeeping requirements of this collection. The reporting and recordkeeping requirements, and the methodology for calculating burden, remain unchanged. Additionally, to simplify it, the COI title is changed from— Applications for Merchant Mariner Credentials (MMC), Application for and Medical Certificates, Application for Medical Certificate -Short Form, Small Vessel Sea Service (Optional) Form, DOT/USCG Periodic Drug Testing (Optional) Form, and Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions (Optional) Form.

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Annual Cost to Federal Government: $33,885,515

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/11/2021

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