1625-0040_SS_r0_2020 (002)

1625-0040

Supporting Statement
for
Applications for Merchant Mariner Credentials and Medical Certificates
OMB No.: 1625-0040
COLLECTION INSTRUMENTS: CG-719B, CG-719C, CG-719K, CG-719K/E,
CG-719P, CG-719S and Instruction
A. Justification
1. Circumstances that make the collection of information necessary.
Title 46, Code of Federal Regulations (CFR), parts 10, 11, 12, 13, and 16, and International Convention
on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended (STCW
Convention) and the STCW Code, require that each applicant for a Merchant Mariner Credential (MMC)
or Medical Certificate make written application to the Coast Guard.
The forms associated with this collection are—
 Application for Merchant Mariner Credential // CG-719B
 Application for Medical Certificate // CG-719K
 Application for Medical Certificate, Short Form // CG-719K/E
 Small Vessel Sea Service Form // CG-719S
 DOT/USCG Periodic Drug Testing Form // CG-719P
 Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions // CG-719C
An applicant will submit on a form CG-719B, Application for Merchant Mariner Credential, and provide
documentation that they are medically fit to perform the functions of the credential sought on a Form CG719K or Form CG-719K/E. The regulations also require that applicants for a MMC provide documentary
evidence of sea service or accepted substitute of sea service; evidence of having passed a chemical test
for dangerous drugs, and, documentation of safety and suitability, to include a criminal record review and
information supplied by the Transportation Security Administration (TSA). Optional forms CG-719S, CG719P, and CG-719C are provided that applicants may use to meet these additional reporting
requirements.
2. Purpose of the information collection.
The Coast Guard conducts this collection of information solely for the purposes of determining eligibility
for issuance of an MMC and/or Medical Certificate, in accordance with applicable statutes and
regulations. This evaluation is performed on occasion, meaning as submitted by the respondent when he
or she applies for an MMC or Medical Certificate. In general, applicants for a MMC submit the CG-719B
every five years for renewal or when seeking a new MMC endorsement , and applicants for the medical
certificate submit the 719K every two years or every five years, depending upon the type of credential or
endorsements held and the applicant’s medical status. The Coast Guard evaluates the collected
information to determine whether applicants are qualified to serve under the authority of the requested
credential with respect to their medical fitness, their professional qualifications, and their safety and
suitability. Upon review of the information, the Coast Guard processes applications and issues MMCs
and/or Medical Certificates to applicants who are qualified to serve without posing a significant threat to
safety of life or property. If this collection of information was not performed, the Coast Guard’s
credentialing and prevention missions would be impaired; and the agency’s ability to ensure the safety
and security of U.S. ports and waterways would be significantly curtailed.
3. Consideration of the use of improved collection techniques.
The forms in this collection are available as a fillable PDF online at https://www.dco.uscg.mil/nmc/forms/.
Applicants requesting a MMC or Medical Certificate may apply to any of the Regional Exam Centers
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(RECs) or other location designated by the Coast Guard. Applicants may contact the National Maritime
Center (NMC) by mail at 100 Forbes Drive, Martinsburg, WV 25404, by email at [email protected], or
by contacting an agent in the Customer Service Center by telephone at 1-888-427-5662 or 304-433-3400.
The Coast Guard estimates that 90% of the responses are submitted electronically.
4. Efforts to identify duplication.
Each form in the CG-719 series collects a unique set of information, specific to a regulatory requirement
for credentialing of merchant mariner applicants. However, since there is no requirement to attach forms
to one another, or to submit all forms at the same time, each form collects sufficient personal identification
data to ensure that forms may be properly matched to the correct applicant.
5. Methods to minimize the burden to small businesses if involved.
The information collection does not impact small businesses.
6. Consequences to the Federal program if collection were conducted less frequently.
The Coast Guard is mandated by law to issue MMCs and Medical Certificates to individuals found
qualified as to age, character, habits of life, experience, professional qualifications, and physical fitness.
Without the ability to collect this information the Coast Guard would not be able to adhere to statutory and
regulatory requirements.
7. Special collection circumstances.
This information collection is conducted in manner consistent with the guidelines in 5 CFR 1320.5(d)(2).
8. Consultation.
A 60-day Notice was published in the Federal Register to obtain public comment on this collection (See
[USCG-2020-0666]; October 20, 2020, 85 FR 66573) and 30-Day Notice (January 12, 2021, 86 FR 2429)
were published in the Federal Register to obtain public comment on this collection. The Coast Guard has
not received any comments on this information collection.
9. Provide any payment or gift to respondents.
The Coast Guard does not provide payments or gifts to respondents in exchange for a benefit sought.
10. Describe any assurance of confidentiality provided to respondents.
There are no assurances of confidentiality provided to the respondents for this information collection.
This information collection request is covered by the Merchant Mariner Licensing and Documentation
System (MMLDS) Privacy Impact Assessment (PIA) and Merchant Seamen’s Records System of
Records Notice (SORN). Links to the aforementioned PIA and SORN are provided below:
 https://www.dhs.gov/publication/dhsuscgpia-015-merchant-mariner-licensing-and-documentationsystem
 https://www.gpo.gov/fdsys/pkg/FR-2009-06-25/html/E9-14911.htm
11. Additional justification for any questions of a sensitive nature.
Questions of a sensitive nature are included to the extent required by the statute and the regulation and
used by the Coast Guard to determine whether an applicant meets the safety and suitability, medical, and
professional qualification standards for issuance of a Merchant Mariner Credential and medical certificate.
12. Estimates of annual hour and cost burdens to respondents.

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The estimated number of annual respondents is 90,293.
The estimated number of annual responses is 310,604.
The estimated hour burden is 62,004 hours.
The estimated cost burden is $2,170,140.

The burden to respondents is provided in Appendix A. We estimate that an application (CG-719B) itself
takes approximately 9 minutes to complete, and may be e-mailed, faxed, mailed or hand carried to a
Regional Examination Center for processing. Applications may be accompanied by a CG-719K (18
minutes to complete/ used by ~95% of respondents) or CG-719K/E (10 minutes to complete/used by ~5%
of respondents). In addition, other mariners, annually, only apply for the Medical Certificate by
completing the CG-719K (~95%) or CG-719K/E (~5%). Optional forms CG-719P (5 minutes to complete),
the CG-719S (15 minutes to complete) and the CG-719C (10 minutes to complete) may be used to
provide documentary evidence of meeting additional certification requirements. We estimate that 100%
of MMC applicants submit a form CG-719P, 100% a form CG-719S and 5% a form CG-719C.
For the wage rate, we averaged the Bureau of Labor Statistics (BLS) wage rate for Captains, Mates, and
Pilots of Water Vessels (53-5021) and Sailors and Marine Oilers (53-5011) [May 2019, rounded up].
13. Total annualized capital and start-up costs.
There are no annualized capital and start-up costs.
14. Estimates of annualized cost to the Federal Government.
The estimated annual Federal Government cost is $33,885,515 (see Appendix B). The cost is based on
both Direct Costs to the Government and Indirect Costs (i.e., Contractor).
15. Reasons for the change in burden.
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.
to— Applications for Merchant Mariner Credentials and Medical Certificates.
16. Plans for tabulation, statistical analysis and publication.
There are no current plans to publish the results of the collection of information.
17. Approval for not explaining the expiration date for OMB approval.
The Coast Guard will display the expiration date for OMB approval of this information collection.
18. Explain each exception to the certification statement.
The Coast Guard does not request an exception to the certification of this information collection.

B. Collection of Information Employing Statistical Methods

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This information collection does not employ statistical methods.

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