Adequacy Certification - Application for Certificate of Adequacy (COA)

Adequacy Certification for Reception Facilities and Advance Notice - - 33 CFR Part 158

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
1625-0045_Inst_r5_2021-fac.docx Instruction
1625-0045_Inst_r5_2021-fac.docx 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-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-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-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
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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1625-0045_Inst_r5_2021-fac.docx		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 Marine Information for Safety and Law Enforcement (MISLE)	FR Citation: 74 FR 30305

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	-20	420
Annual IC Time Burden (Hours)	700	40	660
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.