Applications for Merchant Mariner Credentials and Medical Certificates

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CG-719S Small Vessel Sea Service Form	Form	Modified	Available
Form CG-719P DOT/USCG Periodic Drug Testing Form	Form	Modified	Repair queued
Form CG-719K/E Application for Medical Certificate, Short Form	Form and Instruction	Modified	Available
Form CG-719K Application for Medical Certificate	Form and Instruction	Modified	Repair queued
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions	Form and Instruction	Modified	Repair queued
Form CG-719B Application for Merchant Mariner Credential	Form and Instruction	Modified	Repair queued
PTA USCG - Pilots Medical Certificate Validity Period Final Rule 20220506 PRIV Final.pdf	Supplementary Document	Uploaded 2023-08-15	Repair queued
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308.docx	Supplementary Document	Uploaded 2023-04-27	Repair queued
privacy-pia-uscg-015-MMLDS-2011.pdf	Supplementary Document	Uploaded 2023-04-27	Repair queued
1625-0040_SS_r0_2021_calc-sheet_App_A-to-B_pmn-nprm.pdf	Supplementary Document	Uploaded 2023-08-15	Repair queued
CFR-2021-title46-vol1-part16.pdf	Supplementary Document	Uploaded 2023-04-27	Repair queued
CFR-2021-title46-vol1-part13.pdf	Supplementary Document	Uploaded 2023-04-27	Repair queued
CFR-2021-title46-vol1-part12.pdf	Supplementary Document	Uploaded 2023-04-27	Repair queued
CFR-2021-title46-vol1-part11.pdf	Supplementary Document	Uploaded 2023-04-27	Available
CFR-2021-title46-vol1-part10.pdf	Supplementary Document	Uploaded 2023-04-27	Repair queued
1625-0040_SS_r0_2021_pmc-nprm (006).docx	Supporting Statement A	Uploaded 2024-01-26	Repair queued
USCODE-2011-title46-subtitleII-partE.pdf	Supplementary Document	Uploaded 2016-01-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Form	Modified	Small Vessel Sea Service Form
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Form	Modified	DOT/USCG Periodic Drug Testing Form
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Form and Instruction	Modified	Application for Medical Certificate, Short Form
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Form and Instruction	Modified	Application for Medical Certificate
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Form and Instruction	Modified	Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Form and Instruction	Modified	Application for Merchant Mariner Credential
43932	Applications for Merchant Mariner Credentials and Medical Certificates	Instruction	Modified

ICR Details

OMB Control No: 1625-0040	ICR Reference No: 202304-1625-003
Status: Historical Inactive	Previous ICR Reference No: 202102-1625-008
Agency/Subagency: DHS/USCG	Agency Tracking No:
Title: Applications for Merchant Mariner Credentials and Medical Certificates
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 02/10/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/26/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	36 Months From Approved	04/30/2026
Responses	310,604	0	310,604
Time Burden (Hours)	62,004	0	62,004
Cost Burden (Dollars)	0	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. 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.

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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:
	86 FR 48090	08/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 66575	11/04/2022
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Applications for Merchant Mariner Credentials and Medical Certificates	CG-719B, CG-719C, CG-719K, CG-719P, CG-719S, CG-719K/E	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 ,   DOT/USCG Periodic Drug Testing Form ,   Small Vessel Sea Service Form

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The change in burden is a PROGRAM CHANGE due to the 1625-AC63 PMC NPRM. The reporting and recordkeeping requirements, and the methodology for calculating burden, remain unchanged.

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Annual Cost to Federal Government: $14,729,656

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: 01/26/2024

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