Applications for Merchant Mariner Credentials and Medical Certificates

Documents and Forms

Document Name Document Type
1625-0040_Inst_r0_2021-mmc_pmc-nprm (003).docx Instruction
CG-719B Application for Merchant Mariner Credential CG719B.pdf Form and Instruction
CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Othe CG719C (002).pdf Form and Instruction
CG-719K Application for Medical Certificate CG719K.pdf Form and Instruction
CG-719K/E Application for Medical Certificate, Short Form CG719KE (002).pdf Form and Instruction
CG-719P DOT/USCG Periodic Drug Testing Form CG719P.pdf Form
CG-719S Small Vessel Sea Service Form CG719S.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Applications for Merchant Mariner Credentials and Medical Certificates	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 46 CFR 11 46 CFR 10 46 CFR 12 46 CFR 13 46 CFR 16

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1625-0040_Inst_r0_2021-mmc_pmc-nprm (003).docx	Yes	Yes	Printable Only
Form and Instruction	CG-719B	Application for Merchant Mariner Credential	CG719B.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CG-719C	Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions	CG719C (002).pdf	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K	Application for Medical Certificate	CG719K.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K/E	Application for Medical Certificate, Short Form	CG719KE (002).pdf	Yes	Yes	Fillable Printable
Form	CG-719P	DOT/USCG Periodic Drug Testing Form	CG719P.pdf	Yes	Yes	Fillable Printable
Form	CG-719S	Small Vessel Sea Service Form	CG719S.pdf	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records
Title: DHS/USCG-030 Merchant Seamen's Records	FR Citation: 74 FR 30308

Number of Respondents: 68,500	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	245,962	-64,642	310,604
Annual IC Time Burden (Hours)	47,290	-14,714	62,004
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.