CG-4020 (12/18) 4 Hour Advance Notice of Transfer

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard

OMB No: 1625-0042
Exp date: mm/dd/yyyy

From: Owner/Operator

To: Coast Guard Unit Name

Phone

Phone

Fax/email

Fax/email

Transferring From:
)

Facility (Name
Official Number

Vessel/Barge (Name

)

Transferring To:
)

Facility (Name
Official Number

Vessel/Barge (Name
Date of Transfer

Time of Transfer

)
Duration

Name of Product

Amount

Barrels
Gallons

Notes/Comments (optional)

Privacy Act Statement
Authority: 33 U.S.C. 1225; 33 C.F.R. Part 154; and 33 C.F.R. Part 156.118.
Purpose: The Coast Guard will use this information to monitor oil or hazardous material transfer operations to, from, or within a vessel with a capacity of 250
barrels or more at 33 C. F. R. Part 154 regulated facilities.
Routine Uses: The information requested on this form may be shared externally as a “routine use” to other law enforcement or other government agencies as
necessary, pursuant to DHS/USCG-013, Marine Information for Safety and Law Enforcement (MISLE), 74 Federal Register 30305 (June 25, 2009), to assist the
Department of Homeland Security in responding to any incidents that may occur as a result of any oil or hazardous material transfer operation.
Disclosure: Furnishing this information is voluntary; failure to provide this information may result in the delay of transfer operation authorization or other
enforcement actions.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB number.
The Coast Guard estimates that the average burden for this report is 6 minutes. You may submit any comments concerning the accuracy of this burden
estimate or any suggestion for reducing the burden to: Commandant (CG-FAC), U.S. Coast Guard Stop 7501, 2703 Martin Luther King Jr Ave SE, Washington,
DC 20593-7318 or Office of Management and Budget, Paperwork Reduction Project (1625-0042), Washington, DC 20503.
CG-4020 (12/18)

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