Documentation of medical fitness

Standards of Training, Certification and Watchkeeping for Seafarers (STCW), International Convention

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0079 can be found here:

Documents and Forms

Document Name Document Type
1625-0079_Inst_r5_2019-mmc.doc.docx Instruction
1625-0079_Inst_r5_2019-mmc.doc.docx Instruction

Information Collection (IC) Details

IC Title:	Documentation of medical fitness	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 12.02-17

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1625-0079_Inst_r5_2019-mmc.doc.docx		Yes	Yes	Printable Only

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: 35,108	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	33,875	-2,115	35,990
Annual IC Time Burden (Hours)	11,281	-704	11,985
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.