Section 80.59, Compulsory Ship Inspections and Ship Inspection Certificates, FCC Forms 806, 824, 827 and 829

FEDERAL COMMUNICATIONS COMMISSION Not Approved by OMB

3060-0228

Estimated Time Per Response: 10 Minutes

United States of America

COMMUNICATIONS ACT SAFETY RADIOTELEPHONY CERTIFICATE

Name of Vessel	Official Number	Radio Call Sign	Port of Registry	Gross Tonnage

The Government of the United States of America certifies that the radiotelephone installation on board the above-described vessel complies with all relevant provisions of Part III of Title III of the Communications Act, the rules of the Commission made pursuant thereto, the terms of the station license, and successfully completed an operational test at the time this certificate is issued.

Notwithstanding the above, it is unlawful for a vessel of the United States, transporting more than six passengers for hire to be navigated in the open sea or any tidewater with the jurisdiction of the United States adjacent or contiguous to the open sea, unless the vessel is equipped with an efficient radiotelephone installation in operating condition.

Type of radio installations on board this vessel: VHF MF HF EPIRB Recognized Mobile Satellite

Service Ship Earth Station

When a VHF station only is provided, this certificate is valid only while the vessel is within communication range of a public coast state of U.S. Coast Guard station operating in the band 156 to 162 MHz which maintains an efficient watch for reception of

156.8 MHz at all times while the vessel is navigated.

This certificate will remain in force until _ issued at on the day of , 20

Validated: (Licensed Inspector) (License Number of Licensed Inspector)

OMB Control Number 3060-0228

Notice to Individuals Required by the Privacy Act of 1974 and the Paperwork Reduction Act of 1995

The solicitation of information requested in this form is authorized by the Communications Act of 1934, as amended. The

Commission will use FCC-licensed technicians to conduct ship inspections and determine if the radio installation is in compliance with the requirements of the Communications Act of 1934, as amended. All information provided in this form, as well as the form itself, will be available for public inspection.

Public reporting burden for this collection of information is estimated to average 10 minutes per response. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, Office of Managing Director, AMD-PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060-0228). We will also accept your PRA comments via the internet if you e-mail [email protected].

Please DO NOT SEND COMPLETED FORMS TO THE POSTAL OR E-MAIL ADDRESS. You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0228.

THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31,1974, 5 U.S.C. § 552a(e)(3); AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, MAY 22,1995, 44 U.S.C. § 3507.

FCC Form 824

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