Information Collection Request

Applications for Merchant Mariner Credentials and Medical Certificates

ICR 202506-1625-001 · OMB 1625-0040 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CG-719S Small Vessel Sea Service Form Form Modified Available
Form CG-719P DOT/USCG Periodic Drug Testing Form Form Modified Available
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 Available
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions Form and Instruction Modified Available
Form CG-719B Application for Merchant Mariner Credential Form and Instruction Modified Available
1625-0040_SS_r0_2025_calc-sheet_m2m-nprm_App_A-to-B.pdf Supplementary Document Uploaded 2025-06-04 Available
46 CFR Part 13.pdf Supplementary Document Uploaded 2025-06-04 Available
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308 (1).docx Supplementary Document Uploaded 2025-05-19 Available
privacy-pia-uscg-015-MMLDS-2011 (1).pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 16.pdf Supplementary Document Uploaded 2025-05-19 Repair queued
46 CFR Part 12.pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 11.pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 10.pdf Supplementary Document Uploaded 2025-05-19 Available
1625-0040_SS_r0_2025_m2m-nprm.docx Supporting Statement A Uploaded 2025-06-17 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2028 36 Months From Approved 05/31/2028
310,091 0 310,091
61,850 0 61,850
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical CG-719B, CG-719S, CG-719C, CG-719K, CG-719P, CG-719K/E ,   ,   ,   ,   ,  



Reginfo record details
  No