Information Collection

Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical

IC 43932 under ICR 202602-1625-006 · OMB 1625-0040.

Documents and Forms

Document Name Document Type
Form CG-719B Application for Merchant Mariner Credential Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Form CG-719K Application for Medical Certificate Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Form CG-719K/E Application for Medical Certificate, Short Form Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Form CG-719P DOT/USCG Periodic Drug Testing Form Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form
Form CG-719S Small Vessel Sea Service Form Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form
1625-0040_Inst_r4_2025_revised-forms.docx Instruction
CG-719B Application for Merchant Mariner Credential CG_719B_v16_draft.pdf Form and Instruction
CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Othe CG_719C_v10_draft.pdf Form and Instruction
CG-719K Application for Medical Certificate CG_719K_v12_draft.pdf Form and Instruction
CG-719K/E Application for Medical Certificate, Short Form CG_719KE_v12_draft.pdf Form and Instruction
CG-719P DOT/USCG Periodic Drug Testing Form CG_719P_v13_draft.pdf Form
CG-719S Small Vessel Sea Service Form CG_719S_v15_draft.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical	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 46 CFR 16 46 CFR 11 46 CFR 10

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CG-719B	Application for Merchant Mariner Credential	CG_719B_v16_draft.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CG-719C	Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions	CG_719C_v10_draft.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K	Application for Medical Certificate	CG_719K_v12_draft.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K/E	Application for Medical Certificate, Short Form	CG_719KE_v12_draft.pdf	Yes	Yes	Fillable Printable
Form	CG-719P	DOT/USCG Periodic Drug Testing Form	CG_719P_v13_draft.pdf	Yes	Yes	Fillable Printable
Form	CG-719S	Small Vessel Sea Service Form	CG_719S_v15_draft.pdf	Yes	Yes	Fillable Printable
Instruction			1625-0040_Inst_r4_2025_revised-forms.docx	Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records
Title: Merchant Seamen's Records	FR Citation: 74 FR 30308

Number of Respondents: 90,529	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	286,298	-24,415	310,713
Annual IC Time Burden (Hours)	57,333	-4,673	62,006
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.

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