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

Documents and forms in this information collection
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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CG-719B	Yes	Yes	Fillable Printable
Form and Instruction	CG-719C	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K/E	Yes	Yes	Fillable Printable
Form	CG-719P	Yes	Yes	Fillable Printable
Form	CG-719S	Yes	Yes	Fillable Printable
Instruction		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 %

table that charts list of burden
	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

table that charts IC Documents
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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