OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Applications for Merchant Mariner Credentials and Medical Certificates

OMB 1625-0040 · DHS/USCG.

OMB 1625-0040

In accordance with Title 46 CFR Parts 10, 11, 12, 13, and 16, the collection of this information is necessary to determine competency, character & physical qualifications for the issuance of a Merchant Mariner Credential (MMC) or Medical Certificate.

The latest form for Applications for Merchant Mariner Credentials and Medical Certificates expires 2028-09-30 and is listed under ICR 202508-1625-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CG-719S Small Vessel Sea Service FormForm
Form CG-719P DOT/USCG Periodic Drug Testing FormForm
Form CG-719K/E Application for Medical Certificate, Short FormForm and Instruction
Form CG-719K Application for Medical CertificateForm and Instruction
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other ConvictionsForm and Instruction
Form CG-719B Application for Merchant Mariner CredentialForm and Instruction
1625-0040_30-day FR Notice_91FR29976_20260521_.docxSupplementary Document
1625-0040 60-day FR Notice_90FR55147_20251201_.docxSupplementary Document
Copy of 1625-0040_SS_r0_2025_calc-sheet_revised-forms_r1.xlsxSupplementary Document
46cfr_part13_2024.pdfSupplementary Document
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308 (1).docxSupplementary Document
privacy-pia-uscg-015-MMLDS-2011 (1).pdfSupplementary Document
46 CFR Part 16.pdfSupplementary Document
46 CFR Part 12.pdfSupplementary Document
46 CFR Part 11.pdfSupplementary Document
46 CFR Part 10.pdfSupplementary Document
1625-0040_SS_r2_2025_revised-forms.docxSupporting Statement A
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202602-1625-006 Revision of a currently approved collection 2026-07-02
202506-1625-001 Revision of a currently approved collection 2025-07-17 Comment filed on proposed rule and continue
202505-1625-001 Revision of a currently approved collection 2025-05-19 Approved with change
202502-1625-004 Revision of a currently approved collection 2025-03-19
202304-1625-003 Revision of a currently approved collection 2024-01-26
202102-1625-008 Extension without change of a currently approved collection 2021-03-11 Approved with change
201601-1625-009 Reinstatement with change of a previously approved collection 2018-03-01 Approved without change
201409-1625-011 Revision of a currently approved collection 2015-03-26 Approved with change
201404-1625-001 Revision of a currently approved collection 2014-06-12 Improperly submitted and continue
201301-1625-001 No material or nonsubstantive change to a currently approved collection 2014-03-13 Approved without change
201209-1625-003 Revision of a currently approved collection 2012-09-28 Approved with change
201109-1625-003 Revision of a currently approved collection 2012-06-29 Withdrawn and continue
201009-1625-009 Revision of a currently approved collection 2011-06-17 Withdrawn and continue
201002-1625-001 No material or nonsubstantive change to a currently approved collection 2010-04-16 Approved without change
200909-1625-001 No material or nonsubstantive change to a currently approved collection 2009-11-04 Withdrawn and continue
200803-1625-010 Extension without change of a currently approved collection 2009-04-08 Approved with change
200606-1625-001 Revision of a currently approved collection 2006-06-05 Approved without change
200512-1625-002 Revision of a currently approved collection 2005-12-21 Approved without change
200507-1625-005 Reinstatement with change of a previously approved collection 2005-07-18 Approved without change
200303-1625-042 Revision of a currently approved collection 2003-03-01 Approved without change