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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CG-719S Small Vessel Sea Service Form Form
Form CG-719P DOT/USCG Periodic Drug Testing Form Form
Form CG-719K/E Application for Medical Certificate, Short Form Form and Instruction
Form CG-719K Application for Medical Certificate Form and Instruction
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions Form and Instruction
Form CG-719B Application for Merchant Mariner Credential Form and Instruction
1625-0040_SS_r0_2025_calc-sheet_m2m-nprm_App_A-to-B.pdf Supplementary Document
46 CFR Part 13.pdf Supplementary Document
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308 (1).docx Supplementary Document
privacy-pia-uscg-015-MMLDS-2011 (1).pdf Supplementary Document
46 CFR Part 16.pdf Supplementary Document
46 CFR Part 12.pdf Supplementary Document
46 CFR Part 11.pdf Supplementary Document
46 CFR Part 10.pdf Supplementary Document
1625-0040_SS_r0_2025_m2m-nprm.docx Supporting 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All Historical Document Collections

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201109-1625-003 Withdrawn and continue	Revision of a currently approved collection	2012-06-29
201009-1625-009 Withdrawn and continue	Revision of a currently approved collection	2011-06-17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200909-1625-001 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2009-11-04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