OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Continuous Discharge Book, Merchant Mariner Application, Physical Examination Report, Sea Service Report, Chemical Testing, and Entry Level Physical Report

ICR 200512-1625-002 · OMB 1625-0040 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
20522 Continuous Discharge Book, Merchant Mariner Application, Physical Examination Report, Sea Service Report, Chemical Testing, and Entry Level Physical Report Form Migrated
ICR Details
1625-0040 200512-1625-002
Historical Active 200507-1625-005
DHS/USCG
Continuous Discharge Book, Merchant Mariner Application, Physical Examination Report, Sea Service Report, Chemical Testing, and Entry Level Physical Report
Revision of a currently approved collection   No
Emergency 12/30/2005
Approved without change 01/03/2006
Retrieve Notice of Action (NOA) 12/21/2005
In its next submission, the agency will ensure that the cost burden reported in item 14 of Form 83-I excludes monetized burden hours.
  Inventory as of this Action Requested Previously Approved
07/31/2006 07/31/2006 08/31/2008
73,294 0 50,000
329,356 0 21,875
16,258,000 0 0
In accordance with Title 46, United States Code and Title 46, Code of Federal Regulations, the collection of this information is necessary to determine competency, character and physical qualifications for the issuance of Coast Guard licenses, certificates of registry and merchant mariner documents.
None
None
No
1
IC Title Form No. Form Name
Continuous Discharge Book, Merchant Mariner Application, Physical Examination Report, Sea Service Report, Chemical Testing, and Entry Level Physical Report CG-719A, CG-719B, CG-719K, CG-719S, CG-719P, CG-719K/E
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 73,294 50,000 0 23,294 0 0
Annual Time Burden (Hours) 329,356 21,875 0 307,481 0 0
Annual Cost Burden (Dollars) 16,258,000 0 0 16,258,000 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/21/2005