Information Collection

Adequacy Certification for Reception Facilities and Advance Notice - 33 CFR Part 158

IC 20537 under ICR 201110-1625-009 · OMB 1625-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0045 can be found here:

Documents and Forms

Document Name Document Type
Form CG-5401A Adequacy Certification for Reception Facilities and Advance Notice - - 33 CFR Part 158 Form and Instruction
CG-5401A Application for Certificate of Adequacy for Reception Fa CG5401arev1.pdf www.uscg.mil/forms/cg.asp?files=280&id= Form and Instruction
CG-5401B Application for Certificate of Adequacy for Reception Fa CG5401brev1.pdf www.uscg.mil/forms/cg.asp?files=280&id= Form and Instruction
CG-5401C Application for Certifiate of Adequacy for Reception Fac CG5401crev1.pdf www.uscg.mil/forms/cg.asp?files=280&id= Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adequacy Certification for Reception Facilities and Advance Notice - - 33 CFR Part 158	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 33 CFR 158.140

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CG-5401A	Application for Certificate of Adequacy for Reception Facilities	CG5401arev1.pdf	http://www.uscg.mil/forms/cg.asp?files=280&id=	Yes	Yes	Fillable Printable
Form and Instruction	CG-5401B	Application for Certificate of Adequacy for Reception Facilities FORM B	CG5401brev1.pdf	http://www.uscg.mil/forms/cg.asp?files=280&id=	Yes	Yes	Fillable Printable
Form and Instruction	CG-5401C	Application for Certifiate of Adequacy for Reception Facilities FORM C	CG5401crev1.pdf	http://www.uscg.mil/forms/cg.asp?files=280&id=	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 86	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 98 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	100	-22	122
Annual IC Time Burden (Hours)	183	-44	227
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.