Information Collection

Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical

IC 43932 under ICR 201209-1625-003 · OMB 1625-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0040 can be found here:

Documents and Forms

Document Name Document Type
Form CG-719B Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction
CG-719K Merchant Mariner Credential Medical Evaluation Report CG-719K_final draft to vendor OMB_6Dec12.pdf Link will be provided upon OMB approval. Form and Instruction
CG-719K/E Merchant Mariner Evaluation of Fitness for entry Level R CG_719KE.pdf Link will be provided upon OMB approval. Form and Instruction
CG-719P DOT/USCG Periodic Drug Testing Form CG719P.pdf www.uscg.mil/forms Form and Instruction
CG-719S Small Vessel Sea Service Form CG719S.pdf www.uscg.mil/forms Form and Instruction
CG-719B APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERA CG719B_vendor version_6Dec2012.pdf www.uscg.mil/forms Form and Instruction

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 10.105(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CG-719K/E	Merchant Mariner Evaluation of Fitness for entry Level Ratings	CG_719KE.pdf	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719B	APPLICATION FOR LICENSE AS OFFICER, STAFF OFFICER, OPERATOR, AND MERCHANT MARINER'S DOCUMENT	CG719B_vendor version_6Dec2012.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719K	Merchant Mariner Credential Medical Evaluation Report	CG-719K_final draft to vendor OMB_6Dec12.pdf	Link will be provided upon OMB approval.	Yes	Yes	Fillable Printable
Form and Instruction	CG-719P	DOT/USCG Periodic Drug Testing Form	CG719P.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable
Form and Instruction	CG-719S	Small Vessel Sea Service Form	CG719S.pdf	http://www.uscg.mil/forms	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 259,606	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	56,500	-8,799	65,299
Annual IC Time Burden (Hours)	44,258	33,373	10,885
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.