OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Applications for Merchant Mariner Credentials and Medical Certificates

ICR 202508-1625-001 · OMB unassigned · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CG-719S Small Vessel Sea Service Form Form Modified Available
Form CG-719P DOT/USCG Periodic Drug Testing Form Form Modified Available
Form CG-719K/E Application for Medical Certificate, Short Form Form and Instruction Modified Available
Form CG-719K Application for Medical Certificate Form and Instruction Modified Available
Form CG-719C Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions Form and Instruction Modified Available
Form CG-719B Application for Merchant Mariner Credential Form and Instruction Modified Available
1625-0040_SS_r0_2025_calc-sheet_m2m-fr_App_A-to-B.pdf Supplementary Document Uploaded 2025-08-05 Available
46cfr_part13_2024.pdf Supplementary Document Uploaded 2025-08-05 Available
DHS_USCG_030 Merchant Seamens Records_20090625_74 FR 30308 (1).docx Supplementary Document Uploaded 2025-05-19 Available
privacy-pia-uscg-015-MMLDS-2011 (1).pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 16.pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 12.pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 11.pdf Supplementary Document Uploaded 2025-05-19 Available
46 CFR Part 10.pdf Supplementary Document Uploaded 2025-05-19 Available
1625-0040_SS_r0_2025_m2m-fr.docx Supporting Statement A Uploaded 2025-08-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form ModifiedSmall Vessel Sea Service Form
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form ModifiedDOT/USCG Periodic Drug Testing Form
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction ModifiedApplication for Medical Certificate, Short Form
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction ModifiedApplication for Medical Certificate
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction ModifiedDisclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Form and Instruction ModifiedApplication for Merchant Mariner Credential
43932 Continuous Discharge Book, Application, Physical Exam Report, Sea Service Report, Chemical Testing, Entry Lvl Physical Instruction Modified
ICR Details
1625-0040 202508-1625-001
Active 202505-1625-001
DHS/USCG
Applications for Merchant Mariner Credentials and Medical Certificates
Revision of a currently approved collection   No
Regular
Approved without change 09/26/2025
Retrieve Notice of Action (NOA) 08/21/2025
  Inventory as of this Action Requested Previously Approved
09/30/2028 36 Months From Approved 05/31/2028
310,713 0 310,091
62,006 0 61,850
0 0 0
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.
US Code: 46 USC Subtitle II, Part E Name of Law: Mechant Seamen Licenses, Certificates, and Documents
  
None
1625-AC83 Final or interim final rulemaking 89 FR 63830 08/06/2024
No
  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 310,713 310,091 0 622 0 0
Annual Time Burden (Hours) 62,006 61,850 0 156 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The change in burden is a PROGRAM CHANGE due to the 1625-AC83 M2M rulemaking. • Program Change – increase of 156 hours – is due to the addition of an option to exempt certain members of the uniformed services from paying the MMC application fee. To obtain the exemption, the member must provide documentation of their service. The reporting and recordkeeping requirements, and the methodology for calculating burden, remain unchanged.
$33,885,515
No
    Yes
    Yes
No
No
No
No
Michael Toth 304 433-3729 [email protected]
  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.
08/21/2025