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Adequacy Certification - Application for Certificate of Adequacy (COA)
Adequacy Certification for Reception Facilities and Advance Notice - - 33 CFR Part 158
OMB: 1625-0045
IC ID: 20537
OMB.report
DHS/USCG
OMB 1625-0045
ICR 202110-1625-003
IC 20537
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0045 can be found here:
2024-10-24 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
1625-0045_Inst_r5_2021-fac.docx
Instruction
1625-0045_Inst_r5_2021-fac.docx
Instruction
CG-5401A (04/15) Application for Certificate of Adequacy (COA) for Recept
CG-5401A_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form and Instruction
CG-5401A (04/15) Application for Certificate of Adequacy (COA) for Recept
CG-5401A_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form and Instruction
CG-5401B (04/15) Application for Certificate of Adequacy (COA) for Recept
CG-5401B_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form and Instruction
CG-5401B (04/15) Application for Certificate of Adequacy (COA) for Recept
CG-5401B_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form and Instruction
CG-5401C (04/15) Application for a Reception Facility Certificate of Adeq
CG-5401C_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form
CG-5401C (04/15) Application for a Reception Facility Certificate of Adeq
CG-5401C_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form
CG-5401D (04/15) Application for a Reception Facility Certificate of Adeq
CG-5401D_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form
CG-5401D (04/15) Application for a Reception Facility Certificate of Adeq
CG-5401D_04-15_w-exp-date.pdf
www.uscg.mil/forms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Adequacy Certification - Application for Certificate of Adequacy (COA)
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
Instruction
1625-0045_Inst_r5_2021-fac.docx
Yes
Yes
Printable Only
Form and Instruction
CG-5401A (04/15)
Application for Certificate of Adequacy (COA) for Reception Facilities Form A
CG-5401A_04-15_w-exp-date.pdf
http://www.uscg.mil/forms
Yes
Yes
Fillable Fileable
Form and Instruction
CG-5401B (04/15)
Application for Certificate of Adequacy (COA) for Reception Facilities Form B
CG-5401B_04-15_w-exp-date.pdf
http://www.uscg.mil/forms
Yes
Yes
Fillable Fileable
Form
CG-5401C (04/15)
Application for a Reception Facility Certificate of Adequacy for Garbage Form C
CG-5401C_04-15_w-exp-date.pdf
http://www.uscg.mil/forms
Yes
Yes
Fillable Fileable
Form
CG-5401D (04/15)
Application for a Reception Facility Certificate of Adequacy for Ozone Depletion Substances and Exhaust Gas Cleaning System Residue Form D
CG-5401D_04-15_w-exp-date.pdf
http://www.uscg.mil/forms
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Transportation
Subfunction:
Water Transportation
Privacy Act System of Records
Title:
DHS/USCG - 013 Marine Information for Safety and Law Enforcement (MISLE)
FR Citation:
74 FR 30305
Number of Respondents:
400
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
400
0
0
-20
0
420
Annual IC Time Burden (Hours)
700
0
0
40
0
660
Annual IC Cost Burden (Dollars)
0
0
0
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.