Section 80.59, Compulsory Ship Inspections and Ship Inspection Certificates, FCC Forms 806, 824, 827 and 829

FEDERAL COMMUNICATIONS COMMISSION Not Approved by OMB

3060-0228

Estimated Time Per Response: 10 Minutes

CARGO SHIP SAFETY RADIO CERTIFICATE

United States of America

Issued Under the Provisions of the International Convention for the Safety of Life at Sea, 1974, as amended

Particulars of ship

Name of Ship	Distinctive Number or Letters	Port of Registry	Gross Tonnage	Date on which keel was laid or ship was at similar stage of construction or, where applicable, date on which work for a conversion or an alteration or modification of a major character was commenced

Sea areas in which ship is certified to operate (regulation IV/2)¹_________________________________________________________

IMO Number_________________________________________________________________________________________________

The Government of the United States of America certifies:

1. That the ship has been surveyed in accordance with the requirements of regulation I/9 of the Convention;

2. That the survey showed that:

2.1 the ship complied with the requirements of the Convention as regards to radio installations;

2.2 the provision and functioning of the radio installations used in life-saving appliances

complied with the requirements of the Convention;

3. That an Exemption Certificate has/has not² been issued.

This certificate is valid until:

Completion date of the survey on which this certificate is based:________________________________________________(dd/mm/yyyy)

Issued at: (Place of issue of certificate)

(Date of Issue) (Signature of licensed inspector)

(Printed name of licensed inspector)

(FCC license number of issuing inspector)

(Seal or stamp of the issuing authority, as appropriate.)

Not Approved by OMB

3060-0228

RECORD OF EQUIPMENT OF RADIO FACILITIES FOR COMPLIANCE WITH THE INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974, AS AMENDED

1. Particulars of ship

Name of Ship ­­­­­­­­­­­­­­­­­­

Distinctive number or letters

Minimum number of persons with required qualifications to operate the radio installations

2. Details of radio facilities

Item Actual Provision

1. Primary systems…………………………………………………………………………………________________________________

   1. VHF radio installation………………………………………………………………………._______________________________

      1. DSC encoder

      2. DSC watch receiver

      3. Radiotelephony

   2. MF radio installation…………………………………………………………………………________________________________

      1. DSC encoder

      2. DSC watch receiver

      3. Radiotelephony

   3. MF/HF radio installation

      1. DSC encoder

      2. DSC watch receiver

      3. Radiotelephony

      4. Direct printing radiotelegraphy (required by Subpart W)

   4. Recognized mobile satellite service ship earth station

2. Secondary means of initiating the transmission of ship-to-shore distress alerts

3. Facilities for reception of maritime safety information (MSI) and search and rescue

related information…………………………………………………………………………………__________________________________

4. EPIRB……………………………………………………………………………………………..__________________________________

5. Two-way VHF radiotelephone apparatus

   1. Portable two-way VHF radiotelephone apparatus………………………………………….._________________________________

   2. Two-way VHF radiotelephone apparatus fitted in survival craft……………………………_________________________________

6. Search and rescue locating devices

6.1 Radar search and rescue transponders (radar SART) stowed for rapid placement in

survival craft

6.2 Radar search and rescue transponders (radar SART) stowed in survival craft

6.3 AIS search and rescue transmitters (AIS-SART) stowed for rapid placement

in survival craft

6.4 AIS search and rescue transmitters (AIS-SART) stowed in survival craft

Not Approved by OMB

3060-0228

3. Methods used to ensure availability of radio facilities (regulations IV/15.6 and 15.7)

3.1. Duplication of equipment

2. Shore-based maintenance

3. At-sea maintenance capability

THIS IS TO CERTIFY that this Record is correct in all respects. Issued at:

(Place of issue of the Record)

(Date of Issue) (Signature of inspector)

(FCC license number of issuing inspector)

(Seal or stamp of the issuing authority, as appropriate.)

OMB Control Number 3060-0228

Notice to Individuals Required by the Privacy Act of 1974 and the Paperwork Reduction Act of 1995

The solicitation of information requested in this form is authorized by the Communications Act of 1934, as amended. The

Commission will use FCC-licensed technicians to conduct ship inspections and determine if the radio installation is in compliance with the requirements of the Communications Act of 1934, as amended. All information provided in this form, as well as the form itself, will be available for public inspection.

Public reporting burden for this collection of information is estimated to average 10 minutes per response. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, Office of Managing Director, AMD-PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060-0228). We will also accept your PRA comments via the internet if you e- mail PRA@fcc.gov.

Please DO NOT SEND COMPLETED FORMS TO THE POSTAL OR E-MAIL ADDRESS. You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-0228.

THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31,1974, 5 U.S.C.

§ 552a(e)(3); AND THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, MAY 22,1995, 44 U.S.C. § 3507.

1 For a ship certified to operate in sea area A3, indicate the recognized mobile satellite service in brackets.

2 Delete as appropriate.

FCC Form 829 – Page 2

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