FCC Form 827 (for OMD 07312024)

FEDERAL COMMUNICATIONS COMMISSION Not Approved by OMB

3060-0228

Estimated Time Per Response: 10 Minutes

United States of America

VESSEL BRIDGE-TO-BRIDGE RADIOTELEPHONY CERTIFICATE

Name of Ship	Official Number	Radio Call Sign	Port of Registry	Gross Tonnage	Vessel Type

The Government of the United States of America certifies that the bridge-to-bridge station on board the above described vessel complies with all relevant provisions of the Vessel Bridge-to-Bridge Radiotelephone Act, the Rules and Regulations of the

Commission made pursuant thereto, and the terms of the station license.

This certificate will remain in force until	Issued at	Date
Signature of licensed inspector

This certificate, upon request, shall be presented for inspection to the US. Coast Guard. It shall be retained on board the vessel

until its expiration, or until superseded by a subsequent issuance.

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 THIS 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.

FCC Form 827 – Page 1

_____, 2024