Form CG-4423 (09/14) CG-4423 (09/14) Application For Marine Event

DEPARTMENT OF HOMELAND SECURITY
OMB Number: 1625-0008
Expires: 09/30/2017

APPLICATION FOR MARINE EVENT
Date Submitted:
FORM INSTRUCTIONS
1.
2.
3.
4.

Please, complete on a computer, a typewriter, or print in black ink to permit reproduction. You may also submit online at: http://homeport.uscg.mil.
This application must reach the appropriate USCG Sector at least 135 days prior to the event. A list of sectors may be found here: http://www.uscg.mil/top/units/.
Attach a section of a chart or a scale drawing showing boundaries and/or courses and markers contemplated.
Submit a copy of your entry requirements and any special rules pertaining to equipment, rigs, or procedures.

1. Name of Event

2. Date of Event

3. Location of Event

4. Time: From ____________

5. Name and Address of Sponsoring Organization (Include Zip Code)

6. No. of Participants

8. Types of Boats

To __________

7. Sizes of Boats

9. No. of Spectator Craft

10. Description of Events

11. Will This Event Interfere or Impede the Natural Flow of Traffic?

_____ NO

______ YES

11a. If YES, briefly explain:
12. What Extra or Unusual Hazard (to participants or non-participants) Will Be Introduced Into the Regatta Area?

CG-4423 (09/14)

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13. Have any Objections Been Received from Other Interested Parties? _____ NO

_____ YES

13a. If YES, briefly explain:
14. Vessels Provided by Sponsoring Organization for Safety Purposes (number and description)
15. Does the Sponsoring Organization Deem their Patrol Adequate for Safety Purposes? _____ NO

_____ YES

15a. If NO, briefly explain:
16. Is a Coast Guard or Coast Guard Auxiliary Patrol Requested for Control of Spectator and/or Commercial Traffic? _____ NO

_____ YES

16a. If YES, how many vessels do you recommend and why?
17. Person In Charge

18. Where Will ‘Person In Charge’ be During the Event?

19. How Can ‘Person In Charge’ be Contacted During the Event?
20. Person to be Contacted for Further Details (Name, Address, Zip Code)

20a. Area Code and Phone No.:
20b. Email Address:

The undersigned has full authority to represent the sponsoring organization.
21. Name:

22. Title:

23. Address (Include Zip Code)

23a. Area Code and Phone No.:
23b. Email Address:

24. Signature:
PRIVACY ACT STATEMENT

Privacy Act Notice
Authority: 33 U.S.C. §1233 authorizes the collection of this information.
Purpose: The Coast Guard will use this information to determine whether an event poses an extra or unusual hazard to the safety of life and whether or not, and
under which conditions, to permit the event on the navigable waters of the United States.
Routine Uses: The information will be used by and disclosed to Coast Guard personnel to evaluate the request. Additionally, the Coast Guard may share the
information with facility operators, law enforcement or other government agencies as necessary to promote public safety during the requested marine event.
Disclosure: Furnishing this information is voluntary; however, failure to furnish the requested information may delay or prevent the approval of the requested
marine event.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the
average burden for this report is 60 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: United States Coast
Guard, Commandant (WWM-1) Stop 7509, 2703 Martin Luther King Jr. Ave SE, Washington, DC, 20593-7509 or Office of Management and Budget, Paperwork Reduction Project (1625-0008),
Washington, DC 20503.

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