Marine Event Permit Application

CG-4423 Rev. (10-10)

          Application For Marine Event Permit

Expires 9/30/2017
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 collection of information is 55 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (CG-5521), U.S. Coast Guard, 2100 2ND St., SW, Washington D.C. 20593-7683 or Office of Management and Budget, Paperwork Reduction Project (1625-0008), Washington, DC 20593.

I have read the Paperwork Reduction Act Notice                     PRINT BLANK CG-4423                     View Status / Finish Submission
1. Please complete either this online form or a paper CG-4423.
2. This application must reach the appropriate Captain of the Port (selected via dropdown box) at least 135
   days prior to the event.
3. Attach a section of a chart or scale drawing showing boundaries and/or courses and markers contemplated.
   Click "add attachment" to attach a document in one of the following file formats ( .jpg, .pdf, .ppt, .doc, .docx)
4. Submit a copy of your entry requirements, and any special rules pertaining to equipment, rigs or procedures.
5. * Denotes required fields.
6. After submission you will have the ability to print out a completed form.

From: Date Picker To: Date Picker
Reoccurring : Never   Daily   Weekly  
From :   To :
Yes   No   If yes, briefly explain
Yes   No   If Yes, Which Organization and Why?
Number Description Length  
Yes   No   If No, briefly explain
Yes   No   If Yes, how many vessels do you recommend and why?
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The undersigned has full authority to represent the sponsoring organization.
- -   ext
    View COTP Zone Map
Note: You must attach a section of a chart or scale drawing showing the boundaries and/or courses and markers contemplated. You also must attach a copy of your entry requirements and any special rules pertaining to the equipment, rigs, or procedures.
Privacy Act Statement

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.

I have read the Privacy Act Statement

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