Disclosure Furnishing this information is voluntary however failure to furnish the requested information may delay or prevent the approval of the requested marine event. 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. DEPARTMENT OF HOMELAND SECURITY OMB Number 1625-0008 Expires 09/30/2017 APPLICATION FOR MARINE EVENT Date Submitted FORM INSTRUCTIONS Please complete on a computer a typewriter or print in black ink to permit reproduction. You may also submit online at http //homeport. What Extra or Unusual Hazard to participants or non-participants Will Be Introduced Into the Regatta Area CG-4423 09/14 Page 1 of 2 Reset 13. 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. Have any Objections Been Received from Other Interested Parties NO 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 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 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 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. 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.
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