| Required information
| Vessels
neither carrying CDC nor
controlling another vessel carrying CDC
| Vessels
carrying CDC or controlling another vessel carrying CDC
|
|---|
| (1) Vessel Information:
| | |
| (i) Name; | X | X
|
| (ii) Name of the registered owner; | X | X
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| (iii) Country of registry; | X | X
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| (iv) Call sign; | X | X
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| (v) International Maritime Organization (IMO) international number or, if vessel does not have an assigned IMO international number, substitute with official number; | X | X
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| (vi) Name of the operator; | X | X
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| (vii) Name of charterer; | X | X
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| (viii) Name of classification society or recognized organization; | X | X
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| (ix) Maritime Mobile Service Identity (MMSI) number, if applicable; | X | X
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| (x) Whether the vessel is 300 gross tons or less (yes or no); and | X | X
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| (xi) USCG Vessel Response Plan Control Number, if applicable. | X | X
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| (2) Voyage Information:
| | |
| (i) Names of last five foreign ports or places visited; | X | X
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| (ii) Dates of arrival and departure for last five foreign ports or places visited; | X | X
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| (iii) For the port or place of the United States to be visited, list the name of the receiving facility, the port or place, the city, and the state; | X | X
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| (iv) For the port or place of the United States to be visited, the estimated date and time of arrival; | X | X
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| (v) For the port or place in the United States to be visited, the estimated date and time of departure; | X | X
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| (vi) The location (port or place and country) or position (latitude and longitude or waterway and mile marker) of the vessel at the time of reporting; | X | X
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| (vii) The name and telephone number of a 24-hour point of contact; | X | X
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| (viii) Whether the vessel's voyage time is less than 24 hours (yes or no); | X | X
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| (ix) Last port or place of departure; and | X | X
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| (x) Dates of arrival and departure for last port or place of departure. | X | X
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| (3) Cargo Information:
| | |
| (i) A general description of cargo, other than CDC, on board the vessel (e.g., grain, container, oil, etc.); | X | X
|
| (ii) Name of each CDC carried, including cargo UN number, if applicable; and | | X
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| (iii) Amount of each CDC carried. | | X
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| (4) Information for each Crewmember On Board:
| | |
| (i) Full name; | X | X
|
| (ii) Date of birth; | X | X
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| (iii) Nationality; | X | X
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| (iv) Passport * or mariner's document number (type of identification and number); | X | X
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| (v) Position or duties on the vessel; and | X | X
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| (vi) Where the crewmember embarked (list port or place and country). | X | X
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| (5) Information for each Person On Board in Addition to Crew:
| | |
| (i) Full name; | X | X
|
| (ii) Date of birth; | X | X
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| (iii) Nationality; | X | X
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| (iv) Passport number; * and | X | X
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| (v) Where the person embarked (list port or place and country). | X | X
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| (6) Operational condition of equipment required by 33 CFR part 164 of this chapter (see note to table): | X | X
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| (7) International Safety Management (ISM) Code Notice:
| | |
| (i) The date of expiration for the company's Document of Compliance certificate that covers the vessel; | X | X
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| (ii) The date of expiration for the vessel's Safety Management Certificate; and | X | X
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| (iii) The name of the Flag Administration, or the recognized organization(s) representing the vessel Flag Administration, that issued those certificates. | X | X
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| (8) International Ship and Port Facility Security Code (ISPS) Notice:
| | |
| (i) The date of issuance for the vessel's International Ship Security Certificate (ISSC), if any; | X | X
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| (ii) Whether the ISSC, if any, is an initial Interim ISSC, subsequent and consecutive Interim ISSC, or final ISSC; | X | X
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| (iii) Declaration that the approved ship security plan, if any, is being implemented; | X | X
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| (iv) If a subsequent and consecutive Interim ISSC, the reasons therefore; | X | X
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| (v) The name and 24-hour contact information for the Company Security Officer; and | X | X
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| (vi) The name of the Flag Administration or the recognized security organization(s) representing the vessel Flag Administration that issued the ISSC. | X | X
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