Application for Small Vessel Waiver of the Passenger Vessel Services Act

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U.S. Department of Transportation
Maritime Administration

Form Approval: OMB No. 2133-0529

This collection of information is required to obtain a waiver of the U.S.-build and other requirements of the Passenger Services Act (46 U.S.C. 55103) and will be used by the Maritime Administration to determine if the applicant is entitled to a waiver. Public reporting burden is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. No assurances of confidentiality are provided. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB  control number for this collection is 2133-0529.

REQUEST FOR ADMINISTRATIVE WAIVER OF THE JONES ACT
46 U.S.C. 12121, 46 C.F.R. 388

Items marked with an * are required.
* :
2. Owner Information:
     
* :

      * :   

 

  * :

  * :

  * :

* :
* :
* :
6. Size, capacity and net tonnage of the vessel.

      * :             net tons

       * : passengers     

* :
* :
* :
* :
11. By submitting this information you are deemed to have certified that the above information is true and correct. If you believe there may be an error, click the RESET button to clear the form and start again. If the information is  correct, please click SUBMIT to forward the application to the Maritime Administration. Instructions will follow on how to pay the application fee.
FORM MA-1023 (E) (11-10)

 

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