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United States Department of Transportation United States Department of Transportation

Application for Small Vessel Waiver of the Passenger Vessel Services Act

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

Owner Address
Address
(or Hull Identification No., or State No.)
Homeport
(ex. sail, catamaran, hovercraft, motor, etc.)
Feet
Tons
Passengers
(attach pages if needed)*
("All States" is not acceptable)
A statement on the impact this waiver will have on other commercial passenger vessel operators, including a statement describing the operations of existing operators.(attach pages as needed).
Note: we may use the following criteria to determine the effect on U.S. vessel builders: Whether a potentially affected U.S. vessel builder has a history of construction of similar vessels, or can demonstrate the capability and capacity and the fact it has taken definite steps to offer to build a similar vessel, for use in the same geographic region of the United States, as the proposed vessel of the applicant. (attach pages as needed).

12. 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 link here 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)