FEDERAL COMMUNICATIONS COMMISSION Approved by OMB

 3060-0228

 Estimated Time Per Response: 10 Minutes

 

United States of America

COMMUNICATIONS ACT SAFETY RADIOTELEPHONY CERTIFICATE

 

Name of Vessel Official Number Radio Call Sign Port of Registry Gross Tonnage

 

 The Government of the United States of American certifies that the radiotelephone installation on board the above-described 

vessel complies with all relevant provisions of Part III of Title III of the Communications Act, the rules of the Commission made 

pursuant thereto, the terms of the station license, and successfully completes an operational test at the time this certificate is 

issued.

 

 Notwithstanding the above, it is unlawful for an vessel of the United States, transporting more than six passengers for hire to 

be navigated in the open sea or any tidewater with the jurisdiction of the United States adjacent or contiguous to the open sea, 

unless the vessel is equipped with an efficient radiotelephone installation in operating condition.

 Type of radio installations on board this vessel: VHF MF HF EPIRB INMARSAT

 When a VHF station only is provided, this certificate is valid only while the vessel is within communication range of a public 

coast state of U.S. Coast Guard station operating in the band 156 to 162 MHz which maintains an efficient watch for reception of 

156.8 MHz at all times while the vessel is navigated.

 This certificate will remain in force until ___________________________________________________________________

 issued at ___________________________ on the _________________ day of ___________________, 19_____________

Validated: __________________________________________ ____________________________________________________

(Licensed Inspector) (License Number of Licensed Inspector)

 

 FCC Form 824

 August 2012
OMB Control Number 3060-0228

Notice to Individuals Required by the Privacy Act of 1974 and the Paperwork Reduction Act of 1995

The solicitation of information requested in this form is authorized by th e Communications Act of 1934, as amended. The 

Commission will use FCC-licensed technicians to conduct ship inspections and determine if the radio installation is in compliance

with the requirements of the Communications Act of 1934, as amended. All information provided in this form, as well as the form 

itself, will be available for public inspection.

Public reporting burden for this collection of information is estimated to average 10 minutes per response. Our estimate includes the 

time to read the instructions, look through existing records, gather and maintain required d ata, and actually complete and review the 

form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it 

causes you, please write the Federal Communications Commission, Office of Managing Director, AMD-PERM, Washington, DC 

20554, Paperwork Reduction Act Project (3060-0228). We will also accept your PRA comments via the internet if you sent an email to PRA@fcc.gov.

Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. You are not required to respond to a collection of information 

sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently 

valid OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number 

of 3060-0228.

THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31,1974, 5 U.S.C. SECTION 

552a(e)(3) AND THE PAPERWORK REDUCTION ACTION OF 1995, PUBLIC LAW 104-13, OCTOBER 1,1995, 44 U.S.C. 

SECTION 3507.

 FCC Form 824 – Page 2

 August 2012