DEPARTMENT OF HOMELAND SECURITY OMB No: 1625-0010 US COAST-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Campaign Number assigned upon Coast Guard approval at the top of the form.
3. Fill in the Name and Address of the Company conducting the defect notification campaign, ensuring to include the ZIP code.
4. Provide your contact information, including Name, Phone Number, and Email for any follow-up inquiries.
5. If applicable, enter the Manufacturer's Name and Address for any defective components involved.
6. In Section 4a, list all potentially involved boats by completing their model and number potentially involved. Attach additional sheets if necessary.
7. For products not involving boats (Section 4b), provide models, serial numbers, and years as required.
8. Describe the defect or noncompliance in detail in Section 5, followed by assessing the degree of danger to public safety in Section 6.
9. Outline how recalled products will be corrected in Section 7 and describe your proposed correction plan in Section 8.
10. Complete Sections 9 and 10 regarding actions taken to date and current status of the campaign respectively.
11. Finally, sign as preparer at the bottom of the form along with your title and date before submitting.

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