Information Collection

Certification/qualification Program (30 Cfr 75.100, 75.155, 77.100 And 77.105)

IC 168864 under ICR 198601-1219-014 · OMB 1219-0069.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0069 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CERTIFICATION/QUALIFICATION PROGRAM (30 CFR 75.100, 75.155, 77.100 AND 77.105)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MSHA 5000-4				No	No
Form	5000-7				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,800	500	7,300
Annual IC Time Burden (Hours)	1,293	83	1,210
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.