Information Collection

Mined-based Certificate of Electrical Training (State Grantees)

IC 192599 under ICR 201003-1219-011 · OMB 1219-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0001 can be found here:

Documents and Forms

Document Name Document Type
Form MSHA Form 5000-1 Mined-based Certificate of Electrical Training (State Grantees) Form
MSHA Form 5000-1 Certificate of Electrical Training 5000-1.pdf www.msha.gov/forms/elawsforms/5000-1.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mined-based Certificate of Electrical Training (State Grantees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 75.153(a)(2) 30 CFR 77.103(a)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MSHA Form 5000-1	Certificate of Electrical Training	5000-1.pdf	http://www.msha.gov/forms/elawsforms/5000-1.htm	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,062	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,062	1,062
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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