Information Collection

Independent Contractor Registration Request

IC 14399 under ICR 201609-1219-003 · OMB 1219-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0040 can be found here:

Documents and Forms

Document Name Document Type
Form 7000-52 Independent Contractor Registration Request Form and Instruction
MSHA - Forms and Online Filings - Form 7000-52 - Contractor Identification (ID) Request.pdf www.msha.gov/forms/elawsforms/7000-52.htm Instruction
7000-52 Contractor Identification (ID) Request 7000-52 Contractor Id request with TIN.docx www.msha.gov/forms/elawsforms/7000-52.htm Form and Instruction
Screen shots.docx Explanation of Change TIN block added to form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Independent Contractor Registration Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 30 CFR 45.3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7000-52	Contractor Identification (ID) Request	7000-52 Contractor Id request with TIN.docx	http://www.msha.gov/forms/elawsforms/7000-52.htm	Yes	Yes	Fillable Fileable
Instruction			MSHA - Forms and Online Filings - Form 7000-52 - Contractor Identification (ID) Request.pdf	http://www.msha.gov/forms/elawsforms/7000-52.htm	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,296	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 48 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,296	2,296
Annual IC Time Burden (Hours)	306	306
Annual IC Cost Burden (Dollars)	576	576

Documents for IC

Title	Document	Date Uploaded
Explanation of Change TIN block added to form	Screen shots.docx	11/10/2016

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