OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Mine Rescue Teams; Arrangements for Emergency Medical Assistance; and Arrangements for Transportation for Injured Persons

IC 14446 under ICR 202002-1219-006 · OMB 1219-0078.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

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Mine Rescue Teams; Arrangements for Emergency Medical Assistance; and Arrangements for Transportation for Injured Persons
 
No Unchanged
 
Mandatory
 
30 CFR 49.3 30 CFR 49.4 30 CFR 49.2 30 CFR 49.5 30 CFR 49.6 30 CFR 49.7 30 CFR 49.8 30 CFR 49.9

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 5000-3 Certificate of Physical Qualification for Mine Rescue Work 5000-3 CERT of Physical Qualification for Mine Rescue Work (OMB).pdf https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work Yes No Fillable Printable

Workforce Management Worker Safety

 

202 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 19,973 0 0 0 0 19,973
Annual IC Time Burden (Hours) 9,941 0 0 0 0 9,941
Annual IC Cost Burden (Dollars) 309,068 0 0 0 0 309,068

Title Document Date Uploaded
Forms and Filings Intro Page for Form MSHA-5000-3 Certificate of Physical Qualification for Mine Rescue Work.pdf 07/24/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.