Information Collection

MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report

IC 228996 under ICR 202102-1219-003 · OMB 1219-0154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0154 can be found here:

Documents and Forms

Document Name Document Type
Form 5000-50 MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report Form
5000-50 MSHA State Grant Program Performance Report MSHA Form 5000-50 State Grant Technical Accomplishment Form 2021.xlsx www.msha.gov/training-education/training-programs-courses Form
5000-50 MSHA State Grant Program Performance Report MSHA Form 5000-50 State Grant Technical Accomplishment Form 2021.xlsx www.msha.gov/training-education/training-programs-courses Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5000-50	MSHA State Grant Program Performance Report	MSHA Form 5000-50 State Grant Technical Accomplishment Form 2021.xlsx	https://www.msha.gov/training-education/training-programs-courses	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250	-50	300
Annual IC Time Burden (Hours)	625	-125	750
Annual IC Cost Burden (Dollars)	0	-53	53

Documents for IC

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