Information Collection Request
Certificate of Electrical Training and Applications for MSHA Approved Tests and State Tests Administered as Part of an MSHA-approved State Program
ICR 202502-1219-001 · OMB 1219-0001 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1219-0001 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form MSHA Form 5000-1 Certificate of Electrical Training (State Grantees) |
Form and Instruction | Modified | Available |
| Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors) |
Form and Instruction | Modified | Repair queued |
 Justification for No Material and Non substantive Change.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2025-03-05 | Repair queued |
| 1219-0001 Supporting Statement 2022.docx |
Supporting Statement A | Uploaded 2022-08-23 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 208114 |  Evidence of Eligibility |
Unchanged | ||
| 192599 | Certificate of Electrical Training (State Grantees) |
Form and Instruction | Modified | |
| 14333 | Certificate of Electrical Training (instructors and contractors) |
Form and Instruction | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | DOL/MSHA |
| OMB Control No | 1219-0001 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202208-1219-004 |
| Date Submitted to OIRA | 2025-04-07 |
| Requested Expiration Date | 1969-12-31 |