Information Collection

Certificate of Electrical Training (State Grantees)

IC 192599 under ICR 202502-1219-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Certificate of Electrical Training (State Grantees) Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training MSHA_5000-1.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training Intro Certificate of Electrical Noise Training.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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

Is this a Common Form? No		IC Status: Modified

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 and Instruction	MSHA Form 5000-1	Certificate of Electrical Training	MSHA_5000-1.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Yes	Yes	Fillable Fileable
Form and Instruction	MSHA Form 5000-1	Certificate of Electrical Training	Intro Certificate of Electrical Noise Training.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 81 %

	Approved	Previously Approved
Annual Number of Responses for this IC	598	598
Annual IC Time Burden (Hours)	249	249
Annual IC Cost Burden (Dollars)	299	299

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.