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Federal forms, ICRs, and supporting documents

Information Collection

Hazardous Conditions Complaints

IC 14363 under ICR 202504-1219-001 · OMB 1219-0014.

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

View Information Collection (IC)

Hazardous Conditions Complaints
 
No Modified
 
Voluntary
 
30 CFR 43.4 30 CFR 43.7

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Hazardous Conditions Compliant (ENGLISH) Hazard Conditions Compliant_screenshots 2026.pdf https://egov.msha.gov/HazardousConditionComplaint.aspx Yes Yes Fillable Fileable
Instruction 1219-0014 Hazardous Condition Complaint Intro.pdf https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/hazardous-condition-complaint Yes Yes Fillable Fileable
Form and Instruction None Hazardous Conditions Complaint (SPANISH) 1219-0014 Hazardous Conditions Compliant_Spanish Version Screenshot 2026.pdf https://egov.msha.gov/HazardousConditionComplaint.aspx?FormLang=es-MX Yes Yes Fillable Fileable

Workforce Management Worker Safety

 

2,249 0
   
Individuals or Households
 
   96 %

  Approved 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 2,249 0 0 464 0 1,785
Annual IC Time Burden (Hours) 450 0 0 93 0 357
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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