Emergency Mine Evacuation

Form number:	MSHA Form 2000-222
Form name:	SCSR Inventory and Report
Description:	Mine Operators are required to File a report of inventory of all Self-Contained Self-Rescuer (SCSR) at a mine.
OMB Control Number and Expiration Date:	OMB # 1219-0141 Expires 3/31/2010
Filing Options:	Form, SCSR Report can be filed online electronically or the form fill version can be completed, printed (or printed and filled in manually) and sent to MSHA according to the instructions provided below. File online electronically Form fill, print and mail or fax[Link to be inserted once form is posted to website]
Filing Instructions:	This form is for Operators’ use in providing MSHA with complete SCSR inventories, as well as in reporting problems with SCSRs. Operators may attach continuation sheets to this form provided all required SCSR information is included. Detailed Instructions for completing Form SCSR Inventory and Report [Link to be inserted once form is posted to website] Form, SCSR Inventory Report is a two-part form that also provides for attaching multiple units. The form asks for date, MSHA-issued mine ID, mine name, company name, mine address, contact name, telephone number and manufacturer/model of SCSR, date of manufacture, serial number, and report date. Purpose:  30 CFR 75.1714-8 authorizes the collection of this information.  MSHA maintains an inventory of all reported SCSR information to assure the effectiveness of evacuation plans and emergency evacuations.  In addition, such an inventory will assist in targeting SCSR recalls to specific mines. MSHA may not sponsor or endorse products. Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. The use of this form will facilitate SCSR inventory information transfer from mine operators to MSHA. If filing online, copies will be sent electronically to the appropriate offices. Original should be sent to: Mine Safety and Health Administration Technical Support Pittsburgh Safety and Health Technology Center Attn: SCSR Coordinator Cochrans Mill Road P.O. Box 18233 Pittsburgh, Pennsylvania 15236
Contact Information:	Questions regarding this form should be directed to MSHA at (877) 778-6055 or MSHAhelpdesk@dol.gov
Privacy Notice:	Privacy Notice
Legal Authority:	30 CFR 75.1714-8, MSHA may not sponsor or endorse products.
Burden Statement:	Public reporting burden for this collection of information is estimated from 3 hours to 19 hours depending on the size of the mine per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection information. Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Records Management Branch Mine Safety and Health Administration 1100 Wilson Boulevard Arlington, VA 22209-3939