Certificate of Electrical Training and Applications for Mine Safety and Health Administration Approved Tests and State Tests Administered as Part of a Mine Safety and Health Admin. Approved Program

Forms and Documents

Document Name	Status
Form MSHA Form 5000-1 Certificate of Electrical Training (State Grantees) Form and Instruction	Modified
Form MSHA Form 5000-1 Mined-based Certificate of Electrical Training (Contractor Instructors) Form	Removed
Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors) Form and Instruction	Modified
5000-1 Intro Screen Shot.pdf Supplementary Document	2013-09-03
1219-0001 Supporting Statement for ROCIS 2013.docx Supporting Statement A	2013-09-04
1219-0001 PUBLISHED FRN 5-31-13.pdf Supplementary Document	2013-07-31

IC Document Collections

IC ID	Document Title	Status
208114	Evidence of Eligibility	New
192599	Certificate of Electrical Training (State Grantees) Form and Instruction	Modified
192598	Mined-based Certificate of Electrical Training (Contractor Instructors) Form	Removed
14333	Certificate of Electrical Training (instructors and contractors) Form and Instruction	Modified

ICR Details

OMB Control No: 1219-0001	ICR Reference No: 201304-1219-001
Status: Historical Active	Previous ICR Reference No: 201003-1219-011
Agency/Subagency: DOL/MSHA	Agency Tracking No:
Title: Certificate of Electrical Training and Applications for Mine Safety and Health Administration Approved Tests and State Tests Administered as Part of a Mine Safety and Health Admin. Approved Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/31/2013
	Date Received in OIRA: 09/23/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2016	36 Months From Approved	10/31/2013
Responses	2,350	0	2,796
Time Burden (Hours)	995	0	890
Cost Burden (Dollars)	731	0	29,483

---

Abstract: MSHA's Form 5000-1, "Certificate of Electrical Training," is required to be used by instructors for reporting to MSHA the qualification of those persons who have satisfactorily completed a coal mine electrical training program course. The Agency is also requesting approval for applications for MSHA approved tests and for State tests that are administered as part of an MSHA-approved State program.

---

Authorizing Statute(s): PL: Pub.L. 91 - 173 101(a); 103(a)(2); 305(g) Name of Law: Federal Mine Safety and Health Act of 1977
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 32691	05/31/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 58349	09/23/2013
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Evidence of Eligibility
Mined-based Certificate of Electrical Training (Contractor Instructors)	MSHA Form 5000-1	Certificate of Electrical Training
Certificate of Electrical Training (State Grantees)	MSHA Form 5000-1, MSHA Form 5000-1	Certificate of Electrical Training ,   Certificate of Electrical Training
Certificate of Electrical Training (instructors and contractors)	MSHA Form 5000-1, MSHA Form 5000-1	Certificate of Electrical Training ,   Certificate of Electrical Training

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,350	2,796	0	200	-646	0
Annual Time Burden (Hours)	995	890	0	100	5	0
Annual Cost Burden (Dollars)	731	29,483	0	0	-28,752	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Cost to Respondents: Although wages and postage rates have increased since Fiscal Year 2009, the ability to submit evidence of this training electronically has resulted in a decrease in the annual cost burden described in Item 13 ($28,852 to $731). Burden hours: There was an increase in burden hours (890 to 995). This increase relates to the requirement that new applicants submit evidence of one year of experience in performing electrical work which added 100 burden hours. Respondents: There was a decrease related to how respondents were counted. Previously each course was counted as both a response and a respondent. There are not as many instructors as there are responses. Also additional respondents were added to account for the evidence of eligibility requirement. Responses: There was a decrease in responses from 2,796 to 2,350 due to a decrease in the estimate of MSHA Form 5000-1's that are filled out.

---

Annual Cost to Federal Government: $54,045

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/23/2013

---