Certificate of Electrical Training (State Grantees)

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

⚠️ Notice: This information collection may be referencing outdated material.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 Form 5000-1.pdf arlweb.msha.gov/forms/elawsforms/5000-1.htm Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training 5000-1 Intro screenshot.pdf www.msha.gov/forms/elawsforms/5000-1.htm Form and Instruction

Information Collection (IC) Details

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 77.103(a)(2) 30 CFR 75.153(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 Form 5000-1.pdf	http://arlweb.msha.gov/forms/elawsforms/5000-1.htm	Yes	Yes	Fillable Fileable
Form and Instruction	MSHA Form 5000-1	Certificate of Electrical Training	5000-1 Intro screenshot.pdf	http://www.msha.gov/forms/elawsforms/5000-1.htm	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 93	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 66 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	496	-321	817
Annual IC Time Burden (Hours)	207	-133	340
Annual IC Cost Burden (Dollars)	274	-4	278

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.