Mine Safety and Health Administration Grant Performance Reports

Forms and Documents

Document Name	Status
Form 5000-50 MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report Form	New
MSHA-2017-0007-0001.pdf Supplementary Document	2017-11-13
FY17 State Grants FOA.PDF Supplementary Document	2017-11-13
Sup Statement 1219-0NEW 9-2018.docx Supporting Statement A	2018-09-26

IC Document Collections

IC ID	Document Title	Status
228996	MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report Form	New

ICR Details

OMB Control No: 1219-0154	ICR Reference No: 201711-1219-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOL/MSHA	Agency Tracking No:
Title: Mine Safety and Health Administration Grant Performance Reports
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/28/2018
	Date Received in OIRA: 04/02/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved
Responses	300	0	0
Time Burden (Hours)	750	0	0
Cost Burden (Dollars)	53	0	0

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Abstract: MSHA grantees are required by DOL regulations to submit project and final reports. Grantees are also required to submit final reports no later than 90 days after the end of the grant period. Technical Project Reports: A grantee submits a technical project report to MSHA no later than 30 days after quarterly deadlines. Technical project reports provide both quantitative and qualitative information and a narrative assessment of performance for the preceding three-month period. This includes the current grant progress against the overall grant goals. Between reporting dates, the grantee informs MSHA of significant developments or problems affecting the organization's ability to accomplish the work Final Reports: At the end of the grant period, each grantee provides a project summary of its technical project reports, an evaluation report, and a close-out financial report. These final reports are due no later than 90 days after the end of the 12-month performance period.

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Authorizing Statute(s): US Code: 30 USC 811 Name of Law: Federal Mine Safety and Health Act of 1977
   US Code: 30 USC 813(h) Name of Law: Federal Mine Safety and Health Act of 1977
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 26951	06/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 14045	04/02/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report	5000-50	MSHA State Grant Program Performance Report

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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	300	0	0	300	0	0
Annual Time Burden (Hours)	750	0	0	750	0	0
Annual Cost Burden (Dollars)	53	0	0	53	0	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: This is a new information collection.

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Annual Cost to Federal Government: $0

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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: 04/02/2018

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