Forms and Online Filings
Form number: |
MSHA Form 5000-1 |
Form name: |
Certificate of Electrical/Noise Training |
Description: |
All instructors are required to submit to submit to MSHA the
names of persons who have satisfactorily completed required electrical
training. MSHA uses the form information to issue certification cards to those
persons who are qualified. |
OMB Control Number and Expiration Date: |
1219-0001; 4/30/2004 |
Filing Options: |
Form 5000-1, Certificate of Electrical/Noise Training can be
filed online or completed online, printed (or printed and filled in manually) and sent to MSHA
according to the instructions provided below.
File Online
Fill in online, print and mail or fax (or print and fill in
manually) |
Filing Instructions: |
If filing by mail or fax, completed printed forms should be sent
to:
MSHA Qualification and Certification P.O. Box
25367 Denver, Colorado 80225-0367 Fax: (303) 231-5474 |
Contact Information: |
Questions regarding this form should be directed to MSHA at
(877) 778-6055 or
zzMSHA-PEIRHelpDesk@dol.gov |
Privacy Notice: |
Privacy Notice |
Legal Authority: |
30 CFR 75.153(g) and
77.103(g) require
that an individual who is a qualified electrical person in accordance with
Section 75.153 and 77.103 shall annually certify to the district manager that
he has satisfactorily completed a coal mine electrical retraining program
approved by the Secretary in order to retain that qualification. |
Burden Statement: |
Public reporting burden for this collection of information is
estimated to average 25 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the
data need, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to the Office
of Information Management, Department of Labor, Room N-1301, 200 Constitution
Avenue, N.W., Washington, D.C. 20210; and to the Office of Management and Budget,
Paperwork Reduction Project (1219-0001), Washington, D.C. 20503. Persons are not
required to respond to this collection of information unless it displays a currently
valid OMB control number. |
Complete and File Form Online
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