Form number:

None

Form name:

MSHA Notification of Representative of Miners

Description:

A written declaration of an individual or union as the representative of miners for a given operator.

OMB Control Number and Expiration Date:

1219-0042; 10/31/2004

Filing Options:

MSHA Notification of Representative of Miners can be filed online.
File online

This notification may also be filed by submitting a printed letter to your local MSHA District Office.
District office contact information for coal mines
District office contact information for metal/nonmetal mines

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 Part 40.3

Burden Statement:

Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This is a voluntary collection of information (30 CFR Section 40.3). This information is used to identify a person or organization designated as a representative of miners for all purposes provided for in the Mine Act. 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 (1219-0042), Washington, D.C. 20503. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.