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View MSHA's Form 1219-0127 Online 
| Agency: |
MSHA |
| Title: |
Health Activity Certification or Hoisting Engineers Qualification Request Form
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| Form Description: |
All instructors are required to submit to MSHA the names of persons who have satisfactorily completed required mine foreman and pre-shift examiner or hoisting certification training. The 5000-41 is a combined version of the previous 5000-4 and 5000-7 forms. MSHA uses the form information to issue certification cards to qualified persons.
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| OMB Control Number: |
1219-0127 |
| OMB Expiration Date: |
Wednesday, April 30, 2008
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