PHYSICAL QUALIFICATION FOR MINE RESCUE WORK

ICR 198112-1219-020

OMB: 1219-0068

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
123265 Migrated
ICR Details
1219-0068 198112-1219-020
Historical Active
DOL/MSHA
PHYSICAL QUALIFICATION FOR MINE RESCUE WORK
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/28/1981
Retrieve Notice of Action (NOA) 12/17/1981
  Inventory as of this Action Requested Previously Approved
03/31/1982 03/31/1982
7,000 0 0
3,500 0 0
0 0 0

REQUIRES THAT EACH RESCUE TEAM MEMBER AND ALTERNATE BE CERTIFIED BY A PHYSICIAL TO BE FIT TO PERFORM STRENUOUS RESCUE AND RECOVERY WORK. THE CERTIFICATION MUST BE SUBMITTED ON APPROVED MSHA FORMS. AUTHORITY ESTABLISHED BY THE FEDERAL MINE SAFETY ACT OF 1977, P.L. 95-164.

None
None


No

1
IC Title Form No. Form Name
PHYSICAL QUALIFICATION FOR MINE RESCUE WORK MSHA-5000-3

  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 7,000 0 0 0 7,000 0
Annual Time Burden (Hours) 3,500 0 0 0 3,500 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/17/1981


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