Information Collection

Certificate of Electrical Training

IC 14333 under ICR 200703-1219-002 · OMB 1219-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5000-1 Certificate of Electrical Training	Form
5000-1 Certificate of Electrical Training 5000-1.pdf www.msha.gov/forms/elawsforms/5000-1.htm	Form

IC Title:

Certificate of Electrical Training

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 77.103(a)(2) 30 CFR 75.153(a)(2)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5000-1	Certificate of Electrical Training	5000-1.pdf	http://www.msha.gov/forms/elawsforms/5000-1.htm	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,845

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 37 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,294	668	1,626
Annual IC Time Burden (Hours)	138	-3,691	3,829
Annual IC Cost Burden (Dollars)	9,257	-212,743	222,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.