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MSHA - Protecting Miners'
Safety and Health Since 1978

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Advisor

Forms and Online Filings

Form number:

MSHA Form 5000-23

Form name:

Certificate of Training

Description:

This is a mandatory collection of information as required by 30
CFR Part 48.9 and
48.29. The
Certificate of Training Form 5000-23 provides a means for mine
operators to record and certify Part 48 mandatory training received
by miners. The training certificates for each miner shall be
available at the operator minesite for inspection by MSHA and for
examination by the miners, the miner's representative, and State
inspection agencies. At the completion of training, the instructor
MUST give the miner a copy of the training certificate. When a miner
leaves the operator's employ, the miner shall be entitled to a copy
of his training certificates.

OMB Control Number and Expiration Date:

1219-0009; 7/31/2014

OptionsInstructions for Completing the Form:

Please read all instructions here before using the link (below)
to obtain the detailed instructions.

Form 5000-23 may be completed while on your PC screen and printed
(or printed and filled in manually). MSHA does not receive or
maintain copies of the 5000-23. DO NOT FILE THIS FORM WITH
MSHA.

Form fill, print
and mail or fax

Detailed
Instructions for completing Form 5000-23, Certificate of
Training Form.

Contact Information:

Questions regarding this form should be
directed to MSHA at (877) 778-6055 or [email-masked]

Privacy Notice:

Privacy
Notice

Legal Authority:

30 CFR 48.9 and
48.29.

Burden Statement:

Public reporting burden for this collection of information is
estimated to average 5 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. Send comments regarding the collection of
information, including suggestions for reducing this burden, to the
Mine Safety and Health Administration, U.S. Department of Labor,
Records Management Branch, 1100 Wilson Boulevard, Arlington,
Virginia 22209-3939.

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Mine Safety and Health Administration
(MSHA) | 1100 Wilson Boulevard, 21st Floor Arlington, VA
22209-3939
http://www.msha.gov/ | Telephone:
(202) 693-9400 | Fax-on-demand: (202) 693-9401