MSHA form 7000-52 Contractor ID Request

Mine Safety and Health Administration
MSHA - Protecting Miners' Safety and Health Since 1978

Form number:

MSHA Form 7000-52

Form name:

Contractor Identification (ID) Request

Description:

All independent contractors may apply for MSHA contractor
identification numbers. This information is used to assist MSHA in
obtaining MSHA identification numbers for independent contractors.

OMB Control Number and
Expiration Date:

1219-0040; 3/31/2012

Filing Options:

Form 7000-52, Contractor ID Request can be filed online.
File online

Contact Information:

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

Privacy Notice:

Privacy Notice

Legal Authority:

30 CFR 45.3

Burden Statement:

Public reporting burden for this collection of information is estimated to
average 8 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 45.3). This information is used to assist independent
contractors in obtaining permanent MSHA identification numbers. 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,

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D.C. 20210; and to the Office of Management and Budget, Paperwork
Reduction Project (1219-0040), Washington, D.C. 20503. Persons are
not required to respond to this collection of information unless it
displays a currently valid OMB control number.
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U.S. Department of Labor

Contractor Identification Request
New ID's, Changes, Deletes

Mine Safety and Health Administration

Contractor ID Number

Check Appropriate Box:

-

Metal/Nonmetal

Coal

Date: _____/_____/_____

Check Appropriate Box:
New ID

Address Change

Other Change (Specify)

______________________________________________________________________________________________________

Delete (Specify reason for deleting)

New ID (Ownership Changed)

.
.

Name Change (no ownership change)

___________________________________________________________________________________________

_____________________________________________________________________________________________

Specify Previous Company Name ____________________________________________________________________________________________

Specify Previous Contractor ID Number _______________________________________________________________________________________

Company/Trade Name _______________________________________________________________________________________________________________

Business Address ___________________________________________________________________________________________________________________

City ____________________________________________________________________________ State __________ Zip Code _________________________
Mailing Address (Document Delivery) ___________________________________________________________________________________________________

City ____________________________________________________________________________ State __________ Zip Code _________________________

Company Contact Name _______________________________________________________ Title _________________________________________________

Phone Number _(

)_____________________________________

-

Mine ID Number

or Multiple Operations

Contractor's estimated hours on mine property: __________________________ hours

Job

Quarter

Year

Type of Work Performed (Specify) _____________________________________________________________________________________________________

District/Field Office _________________________________________________________________________________________________________________

Name of MSHA Employee Requesting Number ___________________________________________________________________________________________

Phone Number (

)_______________________________________ FAX Number (

)___________________________________________________

FAX Verification

Coder Number: _________________

FAX Number: (303) 231-5515

Attn.

FAX Number:

Attn.

MSHA Form 7000-52, Nov. 97

ADIB

Date: _____/_____/_____

Time: ______

Sender _________________

Date: _____/_____/_____

Time: ______

Sender _________________