Qualification/Certification Program Request for MSHA Individual Identification Number (MIIN)-Private Sector

Qualification/Certification Program Request for Mine Safety and Health Administration Individual Identification Number (MIIN)

5000-46 web p2 MSHA -

Qualification/Certification Program Request for MSHA Individual Identification Number (MIIN)-Private Sector

OMB: 1219-0143

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MSHA Individual Identification Number Request
This information is intended only for the individual named in this request. If you are not the intended recipient, you are notified that use, disclosure, or distribution of the information is strictly
prohibited and may be subject to criminal sanctions. If you received this information in error, please notify Qualification and Certification Unit, Toll Free 1-800-579-2647 or locally in Colorado at
303-231-5472, or via email [email protected] or via the mailing address Mine Safety and Health Administration, P.O Box 25367, Denver, CO 80225-0367, immediately for the return of
this information.
Applying for and receiving a MIIN does not change your immigration status or your right to work in the United States.
Press “next” to proceed with the MIIN Request.
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Mine Safety and Health Administration (MSHA) | 1100 Wilson Boulevard, 21st Floor Arlington, VA 22209-3939
www.msha.gov | Telephone: (202) 693-9400 | Fax-on-demand: (202) 693-9401

https://lakegovprod3.msha.gov/MIIN/MIIN.aspx[2/12/2014 6:35:22 PM]


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File TitleMSHA -
File Modified2014-02-12
File Created2014-02-12

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