Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties

Forms and Documents

Document Name	Status
Form MSHA Form 5000-41 Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties Form	Modified
1219-0127 60-DAY PUBLISHED FRN V79 P19390 4-8-2014.pdf Supplementary Document	2014-06-11
1219-0127 SS 1-2014.docx Supporting Statement A	2014-08-11

IC Document Collections

IC ID	Document Title	Status
14507	Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties Form	Modified

ICR Details

OMB Control No: 1219-0127	ICR Reference No: 201406-1219-006
Status: Historical Active	Previous ICR Reference No: 201101-1219-010
Agency/Subagency: DOL/MSHA	Agency Tracking No:
Title: Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/11/2014
	Date Received in OIRA: 08/15/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	12/31/2014
Responses	5,659	0	6,966
Time Burden (Hours)	548	0	679
Cost Burden (Dollars)	71	0	125

---

Abstract: Pertains to certification of certain persons to perform specific exams and tests. Also contains procedures under which coal mine operators are required to maintain a list of certified and qualified persons, and to develop an approved training plan for hosting engineers or host men. 30 CFR 75.159 and 77.106 require coal mine operators to maintain a list of persons who are certified and those who are qualified to perform duties under Parts 75 and 77, such as conduct examinations for hazardous conditions, conduct tests for methane and oxygen deficiency, conduct tests of air flow, perform electrical work, repair energized surface high-voltage lines, and perform duties of hoisting engineer. The information collection is necessary to ensure that only persons who are properly trained and sufficiently experienced are permitted to perform these duties. Although MSHA does not specify a format for the recordkeeping, it normally consists of the names of the certified and qualified persons listed in two columns on a sheet of paper. One column is for certified persons and the other is for qualified persons.

---

Authorizing Statute(s): PL: Pub.L. 91 - 173 101(a) and 103(a) Name of Law: Federal Mine Safety & Health Act of 1977
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 19390	04/08/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 48254	08/15/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties	MSHA Form 5000-41, MSHA Form 5000-41	Safety and Health Activity Certification or Hoisting Engineers Qualification Request ,   Safety and Health Activity Certification or Hoisting Engineers Qualification Request

---

ICR Summary of Burden

	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	5,659	6,966	0	0	-1,307	0
Annual Time Burden (Hours)	548	679	0	0	-131	0
Annual Cost Burden (Dollars)	71	125	0	0	-54	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in burden hours (from 679 to 548) and the decrease in cost (from $125 to $71) are due to a decrease in the number of respondents (from 1,547 to 1,232).

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/15/2014

---