Certificate of Electrical Training and Applications for Mine Safety and Health Administration Approved Tests and State Tests Administered as Part of a Mine Safety and Health Admin. Approved Program

Forms and Documents

Document Name	Status
Form MSHA Form 5000-1 Certificate of Electrical Training (State Grantees) Form and Instruction	Modified
Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors) Form and Instruction	Modified
1219-0001 PUBLISHED 60 Day FRN May 20 2016 V81 p 31968.pdf Supplementary Document	2016-07-29
1219-0001 Supporting Statement 5-2016.docx Supporting Statement A	2016-08-24

IC Document Collections

IC ID	Document Title	Status
208114	Evidence of Eligibility	Modified
192599	Certificate of Electrical Training (State Grantees) Form and Instruction	Modified
14333	Certificate of Electrical Training (instructors and contractors) Form and Instruction	Modified

ICR Details

OMB Control No: 1219-0001	ICR Reference No: 201604-1219-003
Status: Historical Active	Previous ICR Reference No: 201304-1219-001
Agency/Subagency: DOL/MSHA	Agency Tracking No:
Title: Certificate of Electrical Training and Applications for Mine Safety and Health Administration Approved Tests and State Tests Administered as Part of a Mine Safety and Health Admin. Approved Program
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: 11/07/2016
	Date Received in OIRA: 08/31/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved	11/30/2016
Responses	1,414	0	2,350
Time Burden (Hours)	599	0	995
Cost Burden (Dollars)	274	0	731

---

Abstract: MSHA's Form 5000-1, "Certificate of Electrical Training," is required to be used by instructors for reporting to MSHA the qualification of those persons who have satisfactorily completed a coal mine electrical training program course. The Agency is also requesting approval for applications for MSHA approved tests and for State tests that are administered as part of an MSHA-approved State program.

---

Authorizing Statute(s): US Code: 30 USC 813(h), 103(h) Name of Law: Federal Mine Safety and Health Act of 1977
   US Code: 30 USC 811, 101(a) Name of Law: Federal Mine Safety and 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:
	81 FR 31968	05/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 60024	08/31/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Evidence of Eligibility
Certificate of Electrical Training (State Grantees)	MSHA Form 5000-1, MSHA Form 5000-1	Certificate of Electrical Training ,   Certificate of Electrical Training
Certificate of Electrical Training (instructors and contractors)	MSHA Form 5000-1, MSHA Form 5000-1	Certificate of Electrical Training ,   Certificate of Electrical Training

---

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	1,414	2,350	0	0	-936	0
Annual Time Burden (Hours)	599	995	0	0	-396	0
Annual Cost Burden (Dollars)	274	731	0	0	-457	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: Cost to Respondents: The increased ability for respondents to submit forms electronically has resulted in a decrease in the annual cost burden described in Item 13 from $731 to $274. Burden hours: There is a decrease in burden hours from 995 to 599. This decrease occurs due to the reduction in submissions by respondents. Respondents: There was a net increase in the number of total respondents from 273 to 289. This results from an increase in respondents from business, other for-profit, State, local, and tribal governments, that was offset somewhat by a decrease in respondents from individuals and households. Responses: There was a decrease in responses from 2,350 to 1,414 due to a decrease in the estimate of MSHA Form 5000-1’s that are filled out.

---

Annual Cost to Federal Government: $36,700

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: 08/31/2016

---