Representative of Miners, Notification of Legal Identity, and Notification of Commencement of Operations and Closing of Mines

Representative of Miners Designation Form | Mine Safety and Health Administration (MSHA)

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REPRESENTATIVE OF MINERS

Representative of Miners
Designation Form

Equipment Approval &
Certification

Form ID: 2000-238

Resources & Tools

Description: 

Print

This voluntary form is a written declaration of any person or organization which
Alliances & MOUs
External Mining
Resources

represents two or more miners at a coal or other mine for the purposes of the
Mine Act.
Control ID: 1219-0042
Expiration Date: August 31, 2017
Filing Options: 
Fill in, print and mail or fax
File online
Change online filing registration information
This notification may also be filed by submitting a printed letter to your local
MSHA District Office .
District office contact information for coal mines
District office contact information for metal/nonmetal mines

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Representative of Miners Designation Form | Mine Safety and Health Administration (MSHA)

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 40.3
Burden Statement: 
Public reporting burden for this collection of information estimated to average
10 minutes per response; including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the date need, 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 & Health Administration, U.S. Department of Labor,
Office of Standards, Regulations and Variances, 201 12th Street South, Suite
401 Arlington, VA 22202-5450. Persons are not required to respond to this
collection of information unless it displays a currently OMB Control Number.
Online Filing: 
File Online

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Representative of Miners Designation Form | Mine Safety and Health Administration (MSHA)
Newsletter

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