49.17/ MSHA Form 5000-3

Coal Mine Rescue Teams: Arrangements for Emergency Medical Assistance and Transportation for Injured Persons-Agreements, Reporting Requirements, and Posting Requirements

OMB: 1219-0144

IC ID: 208444

Information Collection (IC) Details

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49.17/ MSHA Form 5000-3
 
No Modified
 
Mandatory
 
30 CFR 49.17

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction MSHA Form 5000-3 Certificate of Physical Qualification for Mine Rescue Work 5000-3 CERT of Physical Qualification for Mine Rescue Work (FILLABLE).pdf http://www.msha.gov/forms/elawsforms/5000-3.htm Yes Yes Fillable Fileable
Form and Instruction MSHA FORM 5000-3 Certificate of Physical Qualification for Mine Rescue Work (Intro Screen) MSHA Form 5000-3 Intro Screen.pdf http://www.msha.gov/forms/elawsforms/5000-3.htm Yes Yes Fillable Fileable

Workforce Management Worker Safety

 

128 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 896 0 0 -336 0 1,232
Annual IC Time Burden (Hours) 224 0 0 -84 0 308
Annual IC Cost Burden (Dollars) 268,800 0 0 -39,200 0 308,000

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