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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form MSHA Form 5000-41 Safety and Health Activity Certification or Hoisting Engineers Qualification Request	Form and Instruction	Modified	Available
Form MSHA Form 5000-41 Safety and Health Activity Certification or Hoisting Engineers Qualification Request	Form	Modified	Available
1219-0127 60-Day FRN 2017.pdf	Supplementary Document	Uploaded 2017-09-27	Available
1219-0127 Supporting Statement 12-2017.docx	Supporting Statement A	Uploaded 2017-12-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
14507	Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties	Form and Instruction	Modified	Safety and Health Activity Certification or Hoisting Engineers Qualification Request
14507	Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties	Form	Modified	Safety and Health Activity Certification or Hoisting Engineers Qualification Request
14507	Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties	Instruction	Modified

ICR Details

OMB Control No: 1219-0127	ICR Reference No: 201708-1219-003
Status: Historical Active	Previous ICR Reference No: 201406-1219-006
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: 02/16/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/31/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	02/28/2018
Responses	4,590	0	5,659
Time Burden (Hours)	465	0	548
Cost Burden (Dollars)	77	0	71

---

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): US Code: 30 USC 813(h) Name of Law: Federal Mine Safety & Health Act of 1977
   US Code: 30 USC 811 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:
	82 FR 34698	07/26/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 152	12/31/2017
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

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

table that charts list 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	4,590	5,659	0	0	-1,069	0
Annual Time Burden (Hours)	465	548	0	0	-83	0
Annual Cost Burden (Dollars)	77	71	0	0	6	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 548 to 465) is due to a decrease in the number of respondents (from 1,232 to 957) and responses (from 5,659 to 4,590). The increase in cost (from $71 to $77) is updated on the number of forms that need postage.

---

Annual Cost to Federal Government: $0

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 12/31/2017

---