Information Collection

MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report

IC 228996 under ICR 201711-1219-001 · OMB 1219-0154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5000-50 MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report	Form
5000-50 MSHA State Grant Program Performance Report MSHA Form 5000-50 State Grant Technical Accomplishment Form.xlsx	Form

IC Title:

MSHA Performance Report Narratives and MSHA Form 5000-50, MSHA State Grant Program Performance Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5000-50	MSHA State Grant Program Performance Report	MSHA Form 5000-50 State Grant Technical Accomplishment Form.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	53	53

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.