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

Mine Safety and Health Administration Grant Performance Reports

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.