Certificate of Electrical Training (State Grantees)

Certificate of Electrical Training and Applications for MSHA Approved Tests and State Tests Administered as Part of an MSHA-approved State Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0001 can be found here:

Documents and Forms

Document Name Document Type
Form MSHA Form 5000-1 Certificate of Electrical Training (State Grantees) Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training 5000-1.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training Intro Certificate of Electrical Noise Training.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training Form and Instruction

Information Collection (IC) Details

IC Title:	Certificate of Electrical Training (State Grantees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 75.153(a)(2) 30 CFR 77.103(a)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MSHA Form 5000-1	Certificate of Electrical Training	5000-1.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Yes	Yes	Fillable Fileable
Form and Instruction	MSHA Form 5000-1	Certificate of Electrical Training	Intro Certificate of Electrical Noise Training.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 79	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 79 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	748	252	496
Annual IC Time Burden (Hours)	312	105	207
Annual IC Cost Burden (Dollars)	413	139	274

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.