Mine Rescue Teams; Arrangements for Emergency Medical Assistance and Transportation for Injured Persons; Agreements; Reporting Requirements; Posting Requirements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0144 can be found here:

Documents and Forms

Document Name Document Type
Form MSHA Form 2000-224 Mine Rescue Teams; Arrangements for Emergency Medical Assistance and Transportation for Injured Persons; Agreements; Reporting Requirements; Posting Requirements Form and Instruction
INTRO Operator’s Annual Certification of Mine Rescue Teams Qualifications.pdf arlweb.msha.gov/forms/elawsforms/2000-224.htm Instruction
INTRO Certificate of Physical Qualification for Mine Rescue Work.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work Instruction
MSHA Form 2000-224 Operator’s Annual Certification of Mine Rescue Team Qual 2000-224_2 2020.pdf arlweb.msha.gov/forms/elawsforms/2000-224.htm Form and Instruction
5000-3 Certificate of Physical Qualification for Mine Rescue Wo 5000-3.pdf www.msha.gov/sites/default/files/Support_Resources/Forms/5000-3.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mine Rescue Teams; Arrangements for Emergency Medical Assistance and Transportation for Injured Persons; Agreements; Reporting Requirements; Posting Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 49.4 30 CFR 49.3 30 CFR 49.2 30 CFR 49.5 30 CFR 49.6 30 CFR 49.7 30 CFR 49.8 30 CFR 49.9 30 CFR 49.12 30 CFR 49.13 30 CFR 49.16 30 CFR 49.17 30 CFR 49.18 30 CFR 49.19 30 CFR 49.50 30 CFR 75.1713-1 30 CFR 77.1702

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 2000-224	Operator’s Annual Certification of Mine Rescue Team Qualifications	2000-224_2 2020.pdf	http://arlweb.msha.gov/forms/elawsforms/2000-224.htm	Yes	Yes	Fillable Fileable
Form	5000-3	Certificate of Physical Qualification for Mine Rescue Work	5000-3.pdf	https://www.msha.gov/sites/default/files/Support_Resources/Forms/5000-3.pdf	Yes	Yes	Fillable Fileable
Instruction			INTRO Operator’s Annual Certification of Mine Rescue Teams Qualifications.pdf	http://arlweb.msha.gov/forms/elawsforms/2000-224.htm	Yes	Yes	Fillable Fileable
Instruction			INTRO Certificate of Physical Qualification for Mine Rescue Work.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 577	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 55 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40,588	19,973	20,215	400
Annual IC Time Burden (Hours)	13,107	9,941	3,163	3
Annual IC Cost Burden (Dollars)	1,980,169	309,068	1,671,001	100

Documents for IC

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