Representative of Miners, Notification of Legal Identity, and Notification of Commencement of Operations and Closing of Mines

Representative of Miners Designation Form | Mine Safety and Health Administration (MSHA)

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UNITED STATES
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Mine Safety and Health Administration (MSHA)
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Form ID: 2000-238

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REPRESENTATIVE OF MINERS

Representative of Miners
Designation Form

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This voluntary form is a written declaration of any person or organization which
represents two or more miners at a coal or other mine for the purposes of the
Mine Act.
Control ID: 1219-0042
Expiration Date: September 30, 2020
Filing Options: 
Fill in, print and mail or fax
File online
Change online filing registration information
This notification may also be filed by submitting a printed letter to your local
MSHA District Office .
District office contact information for coal mines
District office contact information for metal/nonmetal mines
Contact Information: 
Questions regarding this form should be directed to MSHA at (877) 778-6055

https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/representative-miners-designation-form[8/19/2020 2:03:16 PM]

Representative of Miners Designation Form | Mine Safety and Health Administration (MSHA)

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regarding the collection of information, including suggestions for reducing this
burden, to the Mine Safety & Health Administration, U.S. Department of Labor,
Office of Standards, Regulations and Variances, 201 12th Street South, Suite
401 Arlington, VA 22202-5450. Persons are not required to respond to this
collection of information unless it displays a currently OMB Control Number.
Online Filing: 
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