Information Collection

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

IC 208447 under ICR 202301-1219-001 · OMB 1219-0144.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-04-07 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
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
Operator’s Annual Certification of Mine Rescue Teams Qualifications _ Mine Safety and Health Administration (MSHA) more informat www.msha.gov/support-resources/forms-online-filing/2015/11/18/operators-annual-certification-mine-rescue-teams	Instruction
Operator’s Annual Certification of Mine Rescue Teams Qualifications _ Mine Safety and Health Administration (MSHA) more informat www.msha.gov/support-resources/forms-online-filing/2015/11/18/operators-annual-certification-mine-rescue-teams	Instruction
Certificate of Physical Qualification for Mine Rescue Work _ Mine Safety and Health Administration (MSHA) more information.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work	Instruction
Certificate of Physical Qualification for Mine Rescue Work _ Mine Safety and Health Administration (MSHA) more information.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.pdf arlweb.msha.gov/forms/elawsforms/2000-224.htm	Form and Instruction
MSHA Form 2000-224 Operator’s Annual Certification of Mine Rescue Team Qual 2000-224.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
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 49.16 30 CFR 49.13 30 CFR 49.17 30 CFR 49.18 30 CFR 49.4 30 CFR 49.12 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 49.19 30 CFR 49.50 30 CFR 75.1713-1 30 CFR 77.1702

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 and Instruction	MSHA Form 2000-224	Operatorâs Annual Certification of Mine Rescue Team Qualifications	2000-224.pdf	http://arlweb.msha.gov/forms/elawsforms/2000-224.htm	Yes	Yes	Fillable Fileable
Instruction			Operatorâs Annual Certification of Mine Rescue Teams Qualifications _ Mine Safety and Health Administration (MSHA) more information.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/11/18/operators-annual-certification-mine-rescue-teams	Yes	Yes	Fillable Fileable
Instruction			Certificate of Physical Qualification for Mine Rescue Work _ Mine Safety and Health Administration (MSHA) more information.pdf	https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work	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

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 362

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,436	-10,152	40,588
Annual IC Time Burden (Hours)	5,106	-8,001	13,107
Annual IC Cost Burden (Dollars)	265	-1,979,904	1,980,169

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.