MSHA Form 2000-238 Representative of Miners Designation Form _ (MSHA)

6/2/23, 11:18 AM

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

U.S. DEPARTMENT OF LABOR

Mine Safety and Health Administration

Representative of Miners
Designation Form
Form ID: 2000-238
Description
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: Sun, 12/31/2023 - 13:00
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 .
Mine Safety and Health Enforcement
Contact Information

Questions regarding this form should be directed to MSHA at (877) 778-6055
or [email protected]
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Privacy Notice
Legal Authority

30 CFR 40.3

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

Burden Statement
Public reporting burden for this collection of information estimated to average 10 minutes per

response; including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the date need, and completing and reviewing the collection of
information. Send comments 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.
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U.S. DEPARTMENT OF LABOR
Mine Safety and Health Administration
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Representative of Miners Designation Form | Mine Safety and Health Administration (MSHA)

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