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Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties

IC 14507 under ICR 202502-1219-007 · OMB 1219-0127.

Documents and Forms
Document Name
Document Type
Form
Form and Instruction
Instruction
Form
Form and Instruction
Information Collection (IC) Details

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Certification and Qualification to Examine, Test, Operate Hoists, and to Perform Other Duties
 
No Modified
 
Mandatory
 
30 CFR 75.159 30 CFR 75.160 30 CFR 75.100 30 CFR 75.161 30 CFR 77.100 30 CFR 77.105 30 CFR 77.106 30 CFR 77.107 30 CFR 75.155 30 CFR 77.107-1

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form MSHA Form 5000-41 Safety and Health Activity Certification or Hoisting Engineers Qualification Request MSHA_5000-41.pdf https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/health-activity-certification-or-hoisting-engineers Yes Yes Fillable Fileable
Form and Instruction MSHA Form 5000-41 Safety and Health Activity Certification or Hoisting Engineers Qualification Request 5000-41_screenshots 11-2020.docx https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/health-activity-certification-or-hoisting-engineers Yes Yes Fillable Fileable Signable
Instruction INTRO 5000-41.pdf https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/health-activity-certification-or-hoisting-engineers Yes Yes Fillable Fileable

Workforce Management Worker Safety

DOL/MSHA-1, Mine Safety and Health Administration Standardized Information System (MSIS)  81 FR 25766

990 0
   
Private Sector Businesses or other for-profits
 
   80 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,980 0 0 0 0 3,980
Annual IC Time Burden (Hours) 334 0 0 0 0 334
Annual IC Cost Burden (Dollars) 3 0 0 0 0 3

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