Hazardous Conditions Complaints

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Hazardous Conditions Complaint (SPANISH)	Form and Instruction	Modified	Available
Hazardous Conditions Compliant (ENGLISH)	Form and Instruction	Modified	Available
Hazardous Conditions Complaints	Form and Instruction	Modified	Repair queued
1219-0014 Supporting Statement 2026.docx	Supporting Statement A	Uploaded 2025-11-25	Repair queued
1219-0014 Supporting Statement 2026.docx	Supporting Statement A	Uploaded 2025-11-25	Repair queued
1219-0014 60-Day FRN Published 9-25-2025.pdf	Supplementary Document	Uploaded 2025-09-26	Available
1219-0014 60-Day FRN Published 9-25-2025.pdf	Supplementary Document	Uploaded 2025-09-26	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
14363	Hazardous Conditions Complaints	Form and Instruction	Modified	Hazardous Conditions Complaint (SPANISH)
14363	Hazardous Conditions Complaints	Form and Instruction	Modified	Hazardous Conditions Compliant (ENGLISH)
14363	Hazardous Conditions Complaints	Form and Instruction	Modified
14363	Hazardous Conditions Complaints	Instruction	Modified

ICR Details

OMB Control No: 1219-0014	ICR Reference No: 202504-1219-001
Status: Active	Previous ICR Reference No: 202209-1219-001
Agency/Subagency: DOL/MSHA	Agency Tracking No:
Title: Hazardous Conditions Complaints
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/10/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/05/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2029	36 Months From Approved	03/31/2026
Responses	2,249	0	1,785
Time Burden (Hours)	450	0	357
Cost Burden (Dollars)	0	0	0

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Abstract: Under Section 103(g) of the Federal Mine Safety and Health Act of 1977, as amended (Mine Act), a representative of miners, or any individual miner where there is no representative of miners, may submit a written or oral notification of alleged violation or imminent danger of the Mine Act or a mandatory standard or of an imminent danger. The notifier has the right to obtain an immediate inspection by MSHA. A copy of the notice must be provided to the operator, with individual miner names redacted. MSHA regulations at 30 C.F.R. part 43 implement section 103(g) of the Mine Act. These regulations provide the procedures for submitting notification of the alleged violation and the actions that MSHA must take after receiving the notice. Although the regulations contain a review procedure (required by section 103(g)(2) of the Mine Act) whereby a miner or a representative of miners may in writing request a review if no citation or order is issued as a result of the original notice, the option is so rarely used that it was not considered in the burden estimates.

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Authorizing Statute(s): US Code: 30 USC 811 Name of Law: Federal Mine Safety and Health Act of 1977
   US Code: 30 USC 813(h) Name of Law: Federal Mine Safety and Health Act of 1977
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46261	09/25/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 56803	12/08/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Hazardous Conditions Complaints	None, None	Hazardous Conditions Compliant (ENGLISH) ,   Hazardous Conditions Complaint (SPANISH)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,249	1,785	0	0	464	0
Annual Time Burden (Hours)	450	357	0	0	93	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Number of Respondents: The estimated number of respondents increased from 1,785 to 2,249 due to an increase in the number of miners and representatives of miners submitting complaints. Number of Responses: The estimated number of responses increased from 1,785 to 2,249 due to an increase in the number of complaints submitted. Annual Time Burden: The estimated annual time burden increased from 357 to 450 due to an increase in the number of complaints submitted. Costs to Respondents: The estimated annual burden cost remains unchanged at $0.

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Annual Cost to Federal Government: $707,086

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/05/2026

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