Certificate of Electrical Training and Applications for MSHA Approved Tests and State Tests Administered as Part of an MSHA-approved State Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form MSHA Form 5000-1 Certificate of Electrical Training	Form and Instruction	Removed	Available
Form MSHA Form 5000-1 Certificate of Electrical Training	Form and Instruction	Removed	Available
Form MSHA Form 5000-1 Certificate of Electrical Training (State Grantees)	Form and Instruction	Removed	Missing upstream
Form MSHA Form 5000-1 Certificate of Electrical Training	Form and Instruction	Modified	Available
Form MSHA Form 5000-1 Certificate of Electrical Training	Form and Instruction	Modified	Available
Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors)	Form and Instruction	Modified	Repair queued
1219-0001 60-Day FRN Published 7-3-2025.pdf	Supplementary Document	Uploaded 2025-09-03	Available
1219-0001 60-Day FRN Published 7-3-2025.pdf	Supplementary Document	Uploaded 2025-09-03	Repair queued
1219-0001 Supporting Statement 2025.docx	Supporting Statement A	Uploaded 2025-09-03	Repair queued
1219-0001 Supporting Statement 2025.docx	Supporting Statement A	Uploaded 2025-09-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208114	Evidence of Eligibility		Modified
192599	Certificate of Electrical Training (State Grantees)	Form and Instruction	Removed	Certificate of Electrical Training
192599	Certificate of Electrical Training (State Grantees)	Form and Instruction	Removed	Certificate of Electrical Training
192599	Certificate of Electrical Training (State Grantees)	Form and Instruction	Removed
14333	Certificate of Electrical Training (instructors and contractors)	Form and Instruction	Modified	Certificate of Electrical Training
14333	Certificate of Electrical Training (instructors and contractors)	Form and Instruction	Modified	Certificate of Electrical Training
14333	Certificate of Electrical Training (instructors and contractors)	Form and Instruction	Modified

ICR Details

OMB Control No: 1219-0001	ICR Reference No: 202504-1219-004
Status: Active	Previous ICR Reference No: 202502-1219-001
Agency/Subagency: DOL/MSHA	Agency Tracking No:
Title: Certificate of Electrical Training and Applications for MSHA Approved Tests and State Tests Administered as Part of an MSHA-approved State Program
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: 12/12/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/15/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2028	36 Months From Approved	12/31/2025
Responses	1,512	0	1,632
Time Burden (Hours)	695	0	772
Cost Burden (Dollars)	331	0	299

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Abstract: MSHA's Form 5000-1, "Certificate of Electrical Training," is required to be used by instructors for reporting to MSHA the qualification of those persons who have satisfactorily completed a coal mine electrical training program course. The Agency is also requesting approval for applications for MSHA approved tests and for State tests that are administered as part of an MSHA-approved State program.

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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 2958	07/03/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 44397	09/15/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Certificate of Electrical Training (State Grantees)	MSHA Form 5000-1, MSHA Form 5000-1	Certificate of Electrical Training ,   Certificate of Electrical Training
Certificate of Electrical Training (instructors and contractors)	MSHA Form 5000-1, MSHA Form 5000-1	Certificate of Electrical Training ,   Certificate of Electrical Training
Evidence of Eligibility

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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	1,512	1,632	0	-120	0	0
Annual Time Burden (Hours)	695	772	0	-77	0	0
Annual Cost Burden (Dollars)	331	299	0	32	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Number of Respondents: The estimated number of respondents decreased from 294 to 248 due to a decline in the number of submissions of MSHA Form 5000-1 and evidence of eligibility. Number of Responses: The estimated number of responses decreased from 1,632 to 1,512 due to a decline in the number of submissions. Annual Time Burden: The estimated annual time burden decreased from 772 hours to 695 hours due to the decrease in the number of responses. Annual Burden Costs: The estimated annual burden costs increased from $52,687 to $53,568 due to an increase in wages. Annual Other Burden Costs: The estimated annual other burden cost increased, from $299 to $331 due to an increase in the share of forms submitted by mail.   Federal Hours: The estimated annual federal hours remained the same at 730 hours as the time to spent maintaining the database remained constant. Federal Costs: The estimated annual federal costs increased from $35,081 to $42,766 due to an increase in the number of certification cards mailed to miners.

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Annual Cost to Federal Government: $42,766

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: 09/15/2025

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