Information Collection

Certificate of Electrical Training (instructors and contractors)

IC 14333 under ICR 202504-1219-004 · OMB 1219-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors)	Form and Instruction
Form MSHA Form 5000-1 Certificate of Electrical Training Certificate of Electrical Training (instructors and contractors)	Form and Instruction
Form MSHA Form 5000-1 Certificate of Electrical Training Certificate of Electrical Training (instructors and contractors)	Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training MSHA_5000-1.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training MSHA_5000-1.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training 5000-1 Intro screenshot.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training 5000-1 Intro screenshot.pdf www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 77.103(a)(2) 30 CFR 75.153(a)(2)

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 5000-1			https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Yes	Yes	Fillable Fileable
Form and Instruction	MSHA Form 5000-1			https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 207

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 81 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,471	495	976
Annual IC Time Burden (Hours)	613	206	407
Annual IC Cost Burden (Dollars)	331	331	0

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.

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