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

OMB 1219-0001

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.

The latest form for Certificate of Electrical Training and Applications for MSHA Approved Tests and State Tests Administered as Part of an MSHA-approved State Program expires 2023-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form MSHA Form 5000-1 Certificate of Electrical Training (State Grantees) Form and Instruction
Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors) Form and Instruction
1219-0001 Supporting Statement 2022.docx Supporting Statement A
Evidence of Eligibility
Certificate of Electrical Training (State Grantees) Form and Instruction
Certificate of Electrical Training (instructors and contractors) Form and Instruction

All Historical Document Collections

202208-1219-004 Approved without change	Extension without change of a currently approved collection	2022-11-23
201909-1219-001 Approved without change	Extension without change of a currently approved collection	2019-11-22
201604-1219-003 Approved without change	Extension without change of a currently approved collection	2016-08-31
201304-1219-001 Approved without change	Revision of a currently approved collection	2013-09-23
201003-1219-011 Approved without change	Revision of a currently approved collection	2010-07-27
200703-1219-002 Approved without change	Extension without change of a currently approved collection	2007-04-18
200404-1219-001 Approved without change	Extension without change of a currently approved collection	2004-04-22
200102-1219-001 Approved without change	Extension without change of a currently approved collection	2001-02-01
199712-1219-003 Approved without change	Extension without change of a currently approved collection	1997-12-31
199410-1219-001 Approved without change	Reinstatement without change of a previously approved collection	1994-10-28
199104-1219-003 Approved without change	Revision of a currently approved collection	1991-04-08
198910-1219-017 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-10-01
198903-1219-002 Approved without change	Revision of a currently approved collection	1989-03-08
198810-1219-014 Approved with change	No material or nonsubstantive change to a currently approved collection	1988-10-01
198609-1219-019 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-09-12
198601-1219-004 Approved without change	Revision of a currently approved collection	1986-01-31
198409-1219-007 Approved with change	No material or nonsubstantive change to a currently approved collection	1984-09-05
198306-1219-002 Approved without change	Revision of a currently approved collection	1983-06-21
198305-1219-027 Approved with change	No material or nonsubstantive change to a currently approved collection	1983-05-27
198202-1219-004 Approved without change	Revision of a currently approved collection	1982-02-22
198112-1219-003 Approved without change	Reinstatement with change of a previously approved collection	1981-12-16
197811-1219-002 Approved without change	Reinstatement with change of a previously approved collection	1978-11-01
197811-1219-001 Not subject to PRA	Revision of a currently approved collection	1978-11-01
197707-1219-001 Approved with change	No material or nonsubstantive change to a currently approved collection	1977-07-01
197608-1219-001 Approved with change	No material or nonsubstantive change to a currently approved collection	1976-08-30
197512-1219-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1975-12-31
197512-1219-001 Approved without change	Extension without change of a currently approved collection	1975-12-23

OMB Details

Certificate of Electrical Training (instructors and contractors)

Federal Enterprise Architecture: Workforce Management - Worker Safety

Form MSHA Form 5000-1	Certificate of Electrical Training	www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Form and instruction
Form MSHA Form 5000-1	Certificate of Electrical Training	www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.