Certificate of Electrical Training (instructors and contractors)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1219-0001 can be found here:

Documents and Forms

Document Name Document Type
Form MSHA Form 5000-1 Certificate of Electrical Training (instructors and contractors) Form and Instruction
MSHA Form 5000-1 Certificate of Electrical Training 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

Information Collection (IC) Details

IC Title:	Certificate of Electrical Training (instructors and contractors)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection 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	Certificate of Electrical Training	5000-1.pdf	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	Certificate of Electrical Training	5000-1 Intro screenshot.pdf	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: 129	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 79 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,219	410	809
Annual IC Time Burden (Hours)	508	171	337
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.