Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
49.12 Modified 10 10 5
49.13 Modified 2 4 5
49.16 (Certify) Modified 10800 1080 0
49.16 (Record Corrective Actions) Modified 1800 450 0
49.17/ MSHA Form 5000-3 Modified 896 224 268800 Form and Instruction MSHA Form 5000-3 Certificate of Physical Qualification for Mine Rescue Work
Form and Instruction MSHA FORM 5000-3 Certificate of Physical Qualification for Mine Rescue Work (Intro Screen)
49.18 Modified 896 180 348160
49.19 Modified 10 20 0
49.50/ MSHA Form 2000-224 (Certifying) Modified 400 100 0 Form and Instruction MSHA Form 2000-224 Operator’s Annual Certification of Mine Rescue Team Qualifications
Instruction
49.50/ MSHA Form 2000-224 (Clerical) Modified 400 3 100 Form and Instruction MSHA Form 2000-224 Operator’s Annual Certification of Mine Rescue Team Qualifications
Instruction
75.1713-1 Modified 10 20 0
77.1702 Modified 56 112 0
Total burden requested under this ICR: 15280 2203 617070  
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