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Agenda
Reg Review
ICR
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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