View Information Collection (IC)

View Information Collection (IC)

IC Title:	Qualification/Certification Program and Man Hoist Operators Physical Fitness	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 75.160 30 CFR 75.159 30 CFR 77.106 30 CFR 75.100 30 CFR 75.161 30 CFR 77.107 30 CFR 77.100 30 CFR 77.105 30 CFR 75.155 30 CFR 77.107-1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5000-41	Safety & Health Activity Certification or Hoisting Engineers Qualification Req.	5000-41 Safety & Health Activity Cert. or Hoisting Engineer Req. (OMB).pdf	http://www.msha.gov/forms/elawsforms/5000-41.htm	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: DOL/MSHA-15 Health & Safety Training and Examination Records	FR Citation: 67 FR 16815

Number of Respondents: 1,547	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 61 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	6,966	0	0	4,534	0	2,432
Annual IC Time Burden (Hours)	679	0	0	-14,676	0	15,355
Annual IC Cost Burden (Dollars)	125	0	0	-7,922	0	8,047

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.