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									Support & Resources

	Representative of Miners Designation Form

		
		Form ID
                    
                2000-238


    Description
                    
                This voluntary form is a written declaration of any person or organization which represents two or more miners at a coal or other mine for the purposes of the Mine Act.


    Control ID
                    
                1219-0042


    Expiration Date
                    
                Thu, 12/31/2026 - 13:00


    Filing Options
                    
                Fill in, print and mail or faxFile onlineChange online filing registration informationThis notification may also be filed by submitting a printed letter to your local MSHA District Office .
Mine Safety and Health Enforcement


    Contact Information
                    
                Questions regarding this form should be directed to MSHA at (877) 778-6055 or desk.help@dol.gov


    Privacy Notice
                    
                Privacy Notice


    Legal Authority
                    
                30 CFR 40.3


    Burden Statement
                    
                Public reporting burden for this collection of information estimated to average 10 minutes per response; including the time for reviewing instructions, searching existing data sources, gathering and maintaining the date need, and completing and reviewing the collection of information. Send comments regarding the collection of information, including suggestions for reducing this burden, to the Mine Safety & Health Administration, U.S. Department of Labor, Office of Standards, Regulations and Variances, 201 12th Street South, Suite 401 Arlington, VA 22202-5450. Persons are not required to respond to this collection of information unless it displays a currently OMB Control Number.


    Online Filing
                    
                File OnlineScroll to Top

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