Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the MSHA Mine Identification Number in the first field. Ensure that the number is accurate to avoid any processing delays.
3. In the field for the Name of Company Officer in Charge of Program, input the full name of the individual responsible for overseeing the health program.
4. Specify the Title of Officer in Charge in the following field, including the official designation of the officer.
5. Enter the Name of Mine Operator/Company in the next section, ensuring the correct company name is used.
6. Fill in the Telephone Number for the officer in charge for any follow-up communication.
7. Provide the Street Address where the company is located.
8. Input the City and State of the mine operator's address.
9. Continue by entering the Zip Code for the address provided.
10. Complete the section for County and Mine Name, ensuring both fields are filled with relevant information.
11. Make sure to input the Mine Mailing Address, specifying the Box number or Street as needed.
12. Indicate the Number of Miners employed at the mine in the subsequent field.
13. Fill in the details for the Time Schedule, including Begin Date and End Date reflecting the duration of the program.
14. Under Mine Type, select the appropriate category that describes the operation.
15. For Mine Status, indicate the current operational status of the mine.
16. Use the Remarks section to provide any additional information, including the setup of mobile facilities if applicable.
17. Before submitting the form, review all entered information for any errors or omissions.
18. Upon completion, you can choose to save changes, download, print, or share the form as needed.

Start filling out the Pdf Form Omb No 0920 0020 online to ensure compliance with health regulations.