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Airman Certificate And-Or Rating Application FAA 8710-1 - Official Federal Forms
| Airman Certificate And-Or Rating Application Form. This is a national form and can be used in Federal Aviation Administration (FAA) . |
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U.S. Department of Transportation Federal Aviation Administration FAA Form 8710-1, Airman Certificate and/or Rating Application Supplemental Information and Instructions Paperwork Reduction Act Statement: The information collected on this form is necessary to determine applicant eligibility for airman ratings. We estimate it will take 15 minutes to complete this form. The information collected is required to obtain a benefit and becomes part of the Privacy Act system of records DOT/FAA 847, General Air Transportation Records on Individuals. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number associated with this collection is 2120-0021. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20. Privacy Act The information on the accompanying form is solicited under authority of Title 14 of the Code of Federal Regulations (14 CFR), Part 61. The purpose of this data is to be used to identify and evaluate your qualifications and eligibility for the issuance of an airman certificate and/or rating. Submission of all requested data is mandatory, except for the Social Security Number (SSN) which is voluntary. Failure to provide all the required information would result in you not being issued a certificate and/or rating. The information would become part of the Privacy Act system of records DOT/FAA 847, General Air Transportation Records on Individuals. The information collected on this form would be subject to the published routine uses of DOT/FAA 847. Those routine uses are: (a) To provide basic airmen certification and qualification information to the public upon request. (b) To disclose information to the national Transportation Safety Board (NTSB) in connection with its investigation responsibilities. (c) To provide information about airmen to Federal, state, and local law enforcement agencies when engaged in the investigation and apprehension of drug violators. (d) To provide information about enforcement actions arising out of violations of the Federal Aviation regulations to government agencies, the aviation industry, and the public upon request. (e) To disclose information to another Federal agency, or to a court or an administrative tribunal, when the Government or one of its agencies is a party to a judicial proceeding before the court or involved in administrative proceedings before the tribunal. Submission of your Social Security Number is voluntary. Disclosure of your SSN will facilitate maintenance of your records which are maintained in alphabetical order and cross-referenced with your SSN and airman certificate number to provide prompt access. In the event of nondisclosure, a unique number will be assigned to your file. See Privacy Act Information above. Detach this part before submitting form. Instructions for completing this form (FAA 8710-1) are on the reverse. If an electronic form is not printed on a duplex printer, the applicant's name, date of birth, and certificate number (if applicable) must be furnished on the reverse side of the application. This information is required for identification purposes. The telephone number and E-mail address are optional. Tear off this cover sheet before submitting this form. FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007 American LegalNet, Inc. www.FormsWorkflow.com AIRMAN CERTIFICATE AND/OR RATING APPLICATION INSTRUCTIONS FOR COMPLETING FAA FORM 8710-1 I. APPLICATION INFORMATION. Check appropriate blocks(s). Block A. Name. Enter legal name. Use no more than one middle name for Block S. Date Issued. Enter the date your medical certificate was issued. Block T. Name of Examiner. Enter the name as shown on medical certificate. record purposes. Do not change the name on subsequent applications unless it is done in accordance with 14 CFR Section 61.25. If you do not have a middle name, enter "NMN". If you have a middle initial only, indicate "Initial only." If you are a Jr., or a II, or III, so indicate. If you have an FAA certificate, the name on the application should be the same as the name on the certificate unless you have had it changed in accordance with 14 CFR Section 61.25. Information Privacy Act. Do not leave blank: Use only US Social Security Number. Enter either "SSN" or the words "Do not Use" or "None." SSN's are not shown on certificates. Block U. Narcotics, Drugs. Check appropriate block. Only check "Yes" if you have actually been convicted. If you have been charged with a violation which has not been adjudicated, check ."No". Block V. Date of Final Conviction. If block "U" was checked "Yes" give the date of final conviction. Block B. Social Security Number. Optional: See supplemental II. CERTIFICATE OR RATING APPLIED FOR ON BASIS OF: Block A. Completion of Required Test. Block C. Date of Birth. Check for accuracy. Enter eight digits; Use numeric characters, i.e., 07-09-1925 instead of July 9, 1925. Check to see that DOB is the same as it is on the medical certificate. Block D. Place of Birth. If you were born in the USA, enter the city and state where you were born. If the city is unknown, enter the county and state. If you were born outside the USA, enter the name of the city and country where you were born. Block E. Permanent Mailing Address. Enter residence number and street, P.O. Box or rural route number in the top part of the block above the line. The City, State, and ZIP code go in the bottom part of the block below the line. Check for accuracy. Make sure the numbers are not transposed. FAA policy requires that you use your permanent mailing address. Justification must be provided on a separate sheet of paper signed and submitted with the application when a PO Box or rural route number is used in place of your permanent physical address. A map or directions must be provided if a physical address is unavailable. Block F. Citizenship. Check USA if applicable. If not, enter the country where you are a citizen. 1. AIRCRAFT TO BE USED. (If flight test required) Enter the make and model of each aircraft used. If simulator or FTD, indicate. 2. TOTAL TIME IN THIS AIRCRAFT (Hrs.) (a) Enter the total Flight Time in each make and model. (b) Pilot-In-Command Flight Time - I
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