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Rotorcraft External-Load Operator Certificate Application FAA 8710-4 - Official Federal Forms
| Rotorcraft External-Load Operator Certificate Application Form. This is a national form and can be used in Federal Aviation Administration (FAA) . |
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US Department of Transportation Federal Aviation Administration ROTORCRAFT EXTERNAL-LOAD OPERATOR CERTIFICATE APPLICATION Paperwork Reduction Act Statement: The information collected on this form is solicited in order to comply with Title 14, Code of Federal Regulations, Part 133. This information is used to establish eligibility for the issuance of the Rotorcraft External-Load Operator Certificate. Confidentiality is neither requested nor provided. We estimate that it will take approximately 0.3 hours to complete the form. 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 connection is 2120-0044. 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 TEAR OFF BEFORE USE FAA Form 8710-4 (6-84) THIS PART SUPERSEDES FAA FORM 8000-32 Electronic Version (Adobe) SUPPLEMENTAL INFORMATION DETACH THIS PART BEFORE USING FORM BELOW American LegalNet, Inc. www.FormsWorkflow.com Form Approved: OMB No. 2120-0044 09/30/2008 US Department of Transportation Federal Aviation Administration Rotorcraft External-Load Operator Certificate Application INSTRUCTIONS: Submit this form in triplicate to local FAA District Office 1. APPLICATION FOR (CHECK APPLICABLE BOX) ORIGINAL ISSUANCE AMENDMENT RENEWAL 2. NAME AND ADDRESS OF APPLICANT (Include Zip Code) CERTIFICATE NO. (For amendment or renewal only.) EXTERNAL - LOAD CLASS AUTHORIZATION (S) A B C 3. PRINCIPAL OR LOCAL BASE OF OPERATIONS (Airport, City, State, and Zip Code) TELEPHONE NUMBER TELEPHONE NUMBER 4. NAME OF CHIEF PILOT OR PILOT IN CHARGE OF LOCAL OPERATION AIRMAN CERTIFICATE ATTACH PREV GRADE NUMBER 5. REGISTRATION NUMBER TYPE MAKE MODEL ROTORCRAFT TO BE USED LOAD CLASS (X) A B C DEVICE APPD. REMARKS YES NO CERTIFICATION I certify that the statements made on this application form and any attachments are true and correct, and that the operations indicated on this application will be conducted within the requirements of the Federal Aviation Act of 1958 and the applicable Federal Aviation Regulations. DATE TITLE OF AUTHORIZED OFFICER SIGNATURE OF APPLICANT OR AUTHORIZED OFFICER FAA Form 8710-4 (6-84) SUPERSEDES FAA FORM 8420-7 and FAA FORM 8000-32 Electronic Version (Adobe) American LegalNet, Inc. www.FormsWorkflow.com INSPECTION REPORT (To be completed by FAA District Office Representative) ROTORCRAFT MAKE MODEL REGISTRATION NUMBER APPROVAL DATE CLASS WEIGHT AUTHORIZED LIMITATIONS AND REMARKS INSPECTOR'S SIGNATURE REMARKS CHIEF PILOT KNOWLEDGE AND SKILL REQUIREMENTS MET BY: NAME OF CHIEF PILOT CLASS A CLASS B CLASS C DATE SIGNATURE OF INSPECTOR Applicant is Fully Qualified to Conduct External - Load Operations in Class (es) CLASS A APPLICATION DISAPPROVED CLASS B REASONS: CLASS C CERTIFICATE NUMBER ISSUED ON FAA DISTRICT OFFICE SIGNATURE OF SUPERVISING INSPECTOR Electronic Version (Adobe) American LegalNet, Inc. www.FormsWorkflow.com
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