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Application And Statement Of Qualification (DME DPRE DAR-T ODAR-T) FAA 8110-28 - Official Federal Forms
| Application And Statement Of Qualification (DME DPRE DAR-T ODAR-T) Form. This is a national form and can be used in Federal Aviation Administration (FAA) . |
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Form Approved OMB No. 2120-0033 04/30/2010 APPLICATION AND STATEMENT OF QUALIFICATION (DME/DPRE/DAR-T/ODAR-T) U.S. Department of Transportation Federal Aviation Administration Supplemental Application and Instructions Paperwork Reduction Act Statement The information collected on this form is necessary to determine applicant eligibility for DME, DPRE, DAR-T, or ODAR-T. The information is used to determine certification eligibility. We estimate that it will take 55 minutes to complete the form. Completion of this form is required to obtain a benefit. The inf ormation c ollected be comes pa rt of the P rivacy A ct s ystem of re cords; D OT/FAA 830, R epresentatives of the Administrator; and confidentiality pursuant to the provisions of the P rivacy A ct is g ranted. Please note tha t a n a gency m ay no t c onduct or sponsor, and a person is not r equired to r espond to, a collection of information unless it dis plays a c urrently valid OMB control number. The OMB control number associated with this collection is 2120-0033. 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. Detach all supplemental information and instruction sheets before submitting application. DESIGNEE/EXAMINER CANDIDATE APPLICATION PROCEDURES HOW TO APPLY For Initial Designations: 1. Complete, sign, and date this application. Complete all applicable blocks fully. Use additional sheets of blank paper if you need more space to complete the answers to a block. Be sure to indicate the number of the block you are answering at the top of the blank sheet. 2. Use a separate sheet for each block requiring additional space. Attach all additional blank sheets to this application. 3. Block 7. See definitions and qualification criteria on page ii of these instructions. 4. Applicants for DAR-T designations must attach a letter of recommendation in accordance with FAA Order 8100.8 latest revision, Designee Management Handbook. WHERE TO SEND APPLICATION FOR INITIAL DESIGNATION (DME, DPRE, and DAR-T applicants ONLY.) ODAR-T applicants will submit this form to the local FSDO or IFO. 1. Your completed application with all attached sheets should be sent to: Federal Aviation Administration Designee Standardization Branch, AFS-640 ATTN: National Examiner Board P.O. Box 25082 Oklahoma City, OK 73125-0082 2. Keep a copy of this application for your personal records. WHAT HAPPENS TO YOUR APPLICATION Your a pplication w ill be e valuated by the Na tional Ex aminer Boa rd (NEB) to e nsure tha t y ou m eet the se lection criteria for the designation sought. The NEB will advise you by letter whether or not you meet the applicable criteria. If you meet this criteria, the letter from the NEB will state that your application has been accepted and instruct you to complete the examiner predesignation knowledge test. If you do not m eet the selection criteria, the NEB will advise you how the deficiency may be corrected. Do not take the predesignation knowledge test until receiving a letter of acceptance from the NEB. Applicants for designation as DAR-T's are not required to take a Predesignation Test. Upon receiving notification that your application has been accepted, take the appropriate predesignation knowledge test at any FAA computerized testing center. Request the Aviation Mechanic Examiner Test or the Parachute Rigger Examiner Test. You must forward test results to the NEB within 10 days of the date you complete the test. Keep a copy of the test report for your personal records. Upon r eceiving th e ap plicant's test rep ort with a sco re o f 8 0 p ercent o r h igher, th e NEB w ill n otify th e ap plicant o f ap proval/nonapproval f or assignment to the national examiner candidate pool. In accordance with candidates' indicated geographic availability, qualifications, and ranking within the pool, the NEB forwards candidate applications to each FSDO requesting a new designee. Your application will be kept on file in the NEB candidate pool for a period of 2 years or until you are selected for designation, whichever comes first. After 2 y ears, a pplications of a ll c andidates not s elected f or de signation w ill be de leted from the NEB pool. An applicant must re peat the application process in order to apply for reassignment to the candidate pool. FAA Form 8110-28 (1-01) Supersedes Previous Edition i NSN: 0052-00-917-0001 American LegalNet, Inc. www.FormsWorkFlow.com PRIVACY ACT STATEMENT: This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a: The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709 and 14 C.F.R. Part 6 1. The principal purpose for which the information is intended to be used is to identify and evaluate your qualifications and eligibility for the issuance of an airman certificate and/or rating. Submission of the data is mandatory, except for the Social Security Number, which is voluntary. Failure to provide all required information will result in our being unable to issue you a certificate and/or rating. The information collected on this form will be included in a Privacy Act System of Records known as DOT/FAA 847, titled "Aviation Records on Individuals" and will be subject to the routine uses published in the System of Records Notice (SORN) for DOT/FAA 847 (see www.dot.gov/privacy/privacyactnotices), including: (a) Providing basic airmen certification and qualification information to the public upon request; examples of basic information include: · The type of certificates and ratings held, limitations, date of issuance and certificate number; · The status of the airman's certificate (i.e., whether it is current or has been amended, modified, suspended or revoked for any reason); · The airman's home address, unless requested by the airman to be withheld from public disclosure per 49 U.S.C. 44703(c); · Information relating to an airman's physical status or condition used to determine statistically the validity of FAA medical standards; and the date, class, and restrictions of the latest physical · Information relating to an individual's eligibility for medical certification, requests for exemption from medical requirements, and requests for review of certificate denials. (b) Using contact information to inform airmen of meetings and seminars conducted by the FAA regarding aviatio
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