Part 65 - Details of IC

Part 65 Forms-Details of IC.xlsx

Certification: Mechanics, Repairman, Parachute Riggers

Part 65 - Details of IC

OMB: 2120-0022

Document [xlsx]
Download: xlsx | pdf

Overview

8610-1 Blocks
8610-2 Blocks
8610-3 Blocks

Sheet 1: 8610-1 Blocks






Differences from previous form revision? Y/N


Page Section/Block # Block Type Block Title Block Help Text Business Need
Describes the Business need for collecting this information from the public.		 8610-1 (07-10) 8610-1 (09-20) 8610-1
Non Sub
(03-25)		 Description of Differences Additional comments Block Completed By:
A=Applicant
F=FAA
O=Other		 Instructions to Applicant
i Supplemental Pages Text Table of Contents
Printing instructions
Paperwork Reduction Action Burden Statement		 None Information for applicant on the proper completion and submission of the form.
Paperwork Reduction Act (PRA) of 1995		 Y Y N No differences.
PRA Burden statement must be updated upon OMB approval of the form to reflect the expiration date issued by OMB, and the burden calculated within the Information Collection (IC) supporting statement. i.e. for this form the burden was estimated at 20 minutes per response.

Verbiage for IACRA instructions is based on information from: https://www.faa.gov/training_testing/testing/acts/		 N/A
ii Supplemental Pages Text Privacy Act Statement None 5 U.S.C. § 552(a) Privacy Act Y Y Y Revised. FAA privacy office directed a revision of the Privacy Act Statement on FAA Form 8610-1. Revisions needed to the Privacy Statement must be coordinated with the FAA's Privacy Office. N/A
iii Supplemental Pages Text Pilot's Bill of Rights Written Notification of Investigation None Public Law (PL) 112‑153, Pilot’s Bill of Rights Act (PBR) N Y N No differences. Verbiage for this page came from 8900.1, Volume 14, Chapter 1, Section 3, Figure 14-1-3B. (8900.1 CHG566) N/A
iv Supplemental Pages Text Instructions for Completing FAA Form 8610-1 None To provide applicants with guidance on how to appropriately complete the form. N Y N No differences. The instructions included in the supplemental pages are directed to the applicant. Instructions for FAA employees or Designees are provided within agency guidance. N/A GENERAL INFORMATION
• An electronic, fillable, printable version of FAA Form 8610-1 is available at www.faa.gov.
• Make all entries using permanent dark blue or black ink, or a typewriter or printer. All signatures must be original, with the name printed or typewritten below or beside the signature.
• Unless otherwise specified, enter all dates using eight-digit numeric characters, MM/DD/YYYY (e.g., 03/29/2019).
• Read all supplemental information provided with this form including the Paperwork Reduction Act Burden statement, the Privacy Act statement, the Pilot’s Bill of Rights Written Notification of Investigation, and the Instructions for Completing FAA Form 8610-1. Remove and retain the supplemental information before submitting the application.
IMPORTANT NOTE: The applicant’s signature on FAA Form 8610-1 confirms the applicant has received the Privacy Act statement and the Pilot’s Bill of Rights Written Notification of Investigation at the time application was made.
1 Form Title Text FAA Form 8610-1, Mechanic's Application for Inspection Authorization
(14 CFR Part 65)		 None The title of the Form/Information Collection approved by OMB Y Y N No differences.
N/A
1 1 Text Name (Last, First, Middle) Required to determine who the applicant is. Y Y N No differences.
A Enter your name as shown on your mechanic’s certificate. Use commas to separate names, i.e. Last, First, Middle.
1 2 Text Mechanic Certificate No.
Required to determine applicant identification and eligibility for an inspection authorization.
65.91		 Y Y N No differences.
A Enter your Mechanic Certificate number as shown on your mechanic’s certificate.
1 3 Text Mailing Address. (Number/Street/PO Box, City, State, Zip Code) Required to be able to deliver the inspection authorization to the mechanic applicant upon approval - Y Y N No differences.
A Enter your mailing address. A post office box is acceptable. If the address is outside of the U.S., include the Country.
1 4 Text Fixed Base of Operations (Address at which you may be located in person during normal working week) Required to determine eligibility.
65.91(c )(3)		 Y Y N No differences. This address could differ from the address on file with airman records. A Enter the address of your fixed base of operations at which you may be located in person during a normal work week.
1 4a Text Telephone Number (At which you may be
contacted during a normal working week)		 Required to determine eligibility.
65.91(c )(3)		 Y Y N No differences.
A Enter your telephone number at which you can be contacted during a normal work week.
1 4b Text Email Address (Enter email address or NONE) Optional entry - assists the FAA in contacting the applicant with applications issues N Y N No differences.
A Enter your email address. If you do not have an email address or choose not to provide one, enter “NONE”. Providing this information will assist the local FAA office in disseminating renewal and other information applicable to holders of an Inspection Authorization.
1 5 Checkbox Do you hold a currently effective mechanic certificate with both airframe and powerplant ratings, and have each of those ratings been
in effect for a total of at least 3 years?
Yes/No		 65.91(c)(1) Required to determine applicant eligibility IAW 65.91(c )(1) Y Y N No differences.
A Blocks 5-9. Eligibility Questions. Answer these questions regarding your eligibility for Inspection Authorization. (reference § 65.91)
1 6 Checkbox Have you been actively engaged, for at least the 2‐year period before the date of application, in maintaining certificated aircraft in
accordance with Title 14 CFR? 		§65.91(c)(2) Required to determine applicant eligibility IAW 65.91(c )(2) Y Y N No differences.
A Blocks 5-9. Eligibility Questions. Answer these questions regarding your eligibility for Inspection Authorization. (reference § 65.91)
1 7 Checkbox Do you have available to you the equipment, facilities, and inspection data necessary to properly inspect airframes, powerplants,
propellers, or any related part or appliance? 		§65.91(c)(4) Required to determine applicant eligibility IAW 65.91(c )(4) Y Y N No differences.
A Blocks 5-9. Eligibility Questions. Answer these questions regarding your eligibility for Inspection Authorization. (reference § 65.91)
1 8 Checkbox Have you attempted the Inspection Authorization written test within 90 days previous to making this application? §65.91 Required to determine applicant eligibility IAW 65.91 - last sentence:
An applicant who fails the test prescribed in paragraph (c)(5) of this section may not apply for retesting until at least 90 days after the date he failed the test.		 Y Y N No differences. Answering YES to this question would make the applicant ineligible for another testing endorsement until 90 days have passed since the applicants last IA test failure. A Blocks 5-9. Eligibility Questions. Answer these questions regarding your eligibility for Inspection Authorization. (reference § 65.91)
Block 8 – This question identifies the following situations:
• Retest Applicants – An applicant must wait 90 days after failure of the IA written/knowledge test and return to a Flight Standards office for
a newly endorsed FAA Form 8610-1. The applicant is required to submit the applicable failed Airman Knowledge Test Report (AKTR) and new endorsed FAA Form 8610-1 to the testing center prior to retesting.
• IA Recent Issuance - Applicants applying for renewal within 90 days of Inspection Authorization issuance are renewed using the recent issuance provisions of §65.93(b). In block 10, check “Recent Issuance” and enter the date your authorization was last issued.
1 9 Checkbox Have you met the minimum requirements for renewal of Inspection Authorization and documented your renewal basis in block 10.
 (FOR RENEWAL ONLY) Provides an indication from the applicant that they have met the minimum renewal requirements and completed Block 10. Y Y N No differences.
A
1 10 Text Basis For Renewal Refer to form instructions for activity recording requirements for renewal of Inspection Authorization.
Y Y N No differences.
A Block 10. BASIS FOR RENEWAL – Complete only when renewing Inspection Authorization.
An Inspection Authorization expires on March 31 of each odd-numbered year. A renewal year/period is based on April 1st of the first year through March 31st of the next year.
RECENT ISSUANCE – Check this block when you have been issued an Inspection Authorization in effect for:
• Less than 90 days before the Inspection Authorization expiration date - Do not record any renewal activity in Block 10.
• Less than 90 days before March 31st of a non-renewal year – Record your 2nd year renewal activity. Enter N/A in the 1st year activity blocks.
Renewal Activity - Reference § 65.93 for renewal activity requirements for each year.
• Enter the number of annual inspections, repairs, alterations, or progressive inspections you have performed, if your renewal will be based on one of these activities. You cannot use a mixture of activities as the basis for renewal within a renewal period because § 65.93(a) does not provide for this. Each renewal year/period must be based on the required number of either: annual inspections, major repairs/alterations, or progressive inspections specified in § 65.93.
 The FAA will review evidence of renewal activity at the time of renewal, e.g. activity sheet, log(s), etc.
• If renewal is based on attendance and completion of a refresher course, enter the FAA accepted course/seminar number, the course location/provider, number of course hours, and the date of course completion. For technical training conducted by a manufacturer, enter the course title, in place of the course/seminar number.
 The FAA will review evidence of training course attendance at the time of renewal, e.g. certificate(s) of course completion.
• If renewal is based on the passing of an oral test conducted by an FAA inspector, enter the date the test was passed.
 The FAA will review evidence of oral test results at the time of renewal, e.g. FAA letter documenting oral test completion and results.
1 10 Checkbox Recent Issuance Enter date only if the recent issuance requirements of §65.93(b) apply, refer to Block 10 Instructions. Required to assist in determining if applicant must show renewal activity.
If the IA was issued less than 90 days before March 31, then certain renewal activity does not need to be shown.
Reference 65.93(b)		 N Y N No differences.
A
1 10 Text Enter Date of Issuance Enter date only if the recent issuance requirements of §65.93(b) apply, refer to Block 10 Instructions. Required to assist in determining if applicant must show renewal activity.
If the IA was issued less than 90 days before March 31, then certain renewal activity does not need to be shown.
Reference 65.93(b)		 N Y N No differences.
A
1 10 Text Annual Insp §65.93(a)(1) Required to determine renewal eligibility based on the activities stated in 65.93. Y Y N No differences.
A
1 10 Text Major Repairs §65.93(a)(2) Required to determine renewal eligibility based on the activities stated in 65.93. Y Y N No differences.
A
1 10 Text Major Alters. §65.93(a)(2) Required to determine renewal eligibility based on the activities stated in 65.93. Y Y N No differences.
A
1 10 Text Prog. Insp. §65.93(a)(3) Required to determine renewal eligibility based on the activities stated in 65.93. Y Y N No differences.
A
1 10 Text Refresher Course §65.93(a)(4)
FAA Course/Seminar No., Location/Provider, Hours, Completion Date – Use separate sheet if needed.		 Required to determine renewal eligibility based on the activities stated in 65.93. y Y N No differences.
A
1 10 Text Oral Test §65.93(a)(5)
Enter date tested 		Required to determine renewal eligibility based on the activities stated in 65.93. N Y N No differences.
A
1 10 Text 1ST Year Renewal Period
(Apr 1st odd – Mar 31st even)		 None Required to determine renewal eligibility based on the activities stated in 65.93. Y Y N No differences.
A
1 10 Text 2ND Year Renewal Period
(Apr 1st even – Mar 31st odd)		 None Required to determine renewal eligibility based on the activities stated in 65.93. Y Y N No differences.
A
1 11 Text AIRCRAFT MAINTENANCE ACTIVITY DURING THE LAST 2 YEARS Continue activity on a separate sheet if needed. Required to determine issuance and renewal eligibility based on 65.91(c )(2)
Have been actively engaged, for at least the 2-year period before the date he applies, in maintaining aircraft certificated and maintained in accordance with this chapter; 		Y Y N No differences.
A Block 11. AIRCRAFT MAINTENANCE ACTIVITY DURING THE LAST 2 YEARS. – Complete for renewal and initial application of Inspection Authorization.
Enter the aircraft maintenance activity showing you are actively engaged in maintaining aircraft certificated and maintained in accordance with Title 14 CFR. All applications (initial or renewal) must enter applicable information in these blocks. Attach additional sheets if necessary to record activity.
Date From. Enter your employment start date in a six-digit (MM/YYYY) numeric format.
Date To. Enter your employment end date in a six-digit (MM/YYYY) numeric format.
Facility Where Activity Performed. Enter the name of your employer and the city and state of your employment.
Description of Activity. Enter the type of work performed with the employer. Job and/or position titles are not a description of work performed.
1 11 Text DATES MM/YYYY Required to determine issuance and renewal eligibility based on 65.91(c )(2)
Have been actively engaged, for at least the 2-year period before the date he applies, in maintaining aircraft certificated and maintained in accordance with this chapter; 		Y Y N No differences.
A
1 11 Text From:
Required to determine issuance and renewal eligibility based on 65.91(c )(2)
Have been actively engaged, for at least the 2-year period before the date he applies, in maintaining aircraft certificated and maintained in accordance with this chapter; 		Y Y N No differences.
A
1 11 Text To:
Required to determine issuance and renewal eligibility based on 65.91(c )(2)
Have been actively engaged, for at least the 2-year period before the date he applies, in maintaining aircraft certificated and maintained in accordance with this chapter; 		Y Y N No differences.
A
1 11 Text FACILITY WHERE ACTIVITY PERFORMED Employer Name, City, State) Required to determine issuance and renewal eligibility based on 65.91(c )(2)
Have been actively engaged, for at least the 2-year period before the date he applies, in maintaining aircraft certificated and maintained in accordance with this chapter; 		Y Y N No differences.
A
1 11 Text DESCRIPTION OF ACTIVITY (Describe work performed, not job titles) Required to determine issuance and renewal eligibility based on 65.91(c )(2)
Have been actively engaged, for at least the 2-year period before the date he applies, in maintaining aircraft certificated and maintained in accordance with this chapter; 		Y Y N No differences.
A
1 12 Text Remarks
Required so that applicant or FAA may enter other pertinent information regarding application or renewal of an inspection authorization. Y Y N No differences.
A
F		 If needed, enter any additional information regarding your initial application or renewal in this block.
1 13 Text Applicants Certification I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to be considered as part of the basis for issuance of any FAA certificate, rating or inspection authorization to me. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies this form. I have also read and understand the Privacy Act statement that accompanies this form. The statement notifies the applicant of the information they are certifying. Y Y N No differences.
A Sign your name. Enter the date you signed the application, in the MM/DD/YYYY format.
1 13 Text Applicants Signature (Print Name and Sign) The applicants signature indicates they have read and agree to the certifying statement. Y Y N No differences.
A Sign your name. Enter the date you signed the application, in the MM/DD/YYYY format.
1 13 Text Dates (MM/DD/YYYY) Indicates date application was signed by applicant. Y Y N No differences.
A Sign your name. Enter the date you signed the application, in the MM/DD/YYYY format.
1 14 Text Record of Action
Records FAA action relative to the application Y Y N No differences.
F
1 14 Checkbox Endorsement (Expires in 30 Days) Records FAA action relative to the application Y Y N No differences.
F
1 14 Text FAA Signature (Print Name and Sign) FAA signature here indicates the FAA's endorsement to allow the applicant to test for an inspection authorization. Y Y N No differences.
F
1 14 Text Date (MM/DD/YYYY) Records the date of the FAA action was approved. Y Y N No differences.
F
1 14 Text FAA Office/Designation No.
Records the FAA office approving the action. Y Y N No differences.
F
1 14 Checkbox Issuance
Records FAA action relative to the application Y Y N No differences.
F
1 14 Checkbox Renewal
Records FAA action relative to the application Y Y N No differences.
F
1 14 Checkbox Voluntary Surrender
Records FAA action relative to the application Y Y N No differences.
F
1 14 Text FAA Signature (Print Name and Sign) Records the FAA's approval of either initial IA issuance, renewal, or a voluntary surrender of the inspection authorization. Y Y N No differences.
F
1 14 Text Date (MM/DD/YYYY) Records the date of the FAA action was approved. Y Y N No differences.
F
1 14 Text FAA Office/Designation No.
Records the FAA office approving the action. Y Y N No differences.
F

Sheet 2: 8610-2 Blocks






ARE THERE CHANGES TO THIS BLOCK FROM LAST REVISION? (Y/N)

Page Section Block Type Block Title Block Help Text Business Need
Describes the Business need for collecting this information from the public.		 8610-2 (01-23) 8610-2
(07-23)		 8610-2
(03-25 Non Sub)
Description of Differences Additional comments Block Completed By:
A=Applicant
D = Designee
F=FAA
O=Other
i Supplemental Pages Text Table of Contents
Printing instructions
IACRA instructions
Paperwork Reduction Action Burden Statement		 None Information for applicant on the proper completion and submission of the form.
Paperwork Reduction Act (PRA) of 1995		 Y Y Y
No changes
N/A
ii Supplemental Pages Text Privacy Act Statement None 5 U.S.C. § 552(a) Privacy Act Y Y N

Revisions needed to the Privacy Statement must be coordinated with the FAA's Privacy Office. N/A
iii Supplemental Pages Text Pilot's Bill of Rights Written Notification of Investigation None Public Law (PL) 112‑153, Pilot’s Bill of Rights Act (PBR) Y Y N

Verbiage for this page came from 8900.1, Volume 14, Chapter 1, Section 3, Figure 14-1-3B. (8900.1 CHG566) N/A
iv Supplemental Pages Text Instructions for Completing FAA Form 8610-2 None To provide applicants with guidance on how to appropriately complete the form. Y Y Y

The instructions included in the supplemental pages are directed to the applicant. Instructions for FAA employees or Designees are provided within agency guidance. N/A
v Supplemental Pages Text Instructions for Completing FAA Form 8610-2, continued None To provide applicants with guidance on how to appropriately complete the form. Y Y N

The instructions included in the supplemental pages are directed to the applicant. Instructions for FAA employees or Designees are provided within agency guidance. N/A
vi BLANK PAGE Text This page is intentionally left blank. None Having a blank page here will assist applicants when printing the form. If they print all pages, the pdf page 7 and 8 (i.e. the page that contain the form itself) will print double sided.
Added 03/24/2025		 N N Y



1 Form Title Text Airman Certificate and/or Rating Application – Mechanic and Parachute Rigger
(14 CFR Part 65)		 None The title of the Form/Information Collection approved by OMB Y Y N


N/A
1 Top Section Section Top Section None Section Y Y N



1 Top Section Checkbox Original Issuance None Indicates the purpose for which the applicant is making application. Y Y N

Original Issuance, Added Rating, Other. Mark the appropriate box to indicate the reason application is being made. Mark “Other” if you are making application due to a change of
address, name, sex, citizenship, nationality, date of birth, or other change, and enter the type of change requested.		 A
1 Top Section Checkbox Added Rating None Indicates the purpose for which the applicant is making application. Y Y N


A
1 Top Section Checkbox Other None Indicates the purpose for which the applicant is making application. Y Y N


A
1 Top Section Text Other None Indicates the purpose for which the applicant is making application. Y Y N


A
1 Top Section Checkbox Mechanic
Airframe, Powerplant		 None Indicates the purpose for which the applicant is making application. Y Y N


A
1 Top Section Text Specify Rating N/A Removed on v01-23 - No need for this free text block on FAA form 8610-2, since mechanic and parachute riggers have specific check boxes for applicable ratings. N N N


N/A
1 Top Section Checkbox Parachute Rigger
Master, Senior
Seat, Back, Chest, Lap		 None Indicates the purpose for which the applicant is making application. Y Y N


A
1 I. Applicant Information Section I. Applicant Information None Section Title Y Y N



1 I. Applicant Information Text A. Name (Last, First, Middle) Provides a description of the individual to whom the certificate is issued. 49 USC 44703.
(b) Contents.-(1) An airman certificate shall-
(A) be numbered and recorded by the Administrator of the Federal Aviation Administration;
(B) contain the name, address, and description of the individual to whom the certificate is issued;
Name changes can be done iaw 65.16.		 Y Y N

49 USC 44703 requires the name address and description of the individual to who the certificate is issued.
Name changes can be done IAW § 65.16.		 A
1 I. Applicant Information
Social Security No. N/A Removed on v01-23-this has been removed from the application (2020). N N N


N/A
1 I. Applicant Information Date B. Date of Birth (MM/DD/YYYY) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Text C. Place of Birth (City and State) or (City and Country) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Text D. Height (Inches) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Text E. Weight (Pounds) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Text F. Hair color (Spell out) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Text G. Eye color (Spell out) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Checkbox H. Sex - Male, Female None Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y Y N


A
1 I. Applicant Information Checkbox I. Citizenship/ Nationality - USA, Other
Assists in FAA evaluation of eligibility for certificate IAW § 65.3, Certification of foreign airmen other than flight crewmembers.
 Y Y N


A
1 I. Applicant Information Text I. Citizenship/ Nationality - Other
§ 65.3 Certification of foreign airmen other than flight crewmembers.
A person who is neither a U.S. citizen nor a resident alien is issued a certificate under subpart D of this part, outside the United States, only when the Administrator finds that the certificate is needed for the operation or continued airworthiness of a U.S.-registered civil aircraft.		 Y Y N

Mechanic applicants (Subpart D) - FAA Guidance describes how the FAA determines when a mechanic certificate is needed. See V5 C5 S3.
 A
1 I. Applicant Information Text J1. Physical Location (Required) 49 USC 44703 (g) - including a physical location of the applicant assists in preventing the used of fictitious addresses(A), and prevent the use by an applicant of a post office box or "mail drop" as a return address to evade identification of the applicants address. Y Y N


A
1 I. Applicant Information Checkbox J1. Directions are Attached
If this box is checked it indicates the applicant acknowledges that directions to a physical location are required if there is no physical address to describe the location, and allows the applicant to acknowledge the physical location block was not inadvertently left blank. Y Y N


A
1 I. Applicant Information Text J2. Mailing Address (Will show on certificate) This is the address of the applicant that will show on the certificate It is the address the certificate will be mailed to, unless the applicant indicates a different location in the remarks block. Y Y N


A
1 I. Applicant Information Checkbox J2. Same as J1.
If this box is checked it indicates the applicant acknowledges the mailing address is the same as the physical location, and the mailing address was not inadvertently left blank. Y Y N


A
1 I. Applicant Information Checkbox K. Do you now hold or have you ever held an FAA airman certificate? - No, Yes
Assists airman registry in ensuring a single record is made for an airman. Y Y N


A
1 I. Applicant Information Text K. Yes, Certificate type and number
Assists airman registry in identifying airman records and assists in ensuring a single record is made for an airman. Y Y N


A
1 I. Applicant Information Checkbox L. Have you ever had an FAA airman certificate suspended or revoked? - No, Yes
Assists FAA in determining if the applicant is eligible for certificate issuance - §§ 65.11(c) and (d)
 Y Y N


A
1 I. Applicant Information Checkbox Do you read, write, speak, and understand the English language? - No, Yes
Assists FAA in determining if applicant is eligible for the certificate, or if certain limitations must be placed on the certificate.
§ 65.71 (mechanic)
§ 65.113(a)(2) (parachute rigger)		 Y Y N

If the applicant answers NO, the applicant may be eligible for a certificate with limitations on validity; refer to § 65.71 (mechanic), § 65.113(a)(2) (parachute rigger). A
1 I. Applicant Information Checkbox N. Drug Conviction Question - No, Yes Refer to § 65.12 and § 91.19(a) Assist FAA in determining if applicant is eligible for a certificate iaw 65.12. Y Y N

Refer to 65.12(a) and 65.12(b), and 91.19(a). A
1 I. Applicant Information Date N. Drug Conviction Question - If yes, Date of Final Conviction (MM/DD/YYYY) Assist FAA in determining if applicant is eligible for a certificate iaw 65.12. Y Y N

Refer to 65.12(a) and 65.12(b), and 91.19(a). A
1 II. Application Basis Section Application Basis Complete Section III, Record of Experience, when application is based on A, B or E (Master Rigger only) basis. This is the title of the Section. Y Y N



1 II. Application Basis Checkbox A. Mechanic-Civil Experience
Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N

Applicants may have both civil and military experience and could therefore check both block and enter appropriate additional information. A
1 II. Application Basis Checkbox B. Mechanic - Military Experience
Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N

Applicants may have both civil and military experience and could therefore check both block and enter appropriate additional information. A
1 II. Application Basis Text B1. Military Service (Branch) Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N


A
1 II. Application Basis Text B2. Military Rank/Grade
Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N


A
1 II. Application Basis Text B3. Military Specialty Code(s)
Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N


A
1 II. Application Basis Checkbox B4. JSAMTCC Curriculum completed - Airframe, Powerplant, Airframe & Powerplant
Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N


A
1 II. Application Basis Date B5. Completion Date (MM/DD/YYYY) Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N


A
1 II. Application Basis Text B6. JSAMTCC Certificate Control No.
Supports FAA evaluation of experience IAW 65.77 Experience Requirements. Y Y N


A
1 II. Application Basis Checkbox C. Mechanic- AMTS Training Course
Verifies experience eligibility IAW 65.77 Experience requirements. Y Y N


A
1 II. Application Basis Checkbox C1. Select Basis - AMTS Graduate, AMTS 65.80 applicant
Verifies experience eligibility IAW 65.77 Experience requirements. Y Y N


A
1 II. Application Basis Text C2. AMTS Certificate Number
Verifies experience eligibility IAW 65.77 Experience requirements. Y Y N


A
1 II. Application Basis Text C3. AMTS Name
Verifies experience eligibility IAW 65.77 Experience requirements. Y Y N



1 II. Application Basis Text C4. AMTS Location (City, State) Verifies experience eligibility IAW 65.77 Experience requirements. Y Y N


A
1 II. Application Basis Checkbox C5. AMTS Curriculum Graduated - Airframe, Powerplant, Airframe & Powerplant (or Curriculum enrolled if §65.80) Supports FAA evaluation of experience eligibility IAW 65.77 Experience requirements. Y Y N


A
1 II. Application Basis Date C6. Graduation Date (MM/DD/YYYY)
(Proposed Date if §65.80)		 Supports FAA evaluation of experience and eligibility for early testing IAW 65.80. Y Y N


A
1 II. Application Basis Checkbox C7. AMTS 65.80 recommendation
Supports FAA evaluation of experience and eligibility for early testing IAW 65.80. Y Y N


O
1 II. Application Basis Text C8. School Officials Signature (For § 65.80 authorization only)
(Print Name and Sign)		 Supports FAA evaluation of experience and eligibility for early testing IAW 65.80. Y Y N


O
1 II. Application Basis Date C9. Date (MM/DD/YYYY) Supports FAA evaluation of experience and eligibility for early testing IAW 65.80. Y Y N


O
1 II. Application Basis Checkbox D. FAA 65.80 test authorization
Deleted this block on v07-23. Replaced with same block in Section V. FAA Endorsement. Y N N


FD
1 II. Application Basis Date D1. Date Authorized (MM/DD/YYYY) Deleted this block on v07-23. The existing Date block in section V. FAA Endorsement is used in place of this block. Y N N


FD
1 II. Application Basis Date D2. Date Auth. Expires (MM/DD/YYYY) Deleted this block on v07-23. Replaced with same block in Section V. FAA Endorsement. Y N N


FD
1 II. Application Basis Signature D3. FAA Signature (Print Name and Sign) Deleted this block on v07-23. The existing FAA Signature block in section V. FAA Endorsement is used in place of this block. Y N N


FD
1 II. Application Basis Text D4. FAA Office/Desig. No.
Deleted this block on v07-23. The existing FAA Office/Design No. block in section V. FAA Endorsement is used in place of this block. Y N N


D
1 II. Application Basis Checkbox D. Parachute Rigger (For Master Parachute Rigger Only) Indicates application basis to support FAA evaluation of experience, to determine eligibility. Y Y N


A
1 II. Application Basis Text D1. Number of Parachutes Packed - Seat, Chest, Back, Lap. (For Master Parachute Rigger Only) Verifies experience IAW 65.115 Experience requirements. Y Y N


A
1 II. Application Basis Checkbox D2. Packed as a: Military Parachute Rigger, Senior Parachute Rigger (For Master Parachute Rigger Only) Verifies experience IAW 65.115 Experience requirements. Y Y N


A
1 III. Record of Experience Section III. Record of Experience Continue additional information on a separate sheet if necessary. This is the title of the Section. Y Y N



1 III. Record of Experience Checkbox Continue additional information on a separate sheet if necessary.
Mark this box if separate sheet attached for additional experience.
Indicates if additional experience records are attached as a separate sheet. Y Y N


A
1 III. Record of Experience Date 1. Date From (MM/YYYY) Support FAA evaluation of experience requirements applicable to certificate type. Y Y N


A
1 III. Record of Experience Date 2. Date To (MM/YYYY) Support FAA evaluation of experience requirements applicable to certificate type. Y Y N


A
1 III. Record of Experience Text 3. Employer and Location Employer Name, City, State Support FAA evaluation of experience requirements applicable to certificate type. Y Y N


A
1 III. Record of Experience Text 4. Type of Work Performed Describe work performed, not job title. Support FAA evaluation of experience requirements applicable to certificate type. Y Y N


A
1 IV. Applicants Certification Section IV. Applicants Certification None This is the title of the Section. Y Y N



1 IV. Applicants Certification Statement Text of the certifying statement - I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies this form. I have also read and understand the Privacy Act statement that accompanies this form.
The statement notifies the applicant of the information they are certifying. Y Y N

The Pilots Bill of Rights Written Notification of Investigation and the Privacy Act statement are made available to the applicant in the supplemental pages of the form. N/A
1 IV. Applicants Certification Signature Applicant's Signature (Print Name and Sign) The applicants signature indicates they have read and agree to the certifying statement. y Y N


A
1 IV. Applicants Certification Date Date (MM/DD/YYYY) Indicates date application was signed by applicant. Y Y N


A
1 V. FAA Endorsement Section V. FAA Endorsement I find this applicant meets the experience requirements of 14 CFR part 65 and is eligible to take the required tests. FAA endorsement for the statement : I find this applicant meets the experience requirements of 14 CFR part 65 and is eligible to take the required tests. Y Y N



1 II. Application Basis Checkbox § 65.80 – Special authorization to take Mechanic’s oral/practical test AMTS student applicants only Indicates FAA approval of early testing eligibility under 65.80 N Y N


FD
1 II. Application Basis Date Date § 65.80 Test Auth. Expires Must be prior to date in block C6
MM/DD/YYYY		 Indicates FAA approval early testing eligibility under 65.80 N Y N


FD



§§ 65.115 or 65.119 – Parachute Rigger test authorization.
Indicates FAA approval for parachute rigger testing eligibility. N N N

Only one block may be checked in this section by an ASI on a single application.
1 V. FAA Endorsement Signature FAA Signature (Print Name and Sign)
Y Y N

"FAA" refers to both FAA employees and FAA designees. FAA policy will state specifically which of these entities has the authority to sign this block. D
F
1 V. FAA Endorsement Date Date (MM/DD/YYYY) Indicates the date the application was signed by the FAA, thereby authorizing the applicant to take the FAA tests for the certificate being applied for. Y Y N


D
F
1 V. FAA Endorsement - for testing eligibility. Text FAA Office/Designation No.
To provide the ability to correlate the FAA person endorsing the application back to an office designator or FAA designee designation. Y Y N

This block supports entry of either the FAA employees office designator, or the designees designation number. FAA policy will state which entity if authorized to use this block and specifically what information either of these entities must place in this block. D
F
2 Applicant Information Section Applicant Information (Required if application is printed on 2 pages) When page one and two of the application are printed on separate pages (i.e. not double sided) this information allows the FAA to ensure all pages can be identified to the applicant. Y Y N



2 Applicant Information Text Name (As shown on page 1 of application) Ensures page 2 of application is identified with applicant on page 1. Y Y N



2 Applicant Information Date Date of Birth (MM/DD/YYYY) Ensures page 2 of application is identified with applicant on page 1. Y Y N



2 Applicant Information Text Certificate Number (if any) Ensures page 2 of application is identified with applicant on page 1. Y Y N



2 Results of Oral and Practical Tests Section Results of Oral and Practical Tests For FAA Use Only
Y Y N



2 Results of Oral and Practical Tests - Mechanic Checkbox Pass None Record of an applicants test results. Used to determine eligibility for certificate issuance. Y Y N


D
F
2 Results of Oral and Practical Tests - Mechanic Checkbox Fail None Record of an applicants test results. Used to determine eligibility for certificate issuance. Y Y N


D
F
2 Results of Oral and Practical Tests - Mechanic Date Expiration Date None Mechanic Test results expire after 24 months. If a certificate was not issued prior to the test expiration date, the expired tests must be retaken in order for an applicant to be eligible for certificate issuance.
65.71(a)(3) Have passed all of the prescribed tests within a period of 24 months; and		 Y Y N


D
F
2 Results of Oral and Practical Tests - Mechanic Text ACS Code None These blocks record the questions/projects failed by the applicant (by ACS code) thereby showing a record of the applicants failure to qualify for certificate issuance. Y Y N

Only failed questions/projects are entered into these blocks. D
F
2 Results of Oral and Practical Tests - Mechanic Checkbox Pass None Record of an applicants test results. Used to determine eligibility for certificate issuance. Y Y N


D
F
2 Results of Oral and Practical Tests - Parachute Rigger Checkbox Fail None Record of an applicants test results. Used to determine eligibility for certificate issuance. Y Y N


D
F
2 Results of Oral and Practical Tests - Parachute Rigger Text Parachute Seal Symbol Assigned None Record of the seal symbol provided to the parachute rigger at the time of certificate issuance. Seal symbol is used to identify who last packed the parachute. Y Y N


D
F
2 Remarks Text Remarks None Used to capture various additional information provided by either the applicant or the FAA, that cannot be captured in prescribed blocks on the application. Y Y N


D
F
2 Applicants Certification Title Applicants Certification This area is completed by the applicant at the time of issuance of the temporary airman certificate (FAA Form 8060‐4). Section Title Y Y N



2 Applicants Certification Checkbox Airman Cert Question - Yes, No
Application and certificate issuance are not typically done on the same day, therefore certain eligibility questions must be asked at the time of certificate issuance to ensure the applicant remains eligible for certificate issuance.
Previously asked in Section I. Item L. on page 1.		 Y Y N

These questions must be asked at the time of certificate issuance to determine the applicants eligibility for the certificate requested. A
2 Applicants Certification Checkbox Drug Question - Yes, No
Application and certificate issuance are not typically done on the same day, therefore certain eligibility questions must be asked at the time of certificate issuance to ensure the applicant remains eligible for certificate issuance.
Previously asked in Section I. Item N. 		Y Y N

Refer to 65.12(a) and 65.12(b) and § 91.19. A
2 Applicants Certification Date Drug question - If yes enter date of final conviction
Application and certificate issuance are not typically done on the same day, therefore certain eligibility questions must be asked at the time of certificate issuance to ensure the applicant remains eligible for certificate issuance.
Previously asked in Section I. Item N. 		Y Y N

Refer to 65.12(a) and 65.12(b) and § 91.19. A
2 Applicants Certification Statement Text of the certifying statement
The statement notifies the applicant of the information they are certifying. Y Y N


A
2 Applicants Certification Signature Applicant Signature
The applicants signature indicates they have read and agree to the certifying statement. Y Y N


A
2 Applicants Certification Date Date (MM/DD/YYYY) Date applicant acknowledged and signed the certification statement. Y Y N


A
2 FAA Examiner's Report Title FAA Examiner's Report None Section Title

N



2 FAA Examiner's Report Statement I have tested this applicant… I have tested this applicant in accordance with pertinent procedures and standards and I have indicated the result as: Indicates what the FAA examiner is basing their report on. Y Y N


D
F
2 FAA Examiner's Report - tested applicant Checkbox Result: Approved (Temporary Certificate Issued) (Temporary Certificate Issued) FAA certification results/record Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - tested applicant Checkbox Result: Approved (Temporary Certificate Not Issued) (Temporary Certificate NOT Issued) FAA certification results/record Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - tested applicant Checkbox Result: 14 CFR § 65.80 – Oral/Practical PASSED
FAA certification results/record Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - tested applicant Checkbox Result: Disapproved
FAA certification results/record Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - tested applicant Signature FAA Signature (Print Name and Sign) Signature of FAA examiner based on statement: I have tested this applicant in accordance with pertinent procedures and standards and I have indicated the result as: Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - tested applicant Date Date (MM/DD/YYYY) Date FAA signed FAA examiners report. Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - tested applicant Text FAA Office/Desig. No.
To provide the ability to correlate the FAA person endorsing the application back to an office designator or FAA designee designation. Y Y N

This block supports entry of either the FAA employees office designator, or the designees designation number. FAA policy will state which entity if authorized to use this block and specifically what information either of these entities must place in this block. D
F
2 FAA Examiner's Report - Examined applicants papers Statement I have examined this applicants papers… I have examined this applicant’s papers and I have indicated the result as: When an applicant tested but was not issued a temporary certificate (age, drug conviction, etc.) and the applicant then returns for a certificate issuance when eligible. Y Y N


D
F

FAA Examiner's Report - Examined applicants papers Checkbox Result: Approved (Temporary Certificate Issued) Temporary Certificate Issued FAA certification results/record Y Y N


D
F
2 FAA Examiner's Report - Examined applicants papers Signature FAA Signature (Print Name and Sign) Signature of FAA examiner based on statement: I have tested this applicant in accordance with pertinent procedures and standards and I have indicated the result as: Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - Examined applicants papers Date Date (MM/DD/YYYY) Date FAA signed FAA examiners report. Y Y N

Only used by FAA examiners who are conducting an actual test on an applicant. D
F
2 FAA Examiner's Report - Examined applicants papers Text FAA Office/Desig. No.
To provide the ability to correlate the FAA person endorsing the application back to an office designator or FAA designee designation. Y
N

This block supports entry of either the FAA employees office designator, or the designees designation number. FAA policy will state which entity if authorized to use this block and specifically what information either of these entities must place in this block. D
F
2 Attachments Section Title Attachments



N



2 Attachments Checkbox Knowledge Test Report(s)
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y Y N


D
F
2 Attachments Checkbox Test Planning Sheet
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y Y N


D
F
2 Attachments Checkbox Temporary Certificate
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y Y N


D
F
2 Attachments Checkbox Superseded Certificate
REMOVED N N N

See revised 8900.1 guidance. Superseded airman certs do not need to be returned to airman records. They can be destroyed (shredded or hole punched and returned to applicant). D
F
2 Attachments Checkbox Graduation/Completion Certificate
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y Y N


D
F
2 Attachments Checkbox Statement of Additional Instruction
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included.
65.19(b)		 Y Y N

Previously the statement could have been annotated under the old checkbox "letter" D
F
2 Attachments Checkbox Seal Symbol Card
Relocated on V01-23 to the Parachute Rigger "Results of oral and Practical Tests" section. N N N


D
F
2 Attachments Checkbox Other See Remarks Section Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y Y N


A
D
F
2 Applicant Identification (ID) Section Applicant Identification (ID)



N



2 Applicant Identification (ID) Text Form of ID (Government Issued Photo ID) Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y Y N

Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Text State or Country
Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y Y N

Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Text ID Number
Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y Y N

Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Date Expiration Date
Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y Y N

Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Text Telephone
Contact information for the applicant to allow contact to correct any errors on the application. Y Y N


A
D
F
2 Applicant Identification (ID) Text Email
Contact information for the applicant to allow contact to correct any errors on the application. Y Y N


A
D
F
2 FAA File Review Section FAA File Review For FAA Use Only When applications are processed by paper, individual designees (Not ODA) must send the certification file to their managing FAA office, which reviews the file and forwards to airman records. Y Y N

Used by FAA Flight Standards Offices only; not used by FAA Designees.
2 FAA File Review Signature FAA Signature (Print Name and Sign) Annotation of that an FAA FS office reviewed the paper file once received by a designee, and before sending to airman records for certificate issuance. Y Y N


F
2 FAA File Review Date Date (MM/DD/YYYY) Annotation of that an FAA FS office reviewed the paper file once received by a designee, and before sending to airman records for certificate issuance. Y Y N


F
2 FAA File Review Text FAA Office
Annotation of that an FAA FS office reviewed the paper file once received by a designee, and before sending to airman records for certificate issuance. Y Y N


F

Sheet 3: 8610-3 Blocks









Page Section Block Type Block Title Block Help Text Business Need
Describes the Business need for collecting this information from the public.		 8610-3 (09-20) 8610-3
(03-25) Non-Sub		 8610-3
MOSAIC		 Description of Differences Additional comments Block Completed By:
A=Applicant
D = Designee
F=FAA
O=Other
i Supplemental Pages Text Table of Contents
Printing instructions
Paperwork Reduction Action Burden Statement		 None Information for applicant on the proper completion and submission of the form.
Paperwork Reduction Act (PRA) of 1995		 Y Y N No changes
PRA Burden statement must be updated upon OMB approval of the form to reflect the expiration date issued by OMB, and the burden calculated within the Information Collection (IC) supporting statement. i.e. for this form the burden was estimated at 20 minutes per response.

Verbiage for IACRA instructions is based on information from: https://www.faa.gov/training_testing/testing/acts/		 N/A
ii Supplemental Pages Text Privacy Act Statement None 5 U.S.C. § 552(a) Privacy Act Y N N No changes Revisions needed to the Privacy Statement must be coordinated with the FAA's Privacy Office. N/A
iii Supplemental Pages Text Pilot's Bill of Rights Written Notification of Investigation None Public Law (PL) 112‑153, Pilot’s Bill of Rights Act (PBR) Y N N No changes Verbiage for this page came from 8900.1, Volume 14, Chapter 1, Section 3, Figure 14-1-3B. (8900.1 CHG566) N/A
iv Supplemental Pages Text Instructions for Completing FAA Form 8610-3, None To provide applicants with guidance on how to appropriately complete the form. Y Y N No changes The instructions included in the supplemental pages are directed to the applicant. Instructions for FAA employees or Designees are provided within agency guidance. N/A
v Supplemental Pages Text Instructions for Completing FAA Form 8610-3, continued None To provide applicants with guidance on how to appropriately complete the form. Y Y Y Revised: Made minor edits to form instructions for consistency with the 8610-2, to be consistent with the changes made due to MOSAIC rulemaking The instructions included in the supplemental pages are directed to the applicant. Instructions for FAA employees or Designees are provided within agency guidance. N/A
vi BLANK PAGE Text This page is intentionally left blank None Having a blank page here will assist applicants when printing the form. If they print all pages, the pdf page 7 and 8 (i.e. the page that contain the form itself) will print double sided. N Y N No changes

1 Form Title Text FAA Form 8610-3, Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65)		 None The title of the Form/Information Collection approved by OMB Y N N No changes
N/A
1 Top Section Section Top Section None Section y N N No changes

1 Top Section Checkbox Original Issuance None Indicates the purpose for which the applicant is making application. Y N Y Revised - changed the name of the certificate from "65.107 light-sport aircraft repairman" to “ 65.107 light-sport repairman” Original Issuance, Added Rating, Other. Mark the appropriate box to indicate the reason application is being made. Mark “Other” if you are making application due to a change of
address, name, sex, citizenship, nationality, date of birth, or other change, and enter the type of change requested.		 A
1 Top Section Checkbox Added Rating None Indicates the purpose for which the applicant is making application. Y N N No changes
A
1 Top Section Checkbox Other None Indicates the purpose for which the applicant is making application. Y N N No changes
A
1 Top Section Text Other None Indicates the purpose for which the applicant is making application. Y N N No changes
A
1 Top Section Checkbox § 65.101 Repairman None Indicates the purpose for which the applicant is making application. Y N N No changes
A
1 Top Section Checkbox 65.104 Experimental Aircraft Builder Repairman None Indicates the purpose for which the applicant is making application. Y N N No changes
A
1 Top Section Checkbox 65.107 Light-Sport Aircraft Repairman
Inspection Rating
Maintenance Rating		 None Indicates the purpose for which the applicant is making application. Y N N No changes
A
1 I. Applicant Information Section I. Applicant Information None Section Title Y N N No changes

1 I. Applicant Information Text A. Name (Last, First, Middle) Provides a description of the individual to whom the certificate is issued. 49 USC 44703.
(b) Contents.-(1) An airman certificate shall-
(A) be numbered and recorded by the Administrator of the Federal Aviation Administration;
(B) contain the name, address, and description of the individual to whom the certificate is issued;
Name changes can be done iaw 65.16.		 Y N N No changes 49 USC 44703 requires the name address and description of the individual to who the certificate is issued.
Name changes can be done IAW § 65.16.		 A
1 I. Applicant Information
Social Security No. N/A Removed-this has been removed from the application (2020). N N N No changes
N/A
1 I. Applicant Information Date B. Date of Birth (MM/DD/YYYY) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Text C. Place of Birth (City and State) or (City and Country) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Text D. Height (Inches) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Text E. Weight (Pounds) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Text F. Hair color (Spell out) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Text G. Eye color (Spell out) Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Checkbox H. Sex - Male, Female
Provides a description of the individual to whom the certificate is issued. 49 USC 44703. Y N N No changes
A
1 I. Applicant Information Checkbox I. Citizenship/ Nationality - USA, Other
Assists the FAA in evaluation of eligibility of a 65.104 repairman certificate.
65.104(a)(4) - experimental aircraft builder repairman must be a citizen of the United States or an individual citizen of a foreign country who has lawfully been admitted for permanent residence in the United States.		 Y N N No changes 65.3 does not apply to repairman, only to mechanics (subpart D)
A
1 I. Applicant Information Text I. Citizenship/ Nationality - Other
Assists the FAA in evaluation of eligibility of a 65.104 or 65.107 repairman certificate.
65.104(a)(4) and 65. 107(a)(1)(iv) - must be a citizen of the United States or an individual citizen of a foreign country who has lawfully been admitted for permanent residence in the United States.		 Y N N No changes 65.3 does not apply to repairman, only to mechanics (subpart D)
A
1 I. Applicant Information Text J1. Physical Location (Required) 49 USC 44703 (g) - including a physical location of the applicant assists in preventing the used of fictitious addresses(A), and prevent the use by an applicant of a post office box or "mail drop" as a return address to evade identification of the applicants address. Y N N No changes
A
1 I. Applicant Information Checkbox J1. Directions are Attached
If this box is checked it indicates the applicant acknowledges that directions to a physical location are required if there is no physical address to describe the location, and allows the applicant to acknowledge the physical location block was not inadvertently left blank. Y N N No changes
A
1 I. Applicant Information Text J2. Mailing Address (Will show on certificate) This is the address of the applicant that will show on the certificate.
It is the address the certificate will be mailed to, unless the applicant indicates a different location in the remarks block. 		Y N N No changes
A
1 I. Applicant Information Checkbox J2. Same as J1.
If this box is checked it indicates the applicant acknowledges the mailing address is the same as the physical location, and the mailing address was not inadvertently left blank. Y N N No changes
A
1 I. Applicant Information Checkbox K. Do you now hold or have you ever held an FAA airman certificate? - No, Yes
Assists airman registry in ensuring a single record is made for an airman. Y N N No changes
A
1 I. Applicant Information Text K. Yes, Certificate type and number
Assists airman registry in identifying airman records and assists in ensuring a single record is made for an airman. Y N N No changes
A
1 I. Applicant Information Checkbox L. Have you ever had an FAA airman certificate suspended or revoked? - No, Yes
Assists FAA in determining if the applicant is eligible for certificate issuance - §§ 65.11(d)(2), revocations.
 Y N N No changes 65.11(c ) does not apply to repairman (suspension) A
1 I. Applicant Information Checkbox Do you read, write, speak, and understand the English language? - No, Yes
Assists FAA in determining if applicant is eligible for the certificate, or if certain limitations must be placed on the certificate.
§ 65.101(a)(6) (repairman)
§ 65.107 (a)(1)(ii)		 Y N N No changes If the applicant answers NO, the applicant may be eligible for a certificate with limitations on validity; refer to § 65.101(a)(6) or 65.107 as applicable.
Note that 65.104 experimental aircraft builder repairman do not have an English language requirement.		 A
1 I. Applicant Information Checkbox N. Drug Conviction Question - No, Yes Refer to § 65.12 and §91.19(a). Assist FAA in determining if applicant is eligible for a certificate iaw 65.12 Y N N No changes Refer to 65.12(a) and 65.12(b) and 91.19(a). Denial of the application for a period of up to 1 year after the date of final conviction may be appropriate. A
1 I. Applicant Information Date N. Drug Conviction Question - If yes, Date of Final Conviction (MM/DD/YYYY) Assist FAA in determining if applicant is eligible for a certificate iaw 65.12 Y N N No changes Refer to 65.12(a) and 65.12(b) and 91.19(a). Denial of the application for a period of up to 1 year after the date of final conviction may be appropriate. A
1 II. Application Basis Section Application Basis
This is the title of the Section. Y N Y Revised : specific blocks in this section were revised as described below:

1 II. Application Basis Checkbox A. 65.101 REPAIRMAN
Assist applicant in completing required section of the form. Y N N No changes Often at air carriers and repair stations the employer will complete this section on behalf of the applicant. A
1 II. Application Basis Text A1. Specify Repairman Privileges/Limitations Requested
Specifies the ratings the applicant is requesting to be on the repairman certificate. Y N N No changes Often at air carriers and repair stations the employer will complete this section on behalf of the applicant. A
O
1 II. Application Basis Checkbox A2. I have attached a letter from my employer recommending me for the privileges/limitations sought, and certifying that I meet the requirements of the requested privileges/limitations.
Assists in FAA eligibility determination.
65.101(a)(4) - Be recommended for certification by his employer, to the satisfaction of the Administrator, as able to satisfactorily maintain aircraft or components, appropriate to the job for which he is employed		 Y N N No changes
A
1 II. Application Basis Checkbox B. § 65.104 EXPERIMENTAL AIRCRAFT BUILDER REPAIRMAN
Assist applicant in completing required section of the form. Y N N No changes
A
1 II. Application Basis Text B1. Make
Required in order to issue appropriate privileges and limitations to the certificate holder.
Refer to § 65.104(a)(4)(b)		 Y N N No changes
A
1 II. Application Basis Checkbox B2. Model
Required in order to issue appropriate privileges and limitations to the certificate holder.
Refer to § 65.104(a)(4)(b)		 Y N N No changes
A
1 II. Application Basis Date B3. Serial Number
Required in order to issue appropriate privileges and limitations to the certificate holder.
Refer to § 65.104(a)(4)(b)		 Y N N No changes
A
1 II. Application Basis Text B4. Certification Date
Required in order to issue appropriate privileges and limitations to the certificate holder.
Refer to § 65.104(a)(4)(b)		 Y N N No changes
A
1 II. Application Basis Checkbox C. § 65.107 LIGHT‐SPORT
AIRCRAFT REPAIRMAN
Assist applicant in completing required section of the form. Y N Y Revised - changed the name of the certificate from “§ 65.107 Light-sport Aircraft repairman” to “§ 65.107 Light-Sport Repairman”
A
1 II. Application Basis Checkbox C1. Aircraft Category:
Airplane, Rotorcraft, Glider, Lighter-than-Air, Powered-Lift, Powered parachute, Weight-shift-control.
Required to evaluate eligibility and to issue appropriate privileges and limitations.
Ref. 65.107		 Y N Y Revised:
Revised to: C1. Aircraft Category: Airplane, Rotorcraft, Glider, Lighter-than-Air, Powered lift, powered parachute, weight-shift-control
A
1 II. Application Basis Text C2. Name of Training Course Provider
Required to evaluate eligibility.
Ref. 65.107(a)		 Y N Y Revised: Previous form block was titled: C2. LSA Training Course Provider
Revised to: C2. Name of Training Provider
A
1 II. Application Basis Text C3. Course Name
Required to evaluate eligibility.
Ref. 65.107(a)		 Y N N No changes
A
1 II. Application Basis Text C4. Course Number
Required to evaluate eligibility.
Ref. 65.107(a)		 Y N N No changes
A
1 II. Application Basis Text C5. Course Completion Date
Required to evaluate eligibility.
Ref. 65.107(a)		 Y N N No changes
A
1 II. Application Basis Text C6. Course Hours
Required to evaluate eligibility.
Ref. 65.107(a)		 Y N Y Deleted: C6. Course Hours.
Unneccesary to have applicants list course hours because Inspection Rating courses are only FAA-accepted if they include 16 hours of training, and Maintenance rating courses are now accepted based on course content, not hours.
A
1 II. Application Basis Checkbox C7. N Number Inspection Rating Only Required in order to issue appropriate privileges and limitations to the certificate holder.
Refer to § 65.107(b)		 Y N N No changes
A
1 II. Application Basis Text C8. Serial Number Inspection Rating Only Required in order to issue appropriate privileges and limitations to the certificate holder.
Refer to § 65.107(b)		 Y N N No changes
A
1 III. Record of Experience Section III. Record of Experience or Training Continue additional information on a separate sheet if necessary. This is the title of the Section. y N N No changes

1 III. Record of Experience Checkbox Mark this box if separate sheet attached for additional information.
Indicates if additional experience records are attached as a separate sheet. Y N N No changes
A
1 III. Record of Experience Date 1. Date From (MM/YYYY) Support FAA evaluation of experience requirements applicable to 65.103 repairman.
65.101, Eligibility requirements.		 Y N N No changes
A
1 III. Record of Experience Date 2. Date To (MM/YYYY) Support FAA evaluation of experience requirements applicable to 65.103 repairman Y N N No changes
A
1 III. Record of Experience Text 3. Employer/Trainer Name & Location Employer Name, City, State Support FAA evaluation of experience or training requirements applicable to 65.103 repairman Y N N No changes
A
1 III. Record of Experience Text 4. Type of Work Performed/Training Received Describe work performed, not job title. Support FAA evaluation of experience or training requirements applicable to 65.103 repairman Y N N No changes
A
1 IV. Applicants Certification Section IV. Applicants Certification None This is the title of the Section. y N N No changes

1 IV. Applicants Certification Statement Text of the certifying statement - I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies this form. I have also read and understand the Privacy Act statement that accompanies this form.
The statement notifies the applicant of the information they are certifying. Y N N No changes The Pilots Bill of Rights Written Notification of Investigation and the Privacy Act statement are made available to the applicant in the supplemental pages of the form. N/A
1 IV. Applicants Certification Signature Applicant's Signature
The applicants signature indicates they have read and agree to the certifying statement. y N N No changes
A
1 IV. Applicants Certification Date Date (MM/DD/YYYY) Indicates date application was signed by applicant. Y N N No changes
A
2 Applicant Information Section Applicant Information (Required if application is printed on 2 pages) When page one and two of the application are printed on separate pages (i.e. not double sided) this information allows the FAA to ensure all pages can be identified to the applicant. Y N N No changes

2 Applicant Information Text Name (As shown on page 1 of application) Ensures page 2 of application is identified with applicant on page 1. Y N N No changes

2 Applicant Information Date Date of Birth (MM/DD/YYYY) Ensures page 2 of application is identified with applicant on page 1. Y N N No changes

2 Applicant Information Text Certificate Number (if any) Ensures page 2 of application is identified with applicant on page 1. Y N N No changes

2 Applicants Certification Title Applicants Certification This area is completed by the applicant at the time of issuance of the temporary airman certificate (FAA Form 8060‐4). Section Title Y N N No changes IMPORTANT: This second applicant certification section is required because if application is made on a different day than the date of certificate issuance, the answers to these questions may have changed, thus making the applicant ineligible for a certificate.
2 Applicants Certification Checkbox Airman Cert Question - Yes, No
Assists FAA in determining if the applicant is eligible for certificate issuance - §§ 65.11(d)(2), revocations. Y N N No changes These questions must be asked at the time of certificate issuance to determine the applicants eligibility for the certificate requested. A
2 Applicants Certification Checkbox Drug Question - Yes, No
Assist FAA in determining if applicant is eligible for a certificate iaw 65.12 Y Y N No changes Refer to 65.12(a) and 65.12(b). Denial of the application for a period of up to 1 year after the date of final conviction may be appropriate. A
2 Applicants Certification Date Drug question - If yes enter date of final conviction
Assist FAA in determining if applicant is eligible for a certificate iaw 65.12 Y N N No changes Refer to 65.12(a) and 65.12(b). Denial of the application for a period of up to 1 year after the date of final conviction may be appropriate. A
2 Applicants Certification Statement Text of the certifying statement
The statement notifies the applicant of the information they are certifying. Y N N No changes
A
2 Applicants Certification Signature Applicant Signature (Print Name and Sign) The applicants signature indicates they have read and agree to the certifying statement. Y N N No changes
A
2 Applicants Certification Date Date (MM/DD/YYYY) Date applicant acknowledged and signed the certification statement. Y N N No changes
A
2 FAA Examiner's Report Title FAA Examiner's Report None Section Title Y N N No changes

2 FAA Examiner's Report - Examined applicants papers Statement I have examined this applicants papers… I have examined this applicant’s papers and I have indicated the result as: Repairmen are not tested, therefore all certifications are based on examining documentation showing eligibility. Y N N No changes
D
F

FAA Examiner's Report - Examined applicants papers Checkbox Result: Approved (Temporary Certificate Issued) Temporary Certificate Issued FAA certification results/record Y N N No changes
D
F


Checkbox Result: Disapproved
Indicates if application was not approved. Y N N No changes Guidance: Deny the Certificate. If you disapprove the application, return it to the applicant with a letter explaining the denial. (find VCS reference)
2 FAA Examiner's Report - Examined applicants papers Signature FAA Signature (Print Name and Sign) Signature of FAA examiner based on statement: I have tested this applicant in accordance with pertinent procedures and standards and I have indicated the result as: Y N N No changes "FAA" refers to both FAA employees and FAA designees. FAA policy will state specifically which of these entities has the authority to sign this block.

POLICY OFFICE - need to ensure the guidance clearly states who can sign in this block. Currently only FAA ASI's have the authority to sign this block, and only when they meet certain other qualifications as specified in 8900.1 guidance.		 D
F
2 FAA Examiner's Report - Examined applicants papers Date Date (MM/DD/YYYY) Date FAA signed FAA examiners report. Y N N No changes
D
F
2 FAA Examiner's Report - Examined applicants papers Text FAA Office/Desig. No.
To provide the ability to correlate the FAA person endorsing the application back to an office designator or FAA designee designation. Y N N No changes This block supports entry of either the FAA employees office designator, or the designees designation number. FAA policy will state which entity if authorized to use this block and specifically what information either of these entities must place in this block.
 D
F
2 Remarks Text Remarks None Used to capture various additional information provided by either the applicant or the FAA, that cannot be captured in prescribed blocks on the application. Y N N No changes
D
F
2 Attachments Section Title Attachments


N N No changes

2 Attachments Checkbox Letter
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included - 65.101(a)(4) requires a letter from employer. Y N N No changes
D
F
2 Attachments Checkbox Temporary Certificate
Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y N N No changes
D
F
2 Attachments Checkbox Other See REMARKS section Annotation of attachments provided within the certification package to help ensure all documents supporting the certification are included. Y N N

A
D
F
2 Applicant Identification (ID) Section Applicant Identification (ID)

Y N N No changes

2 Applicant Identification (ID) Text Form of ID (Government Issued Photo ID) Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y N N No changes Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Text State or Country
Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y N N No changes Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Text ID Number
Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y N N No changes Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Date Expiration Date
Annotation area allowing the FAA to indicate what form of ID was used to verify the applicants identity. Y N N No changes Obtain this information from the applicants provided government issued identification. A
D
F
2 Applicant Identification (ID) Text Telephone Number
Contact information for the applicant to allow contact to correct any errors on the application. Y N N No changes
A
D
F
2 Applicant Identification (ID) Text Email Address
Contact information for the applicant to allow contact to correct any errors on the application. Y N N No changes
A
D
F
2 FAA File Review Section FAA File Review For FAA Use Only When applications are processed by paper, designees must send the certification file to their managing FAA office, which reviews the file and forwards to airman records. Y N N No changes Used by FAA Flight Standards Offices only; not used by FAA Designees.
2 FAA File Review Signature FAA Signature (Print Name and Sign) Annotation of that an FAA FS office reviewed the paper file once received by a designee, and before sending to airman records for certificate issuance. Y N N No changes
F
2 FAA File Review Date Date (MM/DD/YYYY) Annotation of that an FAA FS office reviewed the paper file once received by a designee, and before sending to airman records for certificate issuance. Y N N No changes
F
2 FAA File Review Text FAA Office
Annotation of that an FAA FS office reviewed the paper file once received by a designee, and before sending to airman records for certificate issuance. Y N N No changes
F
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00
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