Free FAA Form 8060-11A - Federal

Form Approved:OMB No. 2120-0607 08/31/2010

AIRMAN NOTICE AND RIGHT TO RECEIVE COPY ­ AIR CARRIER AND OTHER
RECORDS (PRIA)

Pilot Records Improvement Act Of 1996 (PRIA)
Title 49 U.S.C. § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended
NOTICE Title 49 U.S.C. § 44703(h)(6) requires the person receiving a records request to notify the individual who is the subject of the request within 20 days after receiving the request, and further entitles the individual the right to receive a complete copy of all Air Carrier And Other Records furnished in response to the request within 30-days after receiving the request. Title 49 U.S.C. § 44703(h)(7) allows for a reasonable charge for the cost of processing the request and furnishing copies of the requested records. PART I: AIRMAN NOTICE AND RIGHT TO RECEIVE COPY
(Airman Name ­ First, Middle, Last) (Airman Certificate Number)

Pursuant to 49 U.S.C. § 44703(h)(6), you are hereby notified that
(Air Carrier Name)

submitted an Air Carrier And Other Records Request (PRIA) dated,
(Air Carrier Certificate Number)

for your records as required under 49 U.S.C. § 44703(h)(1)(B), as amended.
(Date)

You are hereby notified of your right to receive a copy of any and all records furnished by the Air Carrier or Person in response to the aforementioned records request, and that you may request a copy of such records by checking yes, signing, and dating in Part II below. You are also notified that an air carrier that maintains, or requests and receives, the records of an individual under 49 U.S.C. § 44703(h)(1) shall provide you with a reasonable opportunity to submit written comments to correct any inaccuracies contained in the records. (See 49 U.S.C. § 44703(h)(9)). PART II: AIRMAN REQUEST OR NON-REQUEST FOR RECORDS YES, I want a copy of the furnished records.
(Signature) (Not valid unless signed and dated)

NO, I do not want a copy of the furnished records.
(Date)

*Mailing address: (*Indicates required information. See Instructions: Part II, item 3)

Telephone:

FAA Form 8060-11A (10-05)

INSTRUCTIONS FAA FORM 8060-11A, AIRMAN NOTICE AND RIGHT TO RECEIVE COPY ­ AIR CARRIER AND OTHER RECORDS (PRIA)
Pilot Records Improvement Act Of 1996 (PRIA) Title 49 U.S.C § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended NOTICE Request will not be deemed valid unless completed as specified below. This form may be photocopied for use. This form is available at http://www.faa.gov/pilots/lic_cert/pria/ or http://forms.faa.gov/ A separate form must be used for each airman whose records are requested.

Part I ­ Airman Notice and Right To Receive Copy: To be completed by the Air Carrier or Person receiving the Air Carrier And Other Records Request (PRIA). All entries must be completed legibly with black or dark blue ink. 1. Airman's name and certificate number ­ enter the name and certificate number of the individual who is the subject of the request on FAA Form 8060-11, Air Carrier And Other Records Request (PRIA). 2. Air carrier name and certificate number ­ enter the name and certificate number of the air carrier making the request on Air Carrier And Other Records Request (PRIA). 3. Date ­ enter the date of the request listed on FAA Form 8060-11, Air Carrier And Other Records Request (PRIA).

Part II ­ Airman Request or Non-Request For Records: To be completed by Airman/Applicant. All entries must be completed legibly with black or dark blue ink. 1. YES or NO ­ check the appropriate box to indicate whether you DO or DO NOT want a copy of the records furnished. If requested, copies will be mailed to the mailing address provided. 2. Signature and date ­ sign in ink using your legal signature and enter the date. 3. *Mailing address -- This information is required to provide notice to the airman that a request for records has been received and of the airman's right to receive a copy of the records provided to the carrier 4. Return completed copy to air carrier or person. PAPERWORK REDUCTION ACT STATEMENT Title 49 United States Code (49 U.S.C.) § 44703(h), Records of Employment of Pilot Applicants, as amended, requires all air carriers to request FAA records and Air Carrier and Other Records concerning an individual before allowing that individual to begin service as a pilot. 49 U.S.C. § 44703(h)(8) requires the FAA Administrator to promulgate standard forms to request records. The information entered on the standard forms will be used to facilitate the search and retrieval of the required records. It is estimated that the average burden per respondent associated with this collection of Air Carrier and Other Records is 30 minutes. The requirement to collect and evaluate background information on the pilot, before allowing that pilot to begin service, is mandatory; however, the use of this form is not, although it is highly recommended. An agency may not conduct or sponsor, and a person is not required to respond to, this request for information unless a current and valid OMB control number is prominently displayed. The OMB control number assigned to this collection is 2120-0607. 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 .
FAA Form 8060-11A (10-05)