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This request will not be deemed valid unless Parts I and II are completed as specified. Pursuant to 49 U. See the note to the previous employer at the bottom of FAA Form A separate form must be used for each airman whose records are requested.
All entries must be completed legibly with black or dark blue ink. Enter the name and air carrier certificate number of the requesting employer. Enter the name of the Designated Employer Representative authorized to receive the released records. DER answers questions 1 through 6, and prepares copies of the required supporting documents. Enter the name of the Designated Employer Representative authorized to release the requested records. Enter the date that the requested records have been prepared and forwarded to the new employer.
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 beginning 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 Submission of the data is mandatory, except for the Social Security Number, which is voluntary. Department of the Treasury and the U. Fill out the form below to learn how our Forms Workflow solution can streamline your firm. The Name field is required. The Email Address field is required.
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PRIA Policy, Forms, & References