TSA Airspace Waiver Applications International

TSAlFAA Waiver B Airspace Access Program
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PRIVACY ACT FIOTlCE

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AUTHORITY 49 J 5 C 9 1 1 1 F-s.
la?-17ti PRINCIPAL PURPOSE(S) Tnn .nfomiat cn wailb€ ddad lo candoc:
wlh fi cht aurhcrzolrons on0 ,aahsrs d fllghl resnct.:ns ROUTINE USEIS). This
infcrmadon
rnav he shorwd INiM aircraft a i d airaari ooeraton. the FBI, art! t1$ FM. IX for rwfins uses idenafled in TSA
5 y s : e ~of IBC~;CY. ChS.TSA 3 0 . ~ -rar.s:omt~on
.
~ & ~ r ' : Tnront
y
Assesmeqr Sy5te.n DISCLOSURE. VC$unlaV I.lltuf%Ic
t r n rcn me rec-estw in!orm3l~mI-ay rrr-$1.n d a a',s n omcrssrr, p u r aFp.rca(lcn 31 a Cen.31C i yc-r Jppnca2on F 2 ; ~ r zh
prnish your SSN may result in deizys in pmossing ,,ocr apwcatlon
D ~ C ~ G ~ C
cnecms
J ~ O in correcucn
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Paperwork Reduction Act Bjrcen Stacmenc Tnrc-~n:ns inl:(rnal on ccl+c.cn, TSA s ;a;Eerirq .ntcm2rmr. cut yc.. :
;
SC.tale fodr dFpiiaton for a Rtgh. a-tr-nzaion nrn o r r1.1 ~f ficn6:d 92as3n whm5!3n & a t c n ~A1con(3CA!. Tr s is a
msndatcr~cc!lr,ct~onc l ,ifcrrjt.cn i vc- wsn :a cotam a 11.gnt a~tncnzalcn lntc or hm >CA It 's es:lm;riec lhat lhe :c#sr
average h r d c n F.ur response associ:Aed wit.", this ccilection~sopprcximalnk, 6mmuies, i\i:agency m a y not conduct or
sponsor, and 8 person is nct requird LO respond to, R milcction of infonaUor; urdess It 01sFlays a valid OM6 c o n a l number.
Thc control numhar alsigned tc this co1kc:ion is OM@ ?S523033, wtich expires 0912008.

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About Waivor Processing
:fyou are determined to be eligble far a w a N ~ ryou
, '*ill be
notified and proviled with a unique waiver authorization.
Althouch comolece cnminal histor, checks take time b
ccrpl&, r e anuc.pata rrturnrg'rou ts as r3cn as rney an.
recotvN1. crov coc :nere .s nn nlr..?tlcr 01 n crrnlna, h 5t3r-l
Nonail91 the pmcess may take up to 7 d d ~ to
s comples: bul
we ern& the result$ :ode received sooner untsr t h ~ s
ex~~.dllec
precess y . 2 ~rill, ke grartM zrcv:sicnd!
a-(Fctizar!~q.b o s urcn
~
)c,r sLcrr sslcn c i 5.1 ec.. red
information on %is fcrm
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This prccess wit1 be supplemented by a fingerprint-based
criminal history chwk. ihat process is being OevdOped. A
list of
- Snceronnt sites Hill be oub!ist;ec an tNs aebsik.Thsre
k c J fec sataorscec fcr 1h1sser.lce. Tho hng6rpm:
r e s ~ i l snfll Ce revemveil by TSA a l d N ,' l c m LLe tasis 'cr
ugpwing ordenyi~g,your reuest. Thn disqualifying crimes
used in this orocsss are listed in Part 1500 of the Code of
Fsceral Rdr;urattcns ::9 C. F R. '5CO' 3nC -eprssint Ire
sane st.cCalCs B P S . ed w a'8la:lcn .1,olk2rs a1 st-xnr,

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About DASSP Flight
. . ...Alrthariation
.. .
Pracnssing

The guidence lisled below is e braad ovewiew Of the flighi
autbcrizaton applicatiun process for operations il;(O DCA.
In oanr to remve 30 aulhoraiion for DCA access f r o r
TSA an oceraicr must Sean lbe TSA DC4 aocrcved
3per?va L
bI
~I
oti
.
e t ~ an
m awvxec TSA Cliremj A
R ~ .t.~ze
C
3 i I A a~crcvw: Armed Becbrty 3 f i c ~ r : A Z C :
1 Ga4.r? :cr":~rltng

lt.efl'gh1 aLln4nzal.cn a;cllca60r. fcrn

F casi? rcsewe a.r F a s.ct rcservallcn 61 'h:sucosce.
,v.%w.Ry 'aa go" Tn s resar~nticnIF tGnuOve ~ n bme
l 9 ghl
a~.lhor~uricn
is n;rscbed

31 hnlcn krre TSA ORCE0'

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a'!prevbus waivers pchinicg to this type dfiight ooersuon
art! vaid.

2 The apprevwd Secllnry cocrolnntor, orcornoany
equr~alent,nLst fill out the ~Ilgt?! aLlhonzabw applkakcn
tam
3. The appbicaticn !am mi~stbe received no latermar; 23
hours pricr lo your departure Jme. Any agpiication mceweb
within 24 haun o i d e w f l u r ~*it! n a 06 orocessed.
J h e .3pv c ~ r i c n
rn-x be Rllec >L! corn&leiEb 'n xuer for
o7occss.ngtc bd ccnc elca nflhm 24 h c ~ r s
5 Fsssc-gsr Cw,, ana . b e a Sm.r?l OlEcer +.SO:
mancrest chs%ws ara prohlhrted wlthrn 24 hours of h e
ceoamre
bme
~.
.
6. L'nco :nn requtt:ur re-ewes I37 C rJn: abtrunzar en
aprrovd letlec
r u s t c o w n b e s~ocrfic;a:suay Sxec
rased cpralcrs (FBC) 5113 S Gnat,r(? P\~:at~cn
a: OCP,:c
notfi, rnGrr a1tne data and llme c l tne.r antcpofec arnva, a:
tn,: Wloaay FGO ~ r . 6DC,\ FBO rpsgeclhe y
7. A!l tl~chtsinrn sate'na, a rpam nrc DCA are r.an-u3y:
Any intermediato %tap~wllvoid theopentor's flight
aulhorhation. T5e Riohr 2r;Bodza:bn crocess mu91then
cogm asa~n-me a 7c.v r+q~Es(fcrdr i W slnl rewr~dlscn
r.uk hemaae Tnls u :Irasu.1 in a ne# 91crta.t?cnzal cn
request and a new 24 hGur requirement.
8. For cues:ions, please cw.lac1 (703) 563-2258
. ~ ? .

Pleaso mmplete each oiocn of requestad informat~onace
~BKIIDBYOW ~ l a m f i schedule
d
oifllght opowtcns
~sdicabnyIhe narnanf tne slad~umjslorevent ar;d tho date
($1 of you- planned apenifons
The informasan on this Form shoulZ be sutrnettadonlv once.
DOnot resubmit infcmwtion !o this site, L m q result in a
delay in processirp ygur applicatlcn. Do cct u.-+e mis fcm lo
submlt changes cr addllocs
If ycu have any qursbons concerning Vlis security
application, ploese c o n W TranspoPation Security
Adminisfmlion at 511-227-1657 or 571-227-1322,

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False statements subminedin connection with an application may be punishable under 18 U.S.C. 1001,

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Federal. Aviation
..
Administration
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Bcinglng Ssfcty

Arncrie8.1

siie;

Airspace Waiver
.....................

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([>r?iZ)
........

...

~ropor:ent

Itinerary

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Aircraft

Waiver Type: !n:eira:.ons!

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~CCIl,.slC

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Sunmltred

, ? ~ ' t h o r ! i r . t ~N8:nber
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Approved

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Marriks:
Secunty Stmt
Summary

Documer!

Conlilmdlion ?: J91:::iC:i

Proponent
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Opr-ator

Cnl.c,

Requestor

Operator

urltcd Slates

I!Jr:;!r:l

'Title:
'First Name:

Middle Name:
'L-rst Name:

sOrssnizattan/Compa~:
'Street:
'City:
'SIateiProvince!

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Zip Code:
'Counlry:

Stat15

'Phone:

,21 hr Phone
*Far:

'Email:

Itinerary
'Waiver Subtypo:
'Flught Tyoe:

'Appltcatuon Date:
D a l e Information

9/15;2Ci:S

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'Final Destination[s):

^Start Date
.End Date
...
......
.......

..-..2

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rurpose or rltgnc
-Purpose I Comments:

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-Tail Number

........
'Type

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'First Name

--

.
..........
UiddleiaLastName

....
.-...-..., . .

'Call Soon

.-...-....

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Aircraft

'Aircraft TVOB

Manifest

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:-a~rth
Date !"Birth C i l l
I

"Birth State
o r Province

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'Birth
Country

'Social
,Security No.

Security Statement

Aflirmahon
'Nsmc
"Title
ate

Under Penalty of Perlury

afi&20@8

U.S. Department of Transportatioo
~ i . 1 1 ! 0 14 J m i n s t r t ? no

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