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Organization Designation AuthorizationStatement Of Completion |
OMB Control Number 2120-0704Expiration Date 09/30/2008 |
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US Department of Transportation Federal Aviation Administration |
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Paperwork Reduction Act Statement: This collection of information is to document FAA determinations of compliance. The FAA uses the information to oversee the work performed by the organization. The burden associated with using this form is .5 hour. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The control number associated with this form is 2120-0704. 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, AES-200. |
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GENERAL USE OF FORM: This form documents the completion of all FAA approvals required for the indicated project or repair or alteration. Signature by the organization's representative indicates that all required substantiation data has been reviewed and the design has been found to comply with all applicable regulatory requirements. For major repairs and major alterations, this form indicates that all required data to accomplish the repair or alteration are listed here and approved. |
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1. ODA HOLDER NAME: |
2. AUTHORIZATION NUMBER: |
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3. PROJECT DESCRIPTION: (Include model and serial number for repairs and alterations) |
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4. TYPE OF PROJECT: |
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STC PMA Major Type Design Change |
The type design, substantiating data, and operating limitations are complete, and comply with all applicable regulatory requirements. Authorized ODA unit members have accomplished and documented all required approvals and inspections. All actions defined by the agreed-to Program Notification Letter have been accomplished and FAA specific findings completed. |
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The data listed here has been approved by authorized ODA unit members and found to comply with the listed airworthiness requirements. No other FAA data approvals are necessary for the repair or alteration as defined by this data. |
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5. AIRWORTHINESS REQUIREMENTS (For major repair or major alteration only): |
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6. LIST OF DATA (For major repair or major alteration only): |
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7. CERTIFICATION: I certify that the above statements are true and that the organization has completed all necessary approvals. |
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Date |
Name (ODA Administrator or ODA Unit Member) |
Signature |
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FAA Form 8100-11 (06-06) |
File Type | application/msword |
File Title | Form Approved OMB-XXXX-XXXX |
Author | Taylor CTR Dahl |
Last Modified By | Taylor CTR Dahl |
File Modified | 2008-09-18 |
File Created | 2008-09-18 |