8100-11 Organization Designation Authorization

Organization Designation Authorization-Part 183, Subpart D

8100-11

Organization Designation Authorization-Part 183, Subpart D

OMB: 2120-0704

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Organization Designation Authorization

Statement Of Completion

OMB Control Number 2120-0704

Expiration Date 09/30/2008


US Department of Transportation

Federal Aviation Administration

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.

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.

1. ODA HOLDER NAME:

2. AUTHORIZATION NUMBER:

3. PROJECT DESCRIPTION: (Include model and serial number for repairs and alterations)

4. TYPE OF PROJECT:

TC

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.

Major Repair

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.

Major Alteration

5. AIRWORTHINESS REQUIREMENTS (For major repair or major alteration only):

6. LIST OF DATA (For major repair or major alteration only):

7. CERTIFICATION: I certify that the above statements are true and that the organization has completed all necessary approvals.

Date

Name (ODA Administrator or ODA Unit Member)

Signature

FAA Form 8100-11 (06-06)


File Typeapplication/msword
File TitleForm Approved OMB-XXXX-XXXX
AuthorTaylor CTR Dahl
Last Modified ByTaylor CTR Dahl
File Modified2008-09-18
File Created2008-09-18

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