Form FAA-8120-11 Suspected Unapproved Parts Notification

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OMB Approved 2120-0552
06/30/2009

SUSPECTED UNAPPROVED PARTS REPORT
Refer to page 2 for instructions on how to complete this form.
1. Date the Part Was Discovered:

2. Part Name:

3. Part Number:

4. Part Serial Number:

5. Quantity:

6. Assembly Name:

7. Aircraft Make & Model:

Assembly Number:
8. Name, Address, and Description of the Company or Person Who Supplied or Repaired the Part:
Name:
Street Address:
City:

State:

Country:

ZIP Code:
Phone Number:

Check One of the Following Applicable to the Company or Person Who Supplied or Repaired the Part:
Air Carrier – Certificate #
Supplier
Mechanic – Certificate #
Production Approval Holder
Repair Station – Certificate #
Manufacturer
Distributor
Owner/Operator
9. Description of the Issue:

Other
Unknown

10. Name and Address of (the Company or Person) Where the Part Was Discovered:
Name:
Street Address:
City:

State:

Country:

ZIP Code:
Phone Number:

Check One of the Following Applicable to the Company or Person Who Discovered the Part:
Air Carrier - Certificate #
FAA Inspector
Mechanic - Certificate #
DOT/Office of Inspector General
Repair Station - Certificate #
Defense Criminal Investigation Service
Distributor
Other Government Agency
Supplier
Foreign Civil Aviation Authority
Owner/Operator
Production Approval Holder
Unknown
Other
11. Date of This Report:
12.

Check this box if you request anonymity - Do not complete blocks 13-15.

13. Name and Address of the Reporter:
Name:

Street Address:

City:

State:

Country:

ZIP Code:
Phone Number:

14.

Check this box if you request confidentiality.

15.

Check this box if you have attached additional information.

FAA Form 8120-11 (10/16/2003) Supersedes Previous Edition

Local Reproduction Authorized

Instructions for Completing FAA Form 8120-11, Suspected Unapproved Parts Report
1.
2.
3.
4.
5.
6.

Record the date the part was discovered.
Record the part name (or a description of the part).
Record the part number or identification number of the part.
Record the serial number on the part, if applicable.
Record the quantity of parts.
Record the assembly name and assembly number (where the part was or could be installed).

Example:

Part Name: Strut
Part Number: PN 12345
Serial Number: 678
Assembly Name: Main Landing Gear
Assembly Number: PN 90101112

Quantity: 1

NOTE: Record additional part numbers on page 3 or a blank sheet of paper with the following column headers:
Part Name —
Part Number — Serial Number — Quantity — Assembly Name — Assembly Number
7. Record the type of aircraft the part was (or could be) installed on.
8. Record the complete name and address of the company or person who produced, repaired, and/or sold the part. Do not list
a P.O. Box address unless a street address is not available.
Check the box that describes the company or person. Provide the certificate number, if known.
Air Carrier - An FAA-certificated company or person who
undertakes directly by lease, or other arrangement, to
engage in air transportation.
Mechanic - A person holding an FAA mechanic certificate
with airframe and/or powerplant ratings.

Repair Station - An FAA-certificated repair station.
Distributor - A broker, dealer, reseller or other person or
agency engaged in the sale of parts.
Owner/Operator - The owner or operator of an aircraft.

Supplier - A company or person who furnishes aircraft parts or
related services, at any tier, to the producer of a product or part
thereof.
Production Approval Holder - A company or person holding
one of the following four types of FAA production approvals:
production certificate, approved production inspection system,
parts manufacturer approval, or technical standard order
authorization.
Manufacturer – The original equipment manufacturer (OEM.)
Other-Record other type of business.
Unknown

9. Record a brief narrative stating why you believe the part is not approved. Include a description of the part (improper
configuration, suspect marking, different material, etc.), where it was obtained, and what type of documentation was supplied
with it.
10. Record the complete name and address of the location where the part was found. Check the appropriate block to reflect the
affiliation of the company or person who discovered the part.
11. Record the date the FAA Form 8120-11 is being submitted.
12. Check this box if you request anonymity (do not wish to provide your identity), and do not complete 13 or 14.
13. Record your name, address and phone number, if desired. This information will enable the FAA to contact you for additional
information, if necessary.
14. Check this box if you request confidentiality of your personal information recorded in block 13.
15. Check this box if you have provided additional information (photos, invoices, certification statements, etc.)
Forward the completed FAA Form 8120-11, Suspected Unapproved Parts Report, to:
Federal Aviation Administration
Office of Accident Investigation, Aviation Safety Hotline, Rm 840
800 Independence Avenue, SW, Washington, DC 20591
An electronic copy of FAA Form 8120-11, Suspected Unapproved Parts Report, is available on the FAA website at
http://www.faa.gov/aircraft/safety/programs/sups. You may complete the electronic FAA Form 8120-11 and send it to
the Aviation Safety Hotline e-mail: [email protected]. The Hotline phone number is (800) 255-1111 or
(866) 835-5322.
Privacy Act and Paperwork Reduction Act Statement:
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 OMB control number for this form is 2120-0552. This information is collected by the FAA's Suspected Unapproved
Parts (SUP) Program, under the authority of 49 USC 44701. The information will be used to support SUP investigations and management
reports. Submission of this information is voluntary, with questions limited to reduce any burden on the reporter. Completion of this form is
estimated to take 30 minutes. Information collected is not available elsewhere and necessary to support the FAA’s commitment to promote
safety. Information is routinely shared with law enforcement agencies for use in civil and criminal investigations. Information developed from
this form is covered under the Privacy Act system of records DOT/FAA 852 and the routine uses of that system will apply. A reporter may
request confidentiality of personal information to the extent permitted by the Freedom of Information Act (5 USC 552) and the Privacy Act (5
USC 552a).

FAA Form 8120-11 (07/20/2007)

Supersedes Previous Edition

Local Reproduction Authorized

FAA Form 8120-11, Suspected Unapproved Parts Report
Continuation Sheet
Page ( ) of ( )
Part Name

Part Number

Serial
Number

Quantity

FAA Form 8120-11 (10/16/2003) Supersedes Previous Edition

Assembly
Name

Assembly
Number

Local Reproduction Authorized