Form 8520-2 Aviation Medical Examiner Designation Application

OMB Control Number 2120-0604
Exp. 8/31/2013

AVIATION MEDICAL EXAMINER
DESIGNATION APPLICATION
PAPERWORK REDUCTION ACT STATEMENT
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to
a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act
unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this
information collection is 2120-0604. Public reporting for this collection of information is estimated to be approximately 30
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, completing and reviewing the collection of information.
All responses to this collection of information are mandatory, are collected only when the applicant wishes to become an
AME, and are solicited under the Authority of 49 U.S.C. 44702 and 14 CFR Part 183. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the
FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, AES-200.
PRIVACY ACT STATEMENT
The information on this form is solicited under the authority of 49 U.S.C. 44702 and 14 CFR Part 183.
No designation as an AME may be made unless a completed application form has been received (14 CFR 183).
This information is to permit consideration of the applicant’s qualifications and suitability to act as an AME for the FAA. It
also is used for publication of AME directories and for other statistical purposes.
The information collected on the form becomes part of the Privacy Act System of Records, DOT/FAA 822, Aviation
Medical Examiner System.
Submission of your Social Security Number (SSN) is not required by law and is voluntary. Refusal to furnish your SSN
will not result in the denial of any right or privilege provided by law. Your SSN is solicited to assist in performing the
agency’s functions under the authority of 49 U.S.C. 44702, and if supplied, will be used to query national and/or state
medical practitioner data banks to verify your medical credentials. If you refuse to supply your SSN, a substitute system
of identification will be necessary to permit the required query.
INSTRUCTIONS
1. Submit your application in duplicate to the FAA Regional Flight Surgeon (RFS) for your locality. Additional copies of
this form can be downloaded at http://feds.faa.gov. Please remember to retain a copy for your file.
2. You can find applicable Regional Flight Surgeon Office addresses at http://www.cami.jccbi.gov, if needed.
3. Retain this instruction sheet for your files since it contains the conditions of your designation.
4. Please attach to your application: copies of your medical school diploma, certificate of any postgraduate professional
training, medical specialty board certification (if any), and certification of current unrestricted valid state license(s) to
practice medicine.
GENERAL INFORMATION
The FAA uses an Aviation Medical Examiner (AME) System to conduct medical examinations of airmen and apply
medical standards prescribed in the Federal Aviation Regulations (FARs). AMEs are authorized to assess airman fitness
and to issue, defer or deny issuance of FAA medical certificates. The responsibility and trust associated with designation
as an AME may necessitate investigation to determine the applicant’s personal and professional suitability. The
information requested on this application may be used to facilitate that investigation.
Only fully licensed physicians in good standing in their communities are designated as AMEs on the basis of training and
experience, adequacy of facilities for performing the prescribed examinations, and the need for examiners in the
geographic area. Training or experience in a particular medical specialty may sometimes be required because of
particular agency needs.

FAA Form 8520-2 (5-09) Supersedes Previous Edition

NSN: 0052-00-035-9005

OMB Control Number 2120-0604
Exp. 8/31/2013

AVIATION MEDICAL EXAMINER
DESIGNATION APPLICATION
GENERAL INFORMATION (CONTINUED)
Designation as an AME authorizes the physician to perform the medical examination of commercial pilots (second-class)
and student and private pilots (third-class), and to issue, defer, or deny issuance of FAA medical certificates. Designation
as a senior AME-to examine airmen of all classes, including airline transport pilots (first-class)-usually requires 3 years
experience as an AME and additional equipment. All designations are for 1 year and, in addition to other criteria specified
in FAA Order 8520.2E as amended, renewal is contingent upon the interest of the AME, accuracy and number of
examinations performed, and compliance with AME training requirements. The FAA makes final determination relative to
the designation of the AME.
The FAA does not supply any medical equipment needed in the conduct of medical examinations except the Near and
Intermediate Vision Acuity Chart but will furnish complete examination instructions and forms. In addition to those items
normally needed for performance of a general medical examination, the equipment listed in Appendix 2 of FAA Order
8520.2E in the “Guide for Aviation Medical Examiners”, as amended, is required. (The equipment list may also be viewed
at www…..) Upon notification of your acceptance as an AME, and before final designation, you will be asked to certify that
FAA acceptable equipment has been acquired. Most of the required medical equipment may be obtained from local
medical supply companies.
CONDITIONS OF DESIGNATION AS AN AME
As conditions of designation as an AME, the designee must:
1. Become thoroughly familiar with instructions regarding evaluation and documentation of medical history. Become
familiar with instructions concerning the proper technique of medical examination of airmen. Consider the aviation
medical significance of all medical tests, laboratory reports, consultation reports, and other medical information available.
Become familiar with the provisions of 14 CFR Part 67, FAA Order 8520.2E, and the instructions in the “Guide for Aviation
Medical Examiners”. Considering all medical information available, be able to make a proper decision to issue, defer or
deny airman medical certification;
2. Abide by the rules and regulations of the FAA;
3. Personally take medical history of and perform the medical examination of applicants for airman medical certificates.
Under certain circumstances other personnel may be permitted to perform the paraprofessional portion of such
examinations, but regardless of who performs the tests, the AME is responsible for the accuracy of the findings, and this
responsibility may not be delegated;
4. Use the Airman medical Certification System (AMCS) for the recording, validation, and transmission of airman medical
certification data. Detailed information on the AMCS may b obtained by contacting the AMCS hotline at (405) 954-3238;
5. Keep current in the practice and science of changes in aerospace medicine;
6. Complete FAA-sponsored Medical Certification Standards and Procedures Training (MCSPT), Clinical Aerospace
Physiology Review for AMEs (CAPAME), and a Basic AME Seminar prior to designation and subsequently complete an
AME Seminar or other equivalent training every 3 years;
7. Assure that a member of the AME’s staff completes MCSPT before the AME is initially designated;
8. Inform the FAA of any change of address, telephone, Fax number, or e-mail address;
9. Inform the FAA of any investigation, indictment, or pending action in any local, state, or Federal Court; and
10. Inform the FAA of any action against the AME’s medical license by a State licensing board or the Drug Enforcement
Administration (DEA); or of any action to remove or restrict the AME’s medical privileges by an hospital or specialty board
or the DEA.
If at any time after designation there is discovered any error, omission, or misrepresentation or concealment of material
fact in this application this will be regarded as sufficient reason for the termination of such a designation.

FAA Form 8520-2 (5-09) Supersedes Previous Edition

NSN: 0052-00-035-9005