Form 1200-5 NAS Data Release Request

NAS Data Release Request

OMB Approved 2120-0668
04/30/2014

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 current valid OMB Control Number.
The OMB Control Number for this information collection is 2120-0668. Public reporting for this collection of information is estimated to be approximately 27 hours per response, including
the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory per Public Law 100-235.
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, ASP-110.

1. Business/Organization Name

3. Address

2. Business Phone Number

(Street, City, State, ZIP Code)

4. Point of Contact (POC) Name

5. Phone Number

7. Are you currently receiving NAS data?

Yes

No (If no, skip to #10)
Memorandum of Agreement
Other (Explain)

8. Indicate your authority to access NAS data:
(Attach documentation)
9. Indicate if you have an approved NCP(s) on file:
10a. Type of data you are requesting:

6. Full E-mail address

Delayed

Yes

Government contract

No If yes, list the case file number(s):

Recorded 10b. Describe the data requested: (Attach additional sheets)

11. Describe your proposed method for acquiring data: (Attach additional sheets)

12. Describe the nature of your organization/business and the purpose for this request. (Attach additional sheets)

13. Describe your sensitive data filtering process. (Attach additional sheets)

14. List any non- U.S. citizen personnel you will employ for this data request. Explain his/her duties in relation to this data request. (Attach
additional sheets)

FOR OFFICE USE ONLY: Request Date: ____/____/____
Issue Date:
(FAA FORM 1200-5) (2-02)

____/____/____
Local Reproduction Authorized

Package Date: ____/____/____
Review Date:

____/____/____
NSN: 0052-00-923-3000

If you require additional space to provide your answers, write them on a separate sheet
preceded by the item number and attach them to this request.
1. Enter the complete registered name of the business or organization that has authority for all operations.
2. Enter the phone number of the business or organization.
3. Enter the complete address of the business or organization.
4. Enter the Point of Contact (POC) w ho will have the delegated authority. If this person is the same as the
one stated in 3, indicate by entering “same as above.”
5. Enter the phone number of the POC. If this person is the same as the one stated in item 4, indicate by
entering “same as above.”
6. Enter the business or organization’s e -mail address.
7. Check the appropriate box. If the answer is “Yes,” attach a copy of the appropriate documentation.
8. Check the appropriate box.
9. Indicate whether or not you have an approved NAS Change Proposal (NCP) wi th the FAA and include
that number. If you have more than one NCP, list all NCP numbers.
10. Describe the type of data you are requesting – location, facility, exact data sought. Be as specific as
possible.
11. Describe your method for accessing NAS data. Tell w hat your equipment will do, how it will operate, the
method of filtering, and any other capabilities as required.
12. State the type of business you operate and the specific purpose for using the NAS data.
13. List, in specific detail, your filtering process and data safeguard procedures.
14. Provide the names of any non -U.S. citizen personnel you plan to employ for this data request, along with
the scope and nature of work the individual will perform.