8400-3 Application for an Airman Certificate and/or Rating

U.S. Department

of Transportation

Federal Aviation

Administration

INFORMATION FOR APPLICANT

Application For An Airman Certificate and/or Rating
Paperwork Reduction Act Statement:
The information collected on this form is necessary to determine applicant eligibility for flight
engineer or flight navigator certificates. The information is used to determine certification
eligibility. We estimated that it will take 6 minutes to complete the form. The information
collection is required to obtain a benefit. The information collected becomes part of the
Privacy Act system of records DOT/FAA 847,
Aviation Records on Individuals.
Please note that 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 associated with this collection is 2120-0007.
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.

See Privacy Act Information below.

Tear off this cover sheet before submitting this form.

FAA Form 8400-3 (1-98) Supersedes Previous Edition

Electronic Version (Adobe)

NSN: 0052-00-692-3002

Application For An Airman Certificate and/or Rating

PRIVACY ACT STATEMENT: This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a:
The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709 and 14 C.F.R. Part 6 3. The principal purpose for which the information is
intended to be used is to identify and evaluate your qualifications and eligibility for the issuance of an airman certificate and/or rating. Submission of the data is mandatory, except
for the Social Security Number, which is voluntary. Failure to provide all required information will result in our being unable to issue you a certificate and/or rating. The information collected on this form will be included in a Privacy Act System of Records known as DOT/FAA 847, titled “Aviation Records on Individuals” and will be subject to the routine uses published in the System of Records Notice (SORN) for DOT/FAA 847 (see www.dot.gov/privacy/privacyactnotices), including:
(a) Providing basic airmen certification and qualification information to the public upon request; examples of basic information include:
• The type of certificates and ratings held, limitations, date of issuance and certificate number;
• The status of the airman’s certificate (i.e., whether it is current or has been amended, modified, suspended or revoked for any reason);
• The airman’s home address, unless requested by the airman to be withheld from public disclosure per 49 U.S.C. 44703(c);
• Information relating to an airman’s physical status or condition used to determine statistically the validity of FAA medical standards; and the date, class, and restrictions of the
latest physical
• Information relating to an individual’s eligibility for medical certification, requests for exemption from medical requirements, and requests for review of certificate denials.
(b) Using contact information to inform airmen of meetings and seminars conducted by the FAA regarding aviation safety.
(c) Disclosing information to the National Transportation Safety Board (NTSB) in connection with its investigation responsibilities.
(d) Providing information about airmen to Federal, State, local and tribal law enforcement agencies when engaged in an official investigation in which an airman is involved.
(e) Providing information about enforcement actions, or orders issued thereunder, to Federal agencies, the aviation industry, and the public upon request.
(f) Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury and the U.S. Department of Justice (DOJ) for collection pursuant to 31 U.S.C. 3711(g).
(g) Making records of effective orders against the certificates of airmen available to their employers if the airmen use the affected certificates to perform job responsibilities for
those employers.
(h) Making airmen records available to users of FAA’s Safety Performance Analysis System (SPAS), including the Department of Defense Commercial Airlift Division’s Air Carrier Analysis Support System (ACAS) for its use in identifying safety hazards and risk areas, targeting inspection efforts for certificate holders of greatest risk, and monitoring the
effectiveness of targeted oversight actions.
(i) Making records of an individual’s positive drug test result, alcohol test result of 0.04 or greater breath alcohol concentration, or refusal to submit to testing required under a
DOT-required testing program, available to third parties, including current and prospective employers of such individuals. Such records also contain the names and titles of individuals who, in their commercial capacity, administer the drug and alcohol testing programs of aviation entities.
(j) Providing information about airmen through the Civil Aviation Registry’s Comprehensive Airmen Information System to the Department of Health and Human Services, Office
of Child Support Enforcement, and the Federal Parent Locator Service that locates noncustodial parents who owe child support. Records in this system are used to identify airmen
to the child support agencies nationwide in enforcing child support obligations, establishing paternity, establishing and modifying support orders and location of obligors. Records
listed within the section on Categories of Records are retrieved using Connect: Direct through the Social Security Administration’s secure environment.
(k) Making personally identifiable information about airmen available to other Federal agencies for the purpose of verifying the accuracy and completeness of medical information
provided to FAA in connection with applications for airmen medical certification.
(l) Making records of past airman medical certification history data available to Aviation Medical Examiners (AMEs) on a routine basis so that AMEs may render the best medical
certification decision.
(m) Making airman, aircraft and operator record elements available to users of FAA’s Skywatch system, including the Department of Defense (DoD), the Department of Homeland
Security (DHS), DOJ and other authorized Federal agencies, for their use in managing, tracking and reporting aviation-related security events.
(n) Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for additional uses (65 F.R. 19477-78) For example, a record from
this system of records may be disclosed to the United States Coast Guard (Coast Guard) and to the Transportation Security Administration (TSA) if information from this system
was shared with either agency when that agency was a component of the Department of Transportation (DOT) before its transfer to DHS and such disclosure is necessary to
accomplish a DOT, TSA or Coast Guard function related to this system of records.

FAA Form 8400-3 (1-98) Supersedes Previous Edition

Form Approved
OMB NO. 2120-0007
09/30/2015

U.S. Department of Transportation
Federal Aviation Administration

Application For An Airman Certificate and/or Rating

Flight Engineer
Reciprocating Engine Powered

Flight Navigator

Aircraft Dispatcher

Control Tower Operator

Reissuance of Certificate

Turbopropeller Powered

VFR Tower Rating

Turbojet

Powered

Non-Radar Approach Control
Tower Rating

Additional Rating

3. NAME OF EMPLOYER

2. TIME IN THIS AIRCRAFT

1. TYPE OF AIRCRAFT TO BE USED
4. Applicant Identification
A. NAME (First, Middle, Last)

K. PERMANENT MAILING ADDRESS
(Include Zip Code)

C. DATE OF BIRTH

B. SOCIAL SECURITY NO.

H. SEX

G. EYES

F. HAIR

D. HEIGHT

E. WEIGHT

I. NATIONALITY
TELEPHONE NO.

J. PLACE OF BIRTH
5. Certificates Held by Applicant
A.

Pilot

B. Flight Navigator

E. Ground Inspector

Airline Transport

Flight Instructor

C. Control Tower Operator

F. Aircraft Dispatcher

Commercial

Private

D. Flight Engineer

G. Mechanic

6. Applicant's Certification I certify that I meet all pertinent
requirements of the Regulations for the certificate or
rating applied for
Instructor's Recommendation
7. I consider the above applicant ready to take
the test for which he/she is applying:

Date

A. Oral Test

Applicant's Signature

C. Practical Test
Aircraft Dispatcher

or

B. Flight

D. Date

Instructor's Signature

Instructor's Certificate No. & Expiration Grade & Certificate No.
Date

E. Date

Instructor's Signature

Instructor's Certificate No. & Expiration Grade & Certificate No.
Date

8. Evaluation Record
Inspector

Oral

Examiner

Signature

Date

Practical Test
Aircraft Dispatcher
Practical Test
Control Tower Operator
Simulator Check
Aircraft Flight Check
9. Inspector's Record
Temporary Airman Certificate
Issued

INSPECTOR'S SIGNATURE

DATE
CP

Notice of Disapproval of Application Issued

REQ.

OFFICE

COM ISS

ACT

EMP

TRN M.T. DIS

Examiner's Action Accepted

FAA OFFICE
CLASS

SEX

RATING

STATE

COUNTY

Aircraft Dispatcher

IFO Mailing

Special Mailing

Correspondence

Airmail
FAA Form 8400-3 (1-98) Supersedes Previous Edition

Electronic Version (Adobe)

NSN: 0052-00-692-3002

Form Approved
OMB NO. 2120-0007
03/31/2011

10. Practical Test Report
Grading Legend (All applicable items must be graded S or U)
Explain in ''Remarks'' all items which are not graded.
S-Satisfactory, U-Unsatisfactory

Equipment Examination (Oral)
Preflight Inspection

1
2
3
4
5
6
7

Normal Operating Procedures
Abnormal Operating Procedures
Performance Data and Cruise Control
Trouble Shooting
Emergency Procedures
Forms and Records
Post Flight
Crew Coordination
Judgement

Dispatch and Assistance
Emergency Procedures
Grade
D. Control Tower Operator

VFR TOWER RATING

B. Flight Navigator

Inspector

Examiner

Item No.

Grade

Equipment (Oral)
Equipment Check
Preflight Training

1
2
3
4
5
6
7
8

11. Route of Flight Check
From

1
2
3
4
5
6

Normal Navigation Procedures
Knowledge of Navigation Methods
Co-ordination of Navigational Methods
Emergency Procedures
Co-ordination of Duties
Crew Coordination
Judgement

9
10

To

Examiner

Aircraft
Air Routes and Airports
Altimeters
Weather Analysis
Airman's Information Manual

Hours
Day

Night

The Control Tower
The Airport
The Control Zone
Notice to Airmen
Weather Facilities and Procedures
A Demonstration of Ability to Control
Air Traffic Under VFR

1

NON-RADAR APPROACH CONTROL TOWER RATING
Air Traffic Control Facilities

2

Air Navigation Facilities

3
4
5
6
7
8

Use of Airman's Information Manual
Holding Procedures
Approach Procedures
Missed Approach Facilities
Alternate Airports

9
10

Search and Rescue Procedures
A Demonstration of Ability to Control
Air Traffic Under IFR
Airport Identification

Airmans Identification (ID)

Form of ID
Number
Expiration Date

10. Remarks

FAA Form 8400-3 (1-98) Supersedes Previous Edition

Electronic Version (Adobe)

NSN: 0052-00-692-3002

Inspector

9
10
11

Item No.

7
8

C. Aircraft Dispatcher

Examiner

1
2
3
4
5
6

Item No.

Inspector

Examiner

Item No.

A. Flight Engineer

Inspector

Grade

Grade