COVER SHEET
Reduced Vertical Separation Minimum (RVSM)
Information Sheet
Part 91 RVSM Letter of Authorization
NOTE: FAA Advisory Circular 91-85, Authorization of Aircraft and Operators for Flight in Reduced Vertical Separation Minimum Airspace contains information on airworthiness, continuing airworthiness, and operations programs for Reduced Vertical Separation Minimum (RVSM) operations. The AC is not mandatory and does not constitute a regulation. It describes an acceptable means, but not the only means, for authorization of aircraft and operators to conduct flight in airspace or on routes where RVSM is applied.
Attached is an information sheet package that was developed to assist operators in collecting the necessary data needed to submit an application for a part 91 Reduced Vertical Separation Minimum (RVSM) Letter of Authorization (LOA).
The package consists of three parts:
An Information Sheet to organize RVSM information
Attachment A – an instruction guide on filling in the Information Sheet
Attachment B – the RVSM Authorization Decision Matrix from FAA Order 8900.1
The information sheet in this package was developed to support the streamlined process recommended by the PARC RVSM LOA Process Enhancement Team (composed of FAA & industry representatives). The new policy is contained in revised Federal Aviation Administration (FAA) RVSM guidance material approved in January 2014. The information sheet is based upon the RVSM Authorization Decision Matrix from the FAA Order 8900.1, Volume 4, Chapter 10, Section 1, Paragraph 4-1237- C.
Not all boxes on the information sheet may be required to be filled out. Read fully Attachments A and B before attempting to fill in the information sheet. Pre-coordination with the appropriate Flight Standards District Office (FSDO) or International Field Office (IFO) is strongly encouraged.
NOTE: This package consolidates required items from various FAA and ICAO documents to aid personnel in determining the acceptability of submitted authorization requests. The package itself does not constitute regulatory guidance.
Paperwork Reduction Act Burden 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 2120-0679. Public reporting for this collection of information is estimated to be approximately 16 hours 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 required to obtain or retain a benefit by 14 CFR Part 91. 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, ASP-110.
Section I - Identifying Information
1. Servicing FSDO or IFO Information |
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Phone Number: |
2. Operator’s Name & Primary Business Address |
The operator’s official (legal) name |
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Primary Business Address and City |
State |
Zip Code |
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3. Aircraft M/M-S – (S) |
Manufacturer/Model |
Registration Number |
Serial Number |
Mode S Code |
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4. Aircraft Seating |
Number of Passenger Seats |
Number of Crew Seats |
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5. Aircraft Base of Operations |
Airport Code |
Airport Address and City |
State |
Zip Code |
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6. Alternate Mailing Address |
Mailing Address and City |
State |
Zip Code |
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7. RVSM Point of Contact |
Name: |
Title: |
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Email: |
Phone: |
8. The aircraft identified is equipped to meet all requirements for operations in RVSM airspace. This is shown by original design or alteration records that document compliance with 14 CFR Part 91, Appendix G Section 2. The Aircraft Flight Manual (AFM) and Flight Manual Supplements and supporting Manufacturer’s Operating Guides required by those documents are available to the flight crew. The aircraft, records, and documents are available for FAA inspection. NOTE: Operators should be fully cognizant with RVSM requirements, including status of all required maintenance. Prior to conducting operations in RVSM designated airspace it is necessary that the aircraft meet all applicable RVSM airworthiness. This could include, and is not limited to the altimeters, air data computers, autopilot altitude keeping device, altitude alerter, skin waviness test and more. |
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Responsible Person |
Name: |
Title: |
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Email: |
Phone: |
Section II – RVSM Information
9. Explanation for Request |
a. This request is submitted to amend an existing LOA (Authorization Group I): Previous Part 91 ID Number: (1) Change in Primary Business Address only (2) Change in Responsible Person and/or RVSM Point of Contact (3) Change in Aircraft Registration Number only (note: not a different aircraft) (4) Removal of an aircraft from an existing RVSM authorization with multiple aircraft OR b. This is a request for a new LOA based on one or more existing approved RVSM authorization element(s) (Authorization Group II) OR c. This is a request for a new LOA (Authorization Group III)
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Additional information: |
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10. RVSM Operational Policy and Procedures |
(check one): The RVSM operational policy and procedures previously accepted by the FAA have been thoroughly reviewed, and they continue to meet all requirements for RVSM operations and conform to the applicant’s additional operational requirements. OR New or revised operating procedures are included with this application |
11. Crew Training |
(check one): There have been no changes to previously trained/qualified flight crew personnel and each pilot has an adequate knowledge of RVSM requirements, policies, and procedures. OR Completed by: Date of Completion: |
Copies of Training certificate (s) or other records attached |
12. RVSM Maintenance Program |
(check one): The operator’s RVSM Maintenance Program previously approved by the FAA has been thoroughly reviewed and will continue to meet the RVSM maintenance requirements for the aircraft. Maintenance programs previously approved for specific operators containing operator specific information such as personnel names, company names, registration numbers or incompatible policies or procedures are not appropriate for use by another operator without revision and approval. NOTE: The aircraft instructions for continued airworthiness (ICAs) of a newly manufactured aircraft that has been designed to meet RVSM requirements are FAA approved and may be submitted along with acceptable operator procedures as a previously approved RVSM maintenance program. The manufacturers recommended maintenance procedures when followed without exception constitute acceptable procedures and require no further review. The aircraft may not have been modified from its original RVSM design. It is the operator’s responsibility to provide or identify and reference these documents in a clear and understandable manner. OR The operators RVSM Maintenance Program is submitted for approval with this application. |
13. Minimum Equipment List (MEL) |
(If applicable |
FAA MMEL Revision: Date: |
14. RVSM Airworthiness Date |
Date: |
TCDS/SB/STC used for RVSM Compliance: (see inst.sheet) |
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15. RVSM Equipment |
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Type of Equipment |
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RVSM Equipment Data |
If flight manual supplements are required for equipment, provide copies of the cover page, list of effective pages and a copy of the page that contains the RVSM Capability Statement. |
16. TCAS II (if equipped) |
Note: TCAS is not required for RVSM operations. However, if TCAS II is installed it must comply with TSO C-119b Version 7 or later. |
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Manufacturer |
Model/Part Number |
Version of Software installed |
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17. RVSM Height Monitoring
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RVSM Height Monitoring is Complete OR Intend to complete within 6-months of authorization, if not previously monitored |
Date of last monitoring:
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Number of flight hours since last monitoring (if monitoring date exceeds 2-years): |
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Check here if operator’s aircraft fleet meets group monitoring requirements. |
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Record of completed height monitoring attached (including fleet requirements) |
Table of contents
A. Overview
B. Instructions for completing the Information Sheet in accordance with the RVSM Decision Matrix
C. Explanation for individual items on the Information Sheet
A. Overview
Review the RVSM Decision Matrix. This document provides guidance on the three authorization groups I, II or III that assist operators and inspectors in determining the most efficient review process for the authorization application. The Matrix is found in FAA Order, 8900.1, Volume 4, Chapter 10, Section 1, Paragraph 4-1237-C, Fig. 4-88. (also Attachment B)
NOTE: Guidance has been created in order to allow for the most efficient processing of a RVSM authorization request without sacrificing operational safety. A safety inspector may rely on this guidance in issuing new or amended RVSM authorizations. Each Inspector retains the authority to conduct as much review and research with respect to any proposed RVSM-Compliant Aircraft, RVSM-Approved Maintenance Program or RVSM-operational requirements as is warranted in order to ensure safety and regulatory compliance requirements have been met. Operators are required to ensure that all RVSM documentation is current even if not required to submit it for authorization.
Review the Reduced Vertical Separation Minimum Job Aid. This document identifies core RVSM reference documents for operators and inspectors and provides a list of operator documents or exhibits that an operator should submit to support an application for RVSM authorization.
Make initial contact with the FAA office to service your request, complete the information sheet according to the instructions, collect the required documentation in support of your request, and contact the FAA office for further submission instructions.
NOTE: It is the operator's responsibility to ensure that documentation satisfies the requirements for authorization. A statement by the operator detailing any changes made to previously approved programs will assist the inspector in determining the level of review necessary for approval. The operator should submit final and complete documents. It would be inappropriate for an operator to submit documentation containing specific information for a different operator.
B. Instructions for completing the Information Sheet in accordance with the RVSM Decision Matrix
Section I – Identifying Information
Items 1 -8: Always complete Items 1 through 8
Section II - RVSM Information
Item 9:
Check Item a, b or c depending on which Authorization Group your request falls into.
Item 9-a: Check this box if the request is for an amendment to an existing LOA (RVSM Authorization Group I
Fill in the existing authorization number
Item 9-a-(1): Change in Business Address only
Review items 10 through 13 and ensure that there are no changes to these items
Ensure losing FSDO or IFO is notified in writing of change of business address
Item 9-a-(2): Change in Responsible Person and or RVSM Point of Contact only
Review items 10 through 13 and ensure that there are no changes to these elements
Ensure that the name of the new personnel are listed in boxes 7 and 8,as applicable
Item 9-a-(3): Change in Aircraft Registration Number only (not a different aircraft)
List the old and new registration number in the additional information section of item 9
Ensure the new registration number is included in item 3
Review items 10 through 13 and ensure that there are no changes to these items
Item 9-a-(4): Removal of an aircraft from and existing RVSM authorization with multiple aircraft
List the identifying information of the aircraft to be removed in the additional information section of item 9
Review items 10 through 13 and ensure that there are no changes to these items
Item 9-b: Check this box if the request is for a new LOA based on one or more existing approved RVSM authorization elements (RVSM Authorization Group II)
Determine which existing RVSM authorization elements remain unchanged.
Review items 10 through 13. Provide information as required. Ensure for those items that are changing supporting documentation is provided.
Complete items 14 through 17.
Item 9-c: Requesting a new LOA
Determine that no current authorization elements exist or a new application.
Complete all items on the information sheet.
C. Guidance for Individual Items of the Information Sheet:
1. Servicing FSDO or IFO Information |
List Contact Information for the Office that will issue the authorization Determine the appropriate office for submission and complete as required.
Also, see item 14, the Operator’s “Primary Business Address”.
Note: The Operator’s primary business address must be within the service area for the applicable area.
Ref: FAA Order 8900.1, Vol3, Ch2, Sec2, Para. 3-55 |
2. Operator’s Name and Primary Business Address
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Clearly state the name of the operator. This should be the same for all Part 91 Authorizations assigned to the operator.
Note: The primary business address must be within the service area for the applicable FSDO or IFO.
Ref: FAA
Order FAA Order 8900.1, Vol4, Ch10, Sec 1, Para. 4-1235-B |
3. Aircraft Manufacturer, Model, Registration and Serial Number |
Supply the requested information copied from the aircraft’s Standard Airworthiness Certificate. Supply the Mode S Code from the Registration Certificate. *All Applicants should provide a copy of the aircraft registration and airworthiness certificate for each aircraft.
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4. Aircraft Seating |
Provide aircraft seating information. This is not an RVSM requirement but needed for the authorization template in WebOPSS. |
5. Aircraft Base of Operations |
Submit the requested information for the Aircraft’s Base of Operations.
Ref: FAA Order 8900.1, Vol3, Ch2, Sec2, Para.3-55-A |
6. Alternate Mailing Address (if needed) |
If required provide an alternate mailing address
Ref: FAA Order 8900.1, Vol3,Ch2, Sec2, Para.3-55-B, 3-55-E(2) |
7. RVSM Point of Contact Information |
RVSM Point of Contact (POC) – This person is either the Responsible Person, or if different than the Responsible Person, a person to act as a contact person who has actual day-to-day knowledge of the RVSM-compliant aircraft operations and maintenance. If the POC is other than the Responsible Person, this person does not have authority to sign the LOA.
Ref: FAA Order 8900.1, Vol4, Ch10 Sec 1, Para. 4-1236-E |
8. RVSM Responsible Person’s information |
RVSM Responsible Person – the Operator or the Operator’s legal authority to sign the LOA. This person must be a U.S. citizen, or a person who holds a U.S. pilot certificate and who accepts responsibility for complying with the stated regulations.
Ref: FAA Order 8900.1, Vol4, Ch10 Sec 1, Para. 4-1236-E |
9. Explanation for Request |
Identify if this is a change to an existing LOA or a request for a new LOA. If this is a request for a change to an existing LOA include a copy of the current LOA.
Ref: FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 4-1237 (RVSM Decision Matrix) |
10. RVSM Operational Policy and Procedures |
Identify if the operator will use operational policy and procedures previously accepted by the FAA or New or revised operational policy and procedures are included in the application (If so attach copy) Ref: FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 4-1236 FAA AC 91-85, Para. 12d(4), App 4 and 5 |
11. Crew Training |
Identify if there have been changes to the crew or crew training or if the operator will use training evidence previously accepted by the FAA.
Provide 14 CFR part 142 training center certificates (further evaluation not required); or
Certificates documenting completion of a course of instruction on RVSM Policy and Procedures; and/or an Operator’s in house training program.
Note: The FAA, at its discretion, may evaluate a training course prior to accepting a training certificate.
Ref: FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 4-1236-B FAA AC 91-85, Para. 12d(3) |
12. RVSM Maintenance Program |
Identify if the operator is submitting an RVSM Maintenance program for approval
Ref: FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 4-1235 |
13. Minimum Equipment List (MEL) |
If operating under a MEL supply copies of applicable data.
Ref: FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 4-1236-C FAA AC 91-85 p. 12d(6) |
14. RVSM Airworthiness Date |
List the compliance date when the aircraft became RVSM compliant. Include a copy of the maintenance records to be included with your document submission
If the aircraft was manufactured RVSM compliant the date of the Airworthiness Certificate is usually the compliancy date.
If the aircraft was made RVSM compliant though a STC, and Service Bulletin or a Service Letter, the RVSM compliant date will be found in the maintenance log book. Include copies of the maintenance record return to service entry and FAA form 337s if applicable. |
15. RVSM Equipment |
Identify RVSM required components.
If flight manual supplements are required for equipment, provide copies of the cover page, list of effective pages and a copy of the page that contains the RVSM Capability Statement.
Ref: FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 1235-D-1 FAA AC 91-85, Para. 12d(2) |
16. TCAS II |
List information requested if TCAS equipped.
If you have TCAS II installed, verify that it has version 7 software, or later. Identify the processor part number, model and software version.
Ref: 14 CFR 91 Appendix G section 2 (g). FAA Order 8900.1, Vol4, Ch10 Sec1, Para. 4-1242-E, Fig. 4-87 FAA AC 91-85, Appendix 4 |
17. RVSM Height Monitoring |
Submit evidence of RVSM height monitoring or a plan for monitoring as required.
If the aircraft meets monitoring requirements through an Operator’s fleet group monitoring requirements submit evidence of all relevant height monitoring.
Ref: FAA Order 8900.1, Vol4, Ch1, Sec5, Para. 4-109-H FAA Order 8900.1, Vol4, Ch10, Sec1, Para. 4-1236-D FAA AC 91-85 p. 12h |
Figure 4-88. RVSM Decision Matrix
RVSM DECISION MATRIX |
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AUTHORIZATION GROUP I: RVSM AUTHORIZATION AMENDMENTS
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I. |
A. Examples of Requested Action / Nature of Change |
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B. Applicable Steps and Information Required from RVSM Authorization Holder |
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C. Applicable Procedures to be Followed by the Appropriate FSDO, CHDO, or IFO |
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AUTHORIZATION GROUP II: RVSM AUTHORIZATION BASED ON ONE OR MORE EXISTING APPROVED RVSM AUTHORIZATION ELEMENTS
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II. |
A. Examples of Requested Action/Nature of Change |
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B. Applicable Steps and Information Required from RVSM Authorization Applicant |
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C. Applicable Procedures to be Followed by the Appropriate FSDO, CHDO, or IFO |
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AUTHORIZATION GROUP III: RVSM AUTHORIZATION NOT BASED ON ONE OR MORE EXISTING RVSM AUTHORIZATION ELEMENTS
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COVER SHEET
REV 04142014
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | AVS Enterprise |
File Modified | 0000-00-00 |
File Created | 2021-01-25 |