Privacy Act and Burden Statement

OMB Control No. 2120-0769
Expiration Date 09/30/2019
Privacy Act Statement
This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a. The authority for
collecting personally identifiable information (PII) for the ADS-B Rebate Process is contained in Section
221(a) of the FAA Modernization and Reform Act of 2012, describing the Equipage Incentive Program.
The principal purpose for which the information collected is intended to be used is to identify and
evaluate the applicant’s qualifications for the issuance of the rebate. Submission of the data is
voluntary. However, failure to provide all required information may result in the FAA being unable to
process the rebate requested. The information collected to issue a rebate is included in a Privacy Act
System of Records known as DOT/FAA 801, titled “Aviation Registration Records.” Records from this
system of records may be disclosed in accordance with the routine uses that appear in Department of
Transportation (DOT)/FAA 801, Aviation Registration Records, as published in the Federal Register at 81
Fed. Reg. 54187 August 15, 2016), also available at
https://www.transportation.gov/individuals/privacy/privacy-act-system-records-notices.
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 2120-0769.
Public reporting for this collection of information is estimated to be approximately six (6) 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 voluntary. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood
Parkway, Fort Worth, TX 76177-1524.