Form 6000-10A Technical Reference Data Record

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 21200014. Public reporting for this collection of information is estimated to be approximately 1.72 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 mandatory, in accordance with 14 CFR Part 171. 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.

OMB 2120-0014
07/31/2022
TECHNICAL REFERENCE DATA RECORD (1) Location (City/State)

(4) Location Ident

(5) Facility Type

(2) Date Prepared

(3) Page No.

(6) Equipment/System Type

(7) Date Commissioned

(8) Serial No.

(9) Frequency

(11) Date of Commissioning Flight Inspection

(12) Longitude (13) Latitude

(10) Elevation (MSL)

(14) Reference Handbook/Directive (Number and Title/Subject)

(15) Reference
PAR/DOC
Number

(16)
Parameter

(17)
STD
Value

(18) Initial Tolerance
Maximum

Minimum

(21) Other Data Specified by Washington, DC, or District Offices:

FAA Form 6000-10A (12/2019) (Originally Form FAA-198)

(19)
Measured
Value

(20) Revisions
Type

Date

Initials