Form Pending Request For FAA-Recognized Identification Area Designati

Request For FAA-Recognized Identification Area Designation

OMB CONTROL NUMBER: 2120-XXXX EXPIRATION DATE: mm/dd/yyyy 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-XXXX. Public reporting for this collection of information is estimated to be approximately 2 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 voluntary; the nature and extent of confidentiality to be provided, if any, will be determined). 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, 800 Independence Avenue SW, Washington, D.C. 20591.

The remote identification of unmanned aircraft systems (UAS) is necessary to ensure public safety and the safety and efficiency of the airspace of the United States. For those operators flying legacy UAS, which cannot comply with the law, community-based organizations can apply for FAA-Recognized Identification Area, which then becomes the form of identification.

Complete the application below for your establishment as an FAA-recognized identification area as described in 14 CFR part 89, Remote Identification of Unmanned Aircraft Systems. To request establishment, you must be a community-based organization recognized by the Administrator of the FAA.

1. NAME OF THE COMMUNITY-BASED ORGANIZATION

Legal Name

2. RESPONSIBLE PERSON’S INFORMATION

First Name

Last Name

Email Address

Confirm Email Address

Daytime Phone Number:

Prefix +

Area Code ( )

Number

Confirm that the responsible person identified above has the authority to act on behalf of community-based organization identified above.

Yes

No

Is this request for establishment an initial or renewal application?

Initial

Renewal

3. PHYSICAL ADDRESS OF PROPOSED AREA

Physical Address (P.O. Boxes Not Allowed)

Mailing address (if different from physical address)

Address 1

Address 1

Address 2

Address 2

City

State

Postal Code

City

State

Postal Code

Country

Country

4. GEOGRAPHIC BOUNDARIES

Coordinates depicting the geographical boundary

Altitude

Any of pertinent info:

5. PRODUCER ACKNOWLEDGEMENTS

If applicable, attach any existing letter of agreement regarding the flying site to this application.

If applicable, feel free to provide any operational data that shows annual operations and safety track record.

Attach any other additional information or documentation that would insightful for the Administrator of the FAA to make a determination.

Privacy Act Statement Privacy Act Statement (5 U.S.C. § 552a, as amended): Authority: Information on FAA Form XXX-X, Application for FAA-Recognized Identification Area is solicited under the authority of 49 U.S.C. §106(f) and 49 U.S.C. § 40101(d). Purpose: The purpose of this information is to evaluate an applicant’s request for establishment of an FAA-Recognized Identification Area where Unmanned Aircraft System (UAS) operators can fly legacy or non-compliant remote identification aircrafts. Community-based organizations can apply for this designation when it has members that are operating UASs that do not comply with the standard or limited remote identification requirements. Routine Uses: In accordance with the Privacy Act system of records notice, DOT/FAA 801, Aviation Registration Records, this information is routinely used to: (1) advise UAS operators of where operations of UAS without remote identification are permitted; (2) advise both manned and unmanned aircraft operators of where operations of UAS without remote identification are taking place; (3) inform security and law enforcement agencies of where operations of UAS without remote identification are taking place; and (4) DOT Prefatory Statement of General Routine Uses. Disclosure: Submission of this data is voluntary and will become part of the Privacy Act system of records DOT/FAA 801, Aviation Registration Records. Incomplete submission may result in delay or denial of your request.