Information Collection

Aviation Medical Examiner (AME) Applicants

IC 239810 under ICR 202002-2120-004 · OMB 2120-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0033 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AME-DMS-Registration-ApplyProcess.pdf designee.faa.gov/#/login	Instruction
AME-DMS-Registration-ApplyProcess.pdf designee.faa.gov/#/login	Instruction
14 CFR Part 183.docx 14 CFR part 183	IC Document
14 CFR Part 183.docx 14 CFR part 183	IC Document
DMS Privacy Act Statement (AGC Approved 2-13-20).docx PAS for DMS	IC Document
DMS Privacy Act Statement (AGC Approved 2-13-20).docx PAS for DMS	IC Document

IC Title:

Aviation Medical Examiner (AME) Applicants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 14 CFR 183

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction				https://designee.faa.gov/#/login	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 238

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	476	0	476
Annual IC Time Burden (Hours)	2,856	2,142	714
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
14 CFR part 183		02/05/2020
PAS for DMS		02/19/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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