Form TBD Pilot Consent/Revocation for Air Carrier Access to Pilot

OMB CONTROL NUMBER: 2120-0607
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 2120-0607. Public reporting
for this collection of information is estimated to be approximately 10 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

INSTRUCTIONS FOR COMPLETING FAA FORM 8060-XX
PURPOSE: This form allows pilots who do not have access to the FAA Pilot Records
Database (PRD) to grant or revoke access for air carriers or operators to view the
pilot's PRD records.
Name: Enter your last name, first name and middle name as displayed on your FAA pilot certificate.
(Required)
Date of Birth: Enter your date of birth in the format MM/DD/YYYY. (Required)
FAA Pilot Certificate Number: Enter your certificate number as displayed on your FAA COMMERCIAL or
ATP pilot certificate. If you do not hold a Commercial or ATP certificate, enter the number from your Remote
Pilot Certificate. (Required)
Email Address: Enter your email address. (Optional)
Current Mailing Address, City, State, Zip Code: Enter your mailing address, city, state, and Zip code as
displayed on your FAA pilot certificate. If you need to change your address printed on your certificate, contact
the Airmen Certification Branch at 866-878-2498. Entering a different address here will not update your FAA
address on record and may delay consent or revocation being granted via the PRD. Copies of your PRD Airman
Record will be mailed to the address of record only. (Required)
Granting or Revoking Consent Statement: Select if you intend to grant consent or withdraw a previously
provided consent to air carriers/operators. If you do not make a selection, consent will not be granted or
withdrawn in the PRD for this company. (Required)
Air Carrier Name(s) and Designator(s): Enter the full name of the air carrier or operator that will be allowed to
review your PRD Airman Records. Ask the air carrier or operator what should be entered, as it may not be the
same as the commonly used company name. Also enter the FAA designator assigned to the air carrier or
operator. Ask the air carrier or operator what should be entered. You may list up to four carriers/operators. If you
require more carrier/operator entries, please submit any number of separate FAA Forms XXXX-X. (Required)
Consent Time Period: Select how long you would like your PRD Airman Records to be available for
download for each air carrier or operator. Do not make a selection if you are using this form to withdraw
consent. If left unchecked, the carrier/operator access period will be 30 days. (Optional)
Perjury Statement: Your signature below this statement declares that you understand the penalties for
making a false statement on this form.
Signature: You must sign and date the form for consent or withdrawal to be granted. Typed, printed or
electronic signature is not acceptable. (Required)

U.S. DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
PILOT CONSENT/REVOCATION FOR AIR CARRIER ACCESS TO PILOT RECORDS DATABASE
PRIVACY ACT: This information is required under the authority of Transportation Title 49 U.S.C. Section 44703 et. seq., the Privacy Act at 5 USC § 552a(b), and the Freedom of Information Act at 5 USC § 552. The principal purpose for which the information is intended to
be used is to 1) enable the agency to locate and retrieve the records that you are requesting, and 2) ensure that any applicable Privacy Act requirements for access to these records have been met. Your request cannot be processed unless the data below is complete. Submission
of the data requested on this form is voluntary, and refusal to furnish the information will not result in the denial of any right, benefit, or privilege provided by law; however, failure to provide the requested information may result in the delay of a response or the processing of
your inquiry, or a denial of your request for records. The information collected on this form will be included in a Privacy Act System of Records, which is covered by System of Records Notice (SORN) DOT/ALL 17 titled, “Freedom of Information Act and Privacy Act Case
Files” and will be subject to the routine uses published in that SORN. These routine uses allow disclosure of the information under the following circumstances: 1) to another federal agency (a) with an interest in the record in connection with a referral of a Freedom of
Information Act (FOIA) request to that agency for its views or decision on disclosure, or (b) in order to obtain advice and recommendations concerning matters on which the agency has specialized experience or particular competence that may be useful to the Department of
Transportation (DOT) in making required determinations under the FOIA.; and 2) DOT Prefatory Statement of General Routine Uses, which can be found at https://www.transportation.gov/individuals/privacy/privacy-act-system-records-notices.

Last Name (as appears on your FAA pilot certificate; required) First

Date of Birth (MM/DD/YYYY)

FAA Pilot Certificate Number (required)

Middle

Email Address (optional)

Current Mailing Address: Street Address, Apt./Suite No., PO Box/Rural Route No.

City

State

ZIP Code

I grant or revoke consent to the air carriers and/or operators listed below to access my records within the Pilot Records
Database, and I authorize the Federal Aviation Administration to record that consent or revocation in the PRD.
Check one (required):
Consent
Revoke

Air Carrier Designator(s) (required)

Air Carrier Name(s) (required)

If consenting, please check the appropriate box for length of time that air carriers(s) will have access (optional; 30 days default)
30 Days

45 Days

60 Days

Statement Under Perjury: I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person
named above, and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. Section 1001 by a fine of not more than $10,000 or by
imprisonment of not more than five years or both, and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C. 552a(i)(3)
by a fine of not more than $5,000.

Airman Signature
(Typed, printed or electronic signature is not acceptable.)
FAA Form 8060-XX MM/YY

Date