NSP Form T069 DR and NQT Closure Form / Extension Request

	Federal Aviation Administration National Simulator Program DR and NQT Closure Form / Extension Request (See instructions on page 2)

Return Form To: NSP Duty Officer Inbox

Sponsor Name	Enter Sponsor Name Here

Type (DR / NQT)	FAA ID	Eval Date	Sponsor DR No.	NSP DR No.	Discrepancy Description	Action Taken	Closed Date
DR or NQT	FSTD ID	Mm/dd/yyyy	Your DR No.	NSP DR no. from T002	Description from T002	Description of action taken to close	Mm/dd/yyyy
DR or NQT	FSTD ID	Mm/dd/yyyy	Your DR No.	NSP DR no. from T002	Description from T002	Description of action taken to close	Mm/dd/yyyy
DR or NQT	FSTD ID	Mm/dd/yyyy	Your DR No.	NSP DR no. from T002	Description from T002	Description of action taken to close	Mm/dd/yyyy
DR or NQT	FSTD ID	Mm/dd/yyyy	Your DR No.	NSP DR no. from T002	Description from T002	Description of action taken to close	Mm/dd/yyyy
DR or NQT	FSTD ID	Mm/dd/yyyy	Your DR No.	NSP DR no. from T002	Description from T002	Description of action taken to close	Mm/dd/yyyy

Instructions

Use to report closure of DR or NQT items

For Column: Type

Enter DR for Discrepancy or NQT for A Non-Qualified Task as indicated on your T002 Evaluation Report

For Column: FAA ID

Enter your FAA ID for your FSTD

For Column: Eval Date

Enter the date when the DR or NQT was identified during the evaluation. This is the evaluation start date

For Column: Sponsor DR No.

Enter the DR number from your own DR Log

For Column: NSP DR. No.

Enter the NSP number indicated on the T002 report for this DR/NQT

For Column: Discrepancy Description

Enter the description of the DR/NQT from the eval report

For Column: Action Taken

Enter a description of the actions taken to clear/resolve the issue

For Column: Closed Date

Enter date of closure for this DR/NQT

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NSP Form T069: 11/30/2022

OMB Control Number 2120-0680: Expiration Date 11/30/2025

Completion of this letter is voluntary. You are not required to respond or use this template unless it displays a currently valid OMB control number.