Email from Privacy department requesting change to form 8110-12

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9-AVS-Forms-Program (FAA)
9-AWA-AIRForms (FAA); Williams, Kevin V (FAA); Loveday, Rex A (FAA)
Higginson, Kip (FAA); Houser-Jackson, Celeste A-CTR (FAA); DePaepe, Kathy (FAA); Bell, Essie (FAA)
RE: AVS ACIMS/CPN - PTA
Tuesday, September 10, 2024 2:16:23 PM

Good afternoon Kevin,

Please see email below from privacy office ask OPR to remove the Privacy Act Statement (PAS) the
FAA Form 8110-12.  Once complete, please send the package up for approval before posting. 
Thanks

Thank you J

Kim Chau
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From: Bell, Essie (FAA)
Sent: Tuesday, September 10, 2024 3:12 PM
To: 9-AVS-Forms-Program (FAA) <[email protected]>
Cc: Chau, Kim (FAA) ; Higginson, Kip (FAA) ; HouserJackson, Celeste A-CTR (FAA) ; DePaepe, Kathy (FAA)

Subject: FW: AVS ACIMS/CPN - PTA

Can someone please assist with the removal of the Privacy Act Statement (PAS) the FAA Form 811012.  It has been determined that the information collected by this form is not subject to the Privacy
Act and the PAS need to be removed.  There is a POAM assigned to this task so please remove the
PAS soonest.  Can you please let us know once this task is complete.

Thanks in advance.

Essie L. Bell
Privacy Lead
Work 202-267-6034
Cell 202-379-6826
FAA Privacy Program
DOT Privacy Program

From: Houser-Jackson, Celeste A-CTR (FAA)
Sent: Tuesday, September 10, 2024 2:28 PM
To: Higginson, Kip (FAA)
Cc: Bell, Essie (FAA)
Subject: AVS ACIMS/CPN - PTA

Kip – For your records, attached is the recently adjudicated AVS ACIMS/CPN PTA.  The
DOT CPO has assigned two privacy-related POA&Ms for AVS ACIMS/CPN.  They are:

1. 121917, AP-1 control POA&M -   Issue: ICR (Information Collection Request)
authorizing collection of information from the public does not currently specify any
means of collection of information other than FAA form 8110-12.  Requirement:
Program and AIR-600 must coordinate with FAA’s PRA (Paperwork Reduction Act)
program to evaluate whether the ICR should be revised to specify existing alternative
ways of collecting information. Timeline: 180 days. Note: Information is not to be
collected without proper PRA coverage as this could result in a violation of the PRA.

2. 121918, TR-2 control POA&M - Issue: Form 8110-12 has a Privacy Act Statement
citing DOT/FAA 801, however previously adjudicated PTA states “Information
maintained for the primary purpose of this system are retrieved by company name;
however records are about an aircraft and not an individual and SORN coverage is not
required.” Requirement: Determine if PAS applies and system is subject to PA, or
remove PAS as it is misleading. Timeline: POAM to stay open until PAS is removed.
Note: SORN coverage is not required. The program has been notified that the PAS will
need to be removed from FAA Form 8110- 12.

In conjunction with AIR-600, we urge you to contact Barbara Hall of the PRA Office soonest
to schedule a time to discuss the issues connected with the AP-1 POA&M.  The TR-2 POAM
could be resolved by contacting your Forms Officer and requesting that the PAS be removed
from form 8110-12.

Please let us know if you have questions.

Celeste A. Houser-Jackson
Privacy Analyst
Business Integra Technology Solutions, Inc.
Federal Aviation Administration, AIS 010
301-351-6549
[email protected]
[email protected]