Domestic TSA Airspace Waiver Applications

TSA AIRSPACE WAIVER
APPLICATIONS
Screenshots
0MB control number 1652-0033
Exp. 12/31/2025

Transportatio
Security
Administratio

Aviation Administration
• Federal
8rln&lft& S1fetJ' to Asn.trlc1·s SUu
TSA/FAA Waiver & Airspace Access Program

&

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PRIVACY ACT NOTICE
AUTHORITY: 49 U.S C. § 114 Pub L. 108-176. PRINCIPAL PURPOSE(S): This mformabon vall be used to conduct background checks in
coru,ection wiltl flight authorizations and waivers of flight restncbons. ROUTINE USE(S)· This information may be shared wrth aircraft and airport
operators, the FBI, and the FAA or for routa,e uses identified in TSA syslem of records, DHS/TSA002, Transportation Secunty Threal Assessmen
,
Syslem.
DISCLOSURE:
Volunla.ry;
failure
to furnish
theNumber
requested
informabon
may
result tn {PPN)
delaysmay
in processing
your application
or ayour
denial or
your application.
Failure lo
furnish your
Soc,al
Secunty
(SSN)
or Passpor
t Number
result In delays
in proc es-smg
application.
Paperwork Reduction Act Burden Statemenr Through this infom,ation collecti on, TSA is galhering information about you to facilrtate your
application for a flight authorization or waiver of a flight restriction info or out of Ronald Reagan Washington National Airport (DCA) or other
applica ble flight restricted airspace. This is a mandatory collecffon of information if you wisll to obtai n a ftight aulhorization into 0< from DCA or
warvers of fight restricted airspace It is estimaled that the lotal average burden per response associated with this collection is approximately 45
minutes An agency may not conduct or sponsor. and a person is not required to respand to, a collection of information unless it displays a valid
0MB control number The control number assigned to this collecbon is 0MB 1652-0033, wflich expires 1213112025

About Waiver Processing
If you are determined lo be ellg1ble for a waiver, you
will be notified and provided with a unique waiver
a utno11zat1on. Alll\ough complete ctlmlnal history
ctlec:kS tall'Olllric•
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,;.,ountry

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"1).pllcllUon ID ...

11011912021

waiver Sliilt IOiile
no lmarmatlon provided

nuv.r End Dtna
I
lno .inl'annabon prm,ided
DASl>P lnform.Mloll

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Birth
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CountJ)I &
Number

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PHM!"IQ� DCA
Dell,'Arr

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I 10119.iZ0:21

W.IYfl' End O,I ..
I
Ina lnfonna'.lon provided

W.l'l'fl' Start Date
no ln!ormatJon pro•..tded

DCA n onnnon
FRZ lnlonni!! on

Puirpout, of
Fllgh'li'Comm•nta
_______________________________________________
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Birth
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Birth
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lw- •re UNI, pen10na an 1he manifeat pc141I
lkHntffl-«1 llefon boarding 11'19 1111rc.-aft?

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Provide .addltlanal seeul'lly meall.'llre& taken,

Saclam
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P-•■apolit Counb)! & PilliM Cert Coun-uy &
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mbH

ASO Dept.Airr & TSA
CN,chntillll

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.A'fillrr.natlon !lllllllflr IJM!l'tally .o1l pe;rJul!Y
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kn:JwD,;j and vn ul 1e1s.e Sla':emenl, Of an omtSSMlCfl of :ai lllli!lte J ract on his applcsbcft ITli3Y be
ion 1001 or T,1 UJ. U\n,1
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COde). md moy
gc� ror den I or ,,.
11)1.1
b'f i,
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raQuest or suspension Of re-.oca'IMlll
and Olil8r ll'8Bill es.

AOC l)'tedl
• Do,;.uments

uU'a•rr

l

Load Date,

IAll'eolft OoiiH1tor

TJ1lt,
Fh1N■rne
Mlddfe Name

Alrer-aftO--I

Last Name

Ofa.lCompany
heM

CflY
StataJProvlnc:e
£ID Code
Country
P,hcm,,a
:M hr Phone
Eimall

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IIIWVfl SLflblW)e
FDgM fype
:A-'leatlon Date

10,18/2021

WIiiiver Slut EMie

no lnfonnatlon

�P■ml"'1 PolnU•I
ln18nnedlllbl St01141■I
0.a1inatlon Point
Final De■llnaUonCa,

Waiver End Date
I
lno 1ntormat10n provided

11111-no

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CNIIIIUl1:HIII CO.,g,ct lnl!tHm::i.tlon

Narn,e,
S1r>Nt
City
S't!luu.-..... ,nQII<
Countrv

�coo.
Phone

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Pul')IOM 01'
I:Fligllti'Commenta

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C■IIS:l;n

FUii
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MMne

"" Sc,,;:urnty St:.,f.ernr.,nt

All'Cl"aftlype

Birth
Olla

SOCIII
Security

Regllatratlon

Gron W..liljlhi

P111,portcoumry a Pil�C rt. COilntlY a· ASO DfP/Aff a TI1A I
Number
Number
Creden I

How 1, tl"le ,1rcratt Mcure.ii Wh n r.ot opeq1Mtn,1
· the place ot od;in? (Locked hangar,
-rM wttl'I Gate uc.u, w,cwtty gua,-,d, �)

How ■re, 1he pe,aCIRII. on die IIYnffnt poalll,vet¥
ldtntfflitd btfOM bolrdln:g U. llrcral't?

Provide addlillonall McUJilty na._su� tallen, tf ■n¥.1

Afflnn;1Clon und.-r pen 'lty •11 p,9rjury

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110 In bes.I or my lFile Typeapplication/pdfFile Modified2025-02-05File Created2022-01-21