Form Approved: OMB No. 2120-0607 08/31/2010 AIRMAN NOTICE AND RIGHT TO RECEIVE COPY � FAA RECORDS (PRIA) Pilot Records Improvement Act Of 1996 (PRIA) Title 49 U.S.C. � 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended NOTICE Title 49 U.S.C. � 44703(h)(6) requires the person receiving a records request to notify the individual who is the subject of the request within 20 days after receiving the request, and further entitles the individual the right to receive a complete copy of all FAA records furnished in response to the request within 30-days after receiving the request. Title 49 U.S.C. � 44703(h)(7) allows for a reasonable charge for the cost of processing the request and furnishing copies of the requested records. PART I: AIRMAN NOTICE AND RIGHT TO RECEIVE COPY (Airman Name � First, Middle, Last) (Airman Certificate #) (Air Carrier Name) Pursuant to 49 U.S.C. � 44703(h)(6), you are hereby notified that submitted an FAA Records Request (PRIA) dated (Air Carrier Certificate Number) (Date of Request) for your records concerning: (i) current airman medical certificate; (ii) current airman certificates indicating level, category, class, and associated type ratings, including any limitations to those certificates and ratings; and, (iii) summaries of legal enforcement actions resulting in a finding by the Administrator of a violation of Title 49 U.S.C. or a regulation prescribed or order issued under this Title that was not subsequently overturned [as provided by 49 U.S.C. � 44703(h)(1)(A)]. You are hereby notified of your right to receive a copy of any and all records furnished by the Federal Aviation Administration in response to the aforementioned records request, and that you may request a copy of such records by checking yes, signing, and dating in Part II below. Refer to the NOTICE in the attached instructions. PART II: AIRMAN REQUEST OR NON-REQUEST FOR RECORDS YES, I want a copy of the furnished records. (Signature) (Not valid unless signed and dated) NO, I do not want a copy of the furnished records. (Date) *Mailing address: (*Indicates required information. See Instructions: Part II, item 3) Telephone: FAA Form 8060-10A (10-05) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FAA FORM 8060-10A, AIRMAN NOTICE AND RIGHT TO RECEIVE COPY � FAA RECORDS (PRIA) Pilot Records Improvement Act Of 1996 (PRIA) TITLE 49 U.S.C � 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended NOTICE Request will not be deemed valid unless completed as specified below. This form may be photocopied for use. This form is available at http://www.faa.gov/pilots/lic_cert/pria/ or http://forms.faa.gov/ A separate form must be used for each airman whose records have been requested. DO NOT enter information on this form such as date of birth, social security number, or other information for which the airman may have a reasonable expectation of privacy. *Mailing address � See Part II Item 3. IMPORTANT: If the applicant receives initial notification of a records request from the hiring air carrier by being provided with a completed and signed copy of Form 8060-10A, which serves as a written notification to the airman IAW 49 U.S.C. � 44703(h)(6), further use of this form is not required. Only Form 8060-10 is to be forwarded to the FAA to request records. All applicants, regardless of whether they have indicated a preference for the receipt of a copy of their records, will be provided with a copy of their PRIA Pilot Profile Letter that is maintained by the FAA and furnished, as requested, to the hiring air carrier. The hiring air carrier maintains the original Form 8060-10A. Part I � Airman Notice and Right To Receive Copy: To be completed by the Air Carrier preparing an FAA Records Request (PRIA). All entries must be completed legibly with black or dark blue ink. 1. Airman's name and certificate number � enter the name and certificate number of the individual who is the subject of the request on FAA Form 8060-10, FAA Records Request (PRIA). 2. Air carrier name and certificate number � enter the name and certificate number of the air carrier making the request on FAA Form 8060-10, FAA Records Request (PRIA). 3. Date � enter the date of the request listed on FAA Form 8060-10, FAA Records Request (PRIA). Part II � Airman Request or Non-Request For Records: To be completed by Airman/Applicant. All entries must be completed legibly with black or dark blue ink. 1. YES or NO � check the appropriate box to indicate whether you DO or DO NOT want a copy of the records furnished. If requested, copies will be mailed to the mailing address provided. (Refer to the above NOTICE) 2. Signature and date � sign in ink using your legal signature, then enter the date of the request. 3. *Mailing address � All applicants must ensure that their mailing address, as maintained in FAA records, is complete, accurate, and current. All FAA records mailed to the applicant as the result of a PRIA request, will, for security purposes, be mailed to the address as maintained by the FAA. The applicant, however, should still enter their current mailing address in Part II for confirmation of the valid address. 4. Refer to the above NOTICE. Furnish the applicant with a completed and signed copy of Form 8060-10A, thereby providing a written confirmation that a records request will be made and a copy of FAA records will be received. PAPERWOR REDUCTION ACT ST K ATEMENT Title 49 United States Code (49 U.S.C.) � 44703(h), Records of Employment of Pilot Applicants, as amended, requires all air carriers to request FAA records and Air Carrier and Other Records concerning an individual before allowing that individual to begin service as a pilot. 49 U.S.C. � 44703(h)(8) requires the FAA Administrator to promulgate standard forms to request records. The information entered on the standard forms will be used to facilitate the search and retrieval of the required records. It is estimated that the average burden per respondent associated with this collection of FAA Records is 10 minutes. The requirement to collect and evaluate background information on the pilot, before allowing that pilot to begin service, is mandatory; however, the use of this form is not, although it is highly recommended. An agency may not conduct or sponsor, and a person is not required to respond to, this request for information unless a current and valid OMB control number is prominently displayed. The OMB control number assigned to this collection is 2