OMB No. 2120-0663

1. Submitter Information


2. Codes

Open JASC code lookup

3. Major Equipment Identity

Open aircraft manufacturer lookup Open aircraft model lookup
Open engine manufacturer lookup Open egine model lookup
Open propeller manufacturer lookup Open propeller model lookup

4. Problem Description  (Note: Please limit your description to 1500 characters.)

Your description is 0 characters in length.

5. Specific Part or Structure Causing Difficulty

Open part name lookup Open part manufacturer lookup
Open part condition lookup


6. Component/Assembly That Includes Defective Part

Open component manufacturer lookup


7. Submitted By (This Information is used by the FAA to contact you, only if additional information about the submission is needed and then is removed.)

Paperwork Reduction Act Statement:

Per 14 CFR Part 121.703, the information on this report can be submitted on this form or in another format acceptable to the Administrator. The information collected is used to evaluate certification standards, maintenance programs, regulatory requirements. The information is required to ensure safety in air transportation. We estimate that it will take 9 minutes to complete. Use of this form is mandatory. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number associated with this collection is 2120-0663. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, AES-200.