Form (sample) Unmanned Aircraft Remote Identification Declaration of C

Form Approved OMB No. 2120-0781

Expires: Month dd, yyyy

U.S. Department

Of Transportation Federal Aviation Administration

Information for Applicant

Unmanned Aircraft Remote Identification
DECLARATION OF COMPLIANCE

Paperwork Reduction Act Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0781. Public reporting for this collection of information is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required to obtain or retain a benefit by 14 CFR Part 89. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524.

Privacy Act Statement

This statement is provided pursuant to the Privacy Act of 1974, 5 U.S.C. sec. 552a. The authority for collecting this information on FAA Form 8130-32, Unmanned Aircraft Remote Identification Declaration of Compliance is contained in 49 U.S.C. sections 106(f), 40101, 40103, 44701(a)(5), 44805, 44809, and section 22202 of Pub. L. 114-190 as implemented by 14 CFR Part 89. The purpose of this information is to ensure that the standard remote identification unmanned aircraft or remote identification broadcast module identified on the declaration of compliance is designed and produced in accordance with an FAA-accepted Means of Compliance and complies with the applicable remote identification requirements of part 89. In accordance with the Privacy Act system this information is routinely used to (1) provide persons designing and producing standard remote identification unmanned aircraft or remote identification broadcast modules information about potential mechanical defects or unsafe conditions of their aircraft in the form of a non- compliance letter, (2) locate specific individuals or aircraft for accident investigation, violation, or safety related requirements, and (3) DOT Prefatory Statement of General Routine Uses. Submission of this data is mandatory and will become part of the Privacy Act system of records. Incomplete submission may result in delay or denial of your request.

Sample DOC Form

Unmanned Aircraft Remote Identification Declaration of Compliance [ ] Unmanned Aircraft or [ ] Broadcast Module

The remote identification of unmanned aircraft is necessary to ensure public safety and the safety and efficiency of the airspace of the United States. Once your information is officially processed, you will receive an email notification from the FAA automated mailbox, stating that we have received your Declaration of Compliance.

Please note, UAS certificated under Part 21 (in any equipped operation under this rule) must show compliance in accordance with Part 21 type certification procedures and the applicable airworthiness standards for all systems aboard the aircraft, including remote identification. Complete the application below and receive acceptance for your Declaration of Compliance to 14 CFR part 89, Remote Identification of Unmanned Aircraft. To submit a Declaration of Compliance, you must be 13 years of age or older.

1. PRODUCER INFORMATION

First Name

Last Name

OR

Company Name

Physical Address (P.O. Boxes Not Allowed)

Mailing address (if different from physical address)

Address 1

Address 1

Address 2

Address 2

City

State

Postal Code

City

State

Postal Code

Country

Country

SAMPLE 2. CONTACT INFORMATION

First Name (optional):

Last Name (optional):

Email Address

Telephone Number

Is this declaration of compliance an initial or amended declaration?

Initial

Amended

If this is an amended declaration of compliance, provide the initial DOC Tracking number assigned:

DOC #

If this is an amended declaration of compliance, is the re-submittal a result of a safety issue or a non-compliance with a prior declaration of compliance?

YES

NO

If answered yes above, please briefly explain the safety issue:

4. STANDARD REMOTE ID UNMANNED AIRCRAFT OR REMOTE ID BROADCAST MODULE(S)

Make

MOC Tracking Number(s)

Model

Serial Number(s)

FCC Identifier

5. DECLARATION OF COMPLIANCE WITH APPLICABLE REGULATIONS

Pursuant to § 89.530(b)(7) or § 89.530(c)(7), as applicable, I declare that the standard remote identification unmanned aircraft or remote identification broadcast module(s) with serial numbers listed on this Declaration of Compliance comply with all applicable requirements of 14 CFR part 89 for remote identification of unmanned aircraft, as identified in the following means of compliance: [List applicable MOC tracking number(s) used for compliance in Section 4 above].

Pursuant to § 89.515(b) or § 89.520(b), as applicable, I declare that the person responsible for the production of the standard remote identification unmanned aircraft or remote identification broadcast module listed on this Declaration of Compliance will allow the Federal Aviation Administration to inspect the facilities of the producer identified in the Declaration of Compliance, as well as any associated technical data and any produced standard remote identification unmanned aircraft or remote identification broadcast module, and to witness any tests necessary to determine compliance with part 89.

Pursuant to § 89.515(b) or § 89.520(b), as applicable, I declare that the producer listed on this Declaration of Compliance will conduct independent audits of the facilities, technical data, and any standard remote identification unmanned aircraft or remote identification broadcast modules that are produced and listed under this Declaration of Compliance on a recurring basis to ensure compliance with the requirements of part 89, or if the FAA notifies the producer of non-compliance concerns of any standard remote identification unmanned aircraft or remote identification broadcast modules listed on this Declaration of Compliance.

Pursuant to § 89.515(b) or § 89.520(b), as applicable, I declare that the producer listed on this Declaration of Compliance has product support and notification procedures for the purpose of notifying the public and the FAA of any defect or condition that causes the standard remote identification unmanned aircraft or remote identification broadcast module listed under the Declaration of Compliance to no longer meet the requirements of part 89.

Pursuant to § 89.530(b)(8) or § 89.530(c)(8), as applicable, I declare that the radio frequency equipment used in the standard remote identification unmanned aircraft or remote identification broadcast module(s) listed on this Declaration of Compliance are 47 CFR part 15-compliant and have been integrated into the unmanned aircraft or remote identification broadcast module(s) without modification to its/their authorized radio frequency parameters.

For Remote Identification Broadcast Module(s) ONLY: Pursuant to § 89.530(c)(8), I declare that instructions have been provided for installation of 47 CFR part 15-compliant remote identification broadcast module without modification to the broadcast module’s authorized radio frequency parameters.

If the FAA has designated that you need additional information to support your Declaration of Compliance, please attach to this form.

Name:

Title:

Signature/Date:

FAA Form 8130-32 (10/20)