Unmanned Aircraft System (UAS) Maintenance Reports - PSP

U.S. Department of Transportation
Federal Aviation Administration

OMB Control No. 21XX-XXXX
Collection Expires XX/XX/XXXX

Unmanned Aircraft System (UAS) Maintenance Report
Equipment Degradations, Malfunctions, or Failures

Public 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 21XX-XXXX. Public reporting for
this collection of information is estimated to be approximately 60 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. All responses to this collection of
information are required to obtain or retain a benefit (49 U.S.C. § 106(l) and (m)). 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.

Instructions

Use this form to provide a monthly report of equipment degradations, malfunctions, or failures and the resulting corrective maintenance actions. This form
includes the fields (date, time, aircraft registration number, and description of equipment degradation/malfunction/failure) to meet the equipment
degradation, malfunction, or failure reporting requirement for specific Part 107 waivers. For the applicable Part 107 waiver holders, the resulting report will
be combined with the Part 107 UAS monthly operational flight report to be submitted as one consolidated report to the Administrator at 9-afs-820Part107Reports@faa.gov. Alternatively, you may choose to submit the flight report and the equipment degradation report separately. Part 135 operators
do not need to complete this form. Under 14 CFR Part 135.415, Part 135 operators must submit Service Difficulty Reports (FAA Form 8070-1).

Instrument/UAS Maintenance (5/21)

Page i of i

Unmanned Aircraft System (UAS) Maintenance Report
Equipment Degradations, Malfunctions, or Failures

Question

Response

Participant Name
Company Name/Operator (optional)
Month
Year
Time Zone Used to Record Times

Date

Time
(if using 12hour clock,
include “am”
or “pm”, as
applicable)

Aircraft
Registration
Number or
Nickname

Instrument/UAS Maintenance (5/21)

Description of Equipment
Degradation / Malfunction /
Failure

Subsystem Type

Hours
in
Service

Corrective Maintenance
Action

Page 1 of 1