AMJP 1A.6.5 AMJP Recipient Notification to USDOT of EEG Composition

Form AMJP-1A.6.5

OMB CONTROL NUMBER: 2106-0048
EXPIRATION DATE: 11/30/2021

FORM AMJP-1A.6.5
AMJP RECIPIENT NOTIFICATION TO USDOT OF EEG COMPOSITION

PAPERWORK REDUCTION ACT 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 2106-0048. Public reporting for this collection of information is estimated to be
approximately 120 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 (pursuant to the American Rescue Plan Act of 2021 (ARPA), Public Law (P.L.)
117-2, § 7201-7202). 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, Department of Transportation, OST-S-83, 1200 New Jersey
Avenue S.E., Washington, DC 20590.

OMB CONTROL NUMBER: 2106-0048
EXPIRATION DATE: 11/30/2021

Form AMJP-1A.6.5

FORM AMJP-1A.6.5
AMJP RECIPIENT NOTIFICATION TO USDOT OF EEG COMPOSITION
AMJP Recipient Business Name
AMJP Agreement Number

69A345

AMJ0

Approved Eligible Employee Group Size
Eligible Employee Group Composition:

Using the table format shown below, provide updated information on the composition of the designated Eligible
Employee Group (EEG) subsequent to submission of the AMJP application. Provide the requested information for
each member of the EEG.

EEG
Member ID

Job Category

Compensation Level

Pay Frequency

Assign each
employee a
unique ID
(non PII)

Select the appropriate job category
from the dropdown menu.

List base compensation and
benefits excluding overtime,
premium pay, and any
Federal, State, or local taxes
paid by the employer.

Select pay frequency
that corresponds to
the compensation
level.

EXAMPLES
1001

Fabrication or Assembly

$4,269

Bi-weekly

1002

Fabrication or Assembly

$4,038

Bi-weekly

1003

Procurement

$3,846

Bi-weekly

1004

Inspection

$3,653

Bi-weekly

ACTUAL (You may attach an Excel file instead, especially for EEG sizes greater than 15 employees)
(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

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* "Other" under "Job Category" refers to other positions directly engaged in aviation manufacturing and/or repair. If more than

five (5) percent of the total EEG is classified as "Other," you must provide a detailed listing of the specific positions included as
part of the Attachments to this form.

OMB CONTROL NUMBER: 2106-0048
EXPIRATION DATE: 11/30/2021

AMJP – Form 1A-6.5

EEG
Member ID

Job Category

Compensation Level

Pay Frequency

Assign each
employee a
unique ID
(non PII)

Select the appropriate job category
from the dropdown menu.

List base compensation and
benefits excluding overtime,
premium pay, and any
Federal, State, or local taxes
paid by the employer.

Select pay frequency
that corresponds to
the compensation
level.

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

(Select one)

Attachments:

Provide a list identifying all attachments. Attach documentation as needed to provide the requested
description of the eligible employee group composition. If "Other" was selected under "Pay Frequency,"
ensure documentation specifies the appropriate frequency. Do not include any personally
identifiable information about employees; redact that information as necessary.

Certification:
I certify under penalty of perjury that the information above and attached is true and correct.
I acknowledge that false, fictitious, or fraudulent information, or the omission of any material
fact, may subject me to criminal penalties, civil penalties, or both. (See 18 U.S.C. 287; 18
U.S.C. 1001; 31 U.S.C. 3729; 31 U.S.C. 3802).
Signature

Date

Name of Signing Official

Title of Signing Official

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