NSP Form T001A FSTD Information Form

Federal Aviation Administration National Simulator Program FSTD Information Form	Sponsor:
	FSTD ID:
	Aircraft Type:

Email Form to: 9-ASO-AFS205-NSP-SIMULATOR-SCHEDULING@faa.gov

Sponsor Submission Date: mm/dd/yyyy
Section 1. FSTD Sponsor Information
Sponsor Name:	     	FSTD Location:
Address:	     	Physical Address:	     
City:	     	City:	     
State/Prov/Terr:	     	State:	     
Country:	     	Country:	     
ZIP:	     	ZIP:	     
Sponsor ID No: (FAA Certificate Number)	     	Nearest Airport: (Apt Code)	     
Local FAA Authority: FAA Training Program Approval Authority: (TPAA)
Name:	     
Address:	     	Office Phone	     
City:	     	Cell:	     
State:	     	Fax:	     
ZIP:		Email:	     
FAA Alternate POC (APM, FTPM, if required)
Name:	     
Address :	     	Office Phone	     
City/State:	     	Cell:	     
State:	     	Fax:	     
ZIP:	     	Email:	     
FSTD Management Representative::
Name:	     
Address 1:	     	Office Phone	     
City/State:	     	Cell:	     
State:	     	Fax:	     
ZIP:	     	Email:	     
FSTD Contact:
Name:	     
Address 1:	     	Office Phone	     
City/State:	     	Cell:	     
State:	     	Fax:	     
ZIP:	     	Email:	     

Section 2. FSTD Information
Aircraft make/model/series:	     			A/C Common Name:		     
Qualification Basis: Qualification Level:	           			Manufacture Serial No.:		     
Base Month:      	☐ Full Flight Simulator (FFS) ☐ Flight Training Device (FTD)			Sponsor’s FSTD ID:		i.e. 737-800 #1
National Aviation Authority Qualification (For BASA-SIP Evaluations only):
NAA Name:	     
NAA FSTD ID No:	     			NAA Qualification Basis:			     
NAA Qualification Level:	     
Technical Information:
FAA FSTD ID No:       (If Applicable)	Convertible FSTD: ☐Yes			FSTD Manufacturer:			     
☐eMQTG	Conv. FAA FSTD ID No.      			Date of Manufacture:			MM/DD/YYYY
FSTD Configurations:	                 			                 
Pri. Engine Type/Thrust: Alt. Engine Type/Thrust: Alt. Engine Type/Thrust: Alt. Engine Type/Thrust:	      /             /             /             /      			FADEC Version			                       
Flight Instrumentation/Systems:			☐EFIS ☐HUD/HGS ☐ EVS ☐ WX Radar ☐ NVG ☐GPS ☐ GPWS ☐ FMS ☐ TCAS Ver:       ☐ CPDLC ☐EFB Class:       ☐ Other:      
FSTD seats available: #				Flt. control data revision: Model/Rev.
FSTD host computer:      				Aero model/data: Source/Model/Rev.
Visual image generator: Mfgr./Model				Avionics Type/Suite:      
Visual system display: CrossCkpt or MonoView/FOV				Avionics Std/Rev:      
Visual projector: No. & Type (CRT or Matrix)				FMS: Type/Rev.
				Motion system: Mfgr./Type/Axis
Airport Qualification Models If illustrations or other presentations are attached please specify: ☐
Airport Qualification Model 1 / Available In-Use Runways /Taxiway:		      /       /      
Airport Qualification Model 2 / Available In-Use Runways /Taxiway:		      /       /      
Airport Qualification Model 3 / Available In-Use Runways / Taxiway:		      /       /      
Visual Ground Segment:		      Airport Designator			      Landing Runway

Section 3a. Level 6 and Above--Additional FSTD Qualified Maneuvers, Procedures, Tasks, and Functions (For Level 4 and 5 see Section 3c below) (not stated in 14CFR Part 60 Appendix (A,B,C, or D) Attachment 1, Table 1B)
Except for Non-Qualified items stated in section 4 below, this FSTD is qualified to perform all maneuvers, procedures, tasks, and functions listed in the applicable QPS Appendix, Tables 1B and 1C of 14 CFR Part 60 as amended. Additionally, this FSTD is qualified to perform maneuvers, procedures, tasks, and functions annotated in sections 3a, 3b, or 3c below. Specific use of this device in conjunction with any training program must be approved by the FAA Training Program Approval Authority (TPAA).
FAA Qualifying Official(s):      
Area/Function/Maneuver	Requested (Sponsor Use)	Qualified (FAA Use Only)	Remarks (Including Partial Task Limitations)
CAT I: (Minimums in accordance with sponsor/operator authorization)	☐	☐	     
CAT II: (Minimums in accordance with sponsor/operator authorization)	☐	☐	     
CAT III: (Minimums in accordance with sponsor/operator authorization)	☐	☐	     
Circling Approach : Arpt/Appr/Ldg RW	☐	☐	     
Windshear Training:	☐	☐	     
Auto-coupled Approach	☐	☐	     
Auto Go Around	☐	☐	     
Auto-land / Roll Out Guidance	☐	☐	     
TCAS/ACAS I / II	☐	☐	     
WX-Radar	☐	☐	     
HUD / HGS	☐	☐	     
EFVS	☐	☐	     
TAWS (GPWS / EGPWS)	☐	☐	     
SMGCS: Arpt/Taxi Route, Visibility, mono/bidirectional	☐	☐	     
Enhanced Taxi Markings: Arpt/Taxi Route	☐	☐	     
RWSL/LAHSO	☐	☐	     
☐ LPV ☐ GPS ☐ WAAS	☐	☐	     
RNP/AR	☐	☐	     
ADS-B ☐ In	☐	☐	     
Full Stall (14 CFR Part 60 (2016)/FSTD Directive 2)	☐	☐	     
UPRT (14 CFR Part 60 (2016)/FSTD Directive 2)	☐	☐	     
Icing (14 CFR Part 60 (2016)/FSTD Directive 2)	☐	☐	     
Realistic Gusting Crosswind(14 CFR Part 60 (2016)/FSTD Directive 2)	☐	☐	     
Bounced Landing (14 CFR Part 60 (2016)/FSTD Directive 2)	☐	☐	     

Section 3b. Additional Helicopter FSTD Qualified Maneuvers, Procedures, Tasks, and Functions (not stated in 14CFR Part 60 Appendix (C or D) Attachment 1, Table 1B)
Area/Function/Maneuver	Requested (Sponsor Use)	Qualified (FAA Use Only)	Remarks (Including Partial Task Limitations)
Helicopter Slope Landings	☐	☐	     
Helicopter External Load Operations	☐	☐	     
Helicopter Pinnacle Approach to Landings	☐	☐	     
Helicopter Night Vision Maneuvers Evaluated with Class A Lens ☐ Class B Lens ☐ NVG Confined Area Location:      	☐	☐	     
Helicopter Category A Takeoffs	☐	☐	     
	☐	☐	     
	☐	☐	     
	☐	☐	     
Section 3c. Level 4 & 5 FSTD Only --Optionally Qualified Maneuvers, Procedures, Tasks, and Functions as defined in Table B1B and D1B.
Area/Function/Maneuver	Requested (Sponsor Use)	Qualified (FAA Use Only)		Remarks (Including Partial Task Limitations)
Preflight Procedures
Preflight Inspection (flight deck only).	☐	☐		     
Engine Start	☐	☐		     
Pre-takeoff Checks.	☐	☐		     
In-flight Maneuvers
Approach to Stalls	☐	☐		     Level 5 Only
Engine Failure (procedures only)	☐	☐		     Level 5 Only
Specific Flight Characteristics incorporated into the user’s approved flight training program	☐	☐		     
Instrument Procedures
Standard Terminal Arrival/Flight Management System Arrival	☐	☐		     Level 5 Only
Holding	☐	☐		     Level 5 Only
Precision Instrument, all engines operating	☐	☐		     Level 5 Only
Non-Precision Instrument, all engines operating	☐	☐		     Level 5 Only
Missed Approach	☐	☐		     Level 5 Only
Landings and Approaches to Landings
Visual Approaches (normal, steep, shallow) with visual system	☐	☐		     Level 5 Helicopter
Normal and Abnormal Procedures
Powerplant	☐	☐		     
Fuel System.	☐	☐		     
Area/Function/Maneuver	Requested (Sponsor Use)	Qualified (FAA Use Only)		Remarks (Including Partial Task Limitations)
Electrical System.	☐	☐		     
Environmental and Pressurization Systems	☐	☐		     
Fire Detection and Extinguisher Systems	☐	☐		     
Navigation and Avionics Systems	☐	☐		     
Automatic Flight Control System, Electronic Flight Instrument System, and Related Subsystems.	☐	☐		     
Flight Control Systems	☐	☐		     
Anti-ice and Deice Systems	☐	☐		     
Aircraft and Personal Emergency Equipment	☐	☐		     
Emergency Procedures
Emergency Descent (Max Rate)	☐	☐		     Level 5 Only
Inflight fire and smoke removal	☐	☐		     Level 5 Only
Rapid Decompression	☐	☐		     Level 5 Only
Emergency Evacuation	☐	☐
Post flight Procedures.
After-Landing Procedures	☐	☐		     
Rotor brake operation.	☐	☐		     Helicopter only
Abnormal/emergency procedures	☐	☐		     
     	☐	☐
     	☐	☐
     	☐	☐

Section 4. Non Qualified Tasks
FSTD users should also observe any Non-Qualified Tasks or Missing, Malfunctioning, or Inoperative (MMI) Components noted on the most recent FAA evaluation report or in the Sponsor discrepancy log that may or may not result in a training, testing, or checking restriction.
Maneuvers, Procedures, Tasks, and Functions for which this FSTD is NOT Qualified
Area/Function/Maneuver	Remarks
     	     
     	     
     	     
     	     
     	     
     	     

NSP Form T001A: 11/30/2022

OMB Control Number 2120-0680: Expiration Date 11/30/2025

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