Form 8610-3 Airman Certificate and/or Rating Application – Repairman

FAA Form 8610-3, Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65),
Supplemental Information
The supplemental information for this form includes the following:
Page i………………..
Page ii……………….
Page iii………………
Page iv……………...
Page v………………..

Paperwork Reduction Act Burden Statement
Privacy Act Statement
Pilot’s Bill of Rights Written Notification of Investigation
Instructions for Completing FAA Form 8610-3
Instructions for Completing FAA Form 8610-3, continued.

Detach these supplemental information and instruction parts before submitting the attached form.
Printing double-sided is preferable. If the form is not printed in the double-sided format, complete
the “Applicant Information” section on the top of page 2.
An electronic, fillable, printable version of FAA Form 8610-3 is available at www.faa.gov.
When printing, print pages 6 through 7, if you choose to print only the form.
Integrated Airman Certification and Rating Application (IACRA) is a web-based certification/rating
application that guides the user through the FAA's airman application process. IACRA helps ensure
applicants meet regulatory and policy requirements through the use of extensive data validation. It
also uses electronic signatures to protect the information's integrity, eliminates paper forms, and
prints temporary certificates. IACRA can be accessed here: https//iacra.faa.gov.

OMB CONTROL NUMBER: 2120-0022
EXPIRATION DATE: 03/31/2025
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 2120-0022. Public reporting for this collection of information
is estimated to be approximately 20 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 under
14 CFR part 65. 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

FAA Form 8610-3 (XX-22)

Detach this supplemental information before using the form below
i

FAA Form 8610-3, Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65),
Supplemental Information
PRIVACY ACT STATEMENT
Privacy Act Statement (5 U.S.C. § 552a, as amended):
Authority: The information collected on the FAA Form 8610-3 – Airman Certificate and/or Rating Application – Repairman (14 CFR Part 65), is in
accordance with 49 U.S.C. §§ 106(g), 40113, 44702, 44703, 44709, 44710, 44711(a)(2) and 14 CFR Parts 65.
Purpose: The information collected will be used to identify and evaluate your qualifications and eligibility for the issuance of a repairman certificate and/or
added rating.
Routine Uses: The information collected on this form is included in a Privacy Act System of Records DOT/FAA 847, Aviation Records on Individuals, and
is subject to the routine uses published in the Federal Register (75 FR 68849-52 - Nov. 9, 2010) including;
•
Providing basic airmen certification and qualification information to the public upon request; examples of basic information include:
•
The type of certificates and rating held;
•
The date, class, and restrictions of the latest physical airman’s certificate number;
•
The status of the airman’s certificate (i.e., whether it is current or has been amended, modified, suspended or revoked for any reason);
•
The airman’s home address, unless requested by the airman to be withheld from public disclosure per 49 U.S.C. 44703(c);
•
Information relating to an individual’s physical status or condition used to determine statistically the validity of FAA medical
standards; and
•
Information relating to an individual’s eligibility for medical certification, requests for exemption from medical requirements, and
requests for review of certificate denials.
•
Using contact information to inform airmen of meetings and seminars conducted by the FAA regarding aviation safety.
•
Disclosing information to the National Transportation Safety Board (NTSB) in connection with its investigation responsibilities.
•
Providing information about airmen to Federal, State, local and tribal law enforcement agencies when engaged in an official investigation in
which an airman is involved.
•
Providing information about enforcement actions, or orders issued thereunder, to government agencies, the aviation industry, and the public upon
request.
•
Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury (Treasury) and the U.S.
Department of Justice (DOJ) for collection pursuant to 31 U.S.C. 3711(g).
•
Making records of effective orders against the certificates of airmen available to their employers if the airmen use the affected certificates to
perform job responsibilities for those employers.
•
Making airmen records available to users of FAA’s Safety Performance Analysis System (SPAS), including the Department of Defense
Commercial Airlift Division’s Air Carrier Analysis Support System (ACAS) for its use in identifying safety hazards and risk areas, targeting
inspection efforts for certificate holders of greatest risk, and monitoring the effectiveness of targeted oversight actions.
•
Making records of an individual’s positive drug test result, alcohol test result of 0.04 or greater breath alcohol concentration, or refusal to submit
to testing required under a DOT-required testing program, available to third parties, including employers and prospective employers of such
individuals. Such records also contain the names and titles of individuals who, in their commercial capacity, administer the drug and alcohol
testing programs of aviation entities.
•
Providing information about airmen through the airmen registry certification system to the Department of Health and Human Services, Office to
the Child Support Enforcement, and the Federal Parent Locator Service that locates non-custodial parents who owe child support. Records in this
system are used to identify airmen to the child support agencies nationwide in enforcing child support obligations, establishing paternities,
establishing and modifying support orders and location of obligors. Records named within the section on Categories of Records will be retrieved
using Connect: Direct through the Social Security Administration’s secure environment.
•
Making personally identifiable information about airmen available to other Federal agencies for the purpose of verifying the accuracy and
completeness of medical information provided to FAA in connection with applications for airmen medical certification.
•
Making records of past airman medical certification history data available to Aviation Medical Examiners (AMEs) on a routine basis so that
AMEs may render the best medical certification decision.
•
Making airman, aircraft, and operator record elements available to users of FAA’s Skywatch system, including the Department of Defense
(DoD), the Department of Homeland Security (DHS), the Department of Justice (DOJ) and other authorized government users, for their use in
managing, tracking and reporting aviation related security events.
•
Providing information about airmen to Federal, State, local, and Tribal law enforcement, national security or homeland security agencies
whenever such agencies are engaged in the performance of threat assessments affecting the safety of transportation or national security.
The Department has also published 15 general routine uses applicable to all DOT Privacy Act systems of records. These routine uses are published in the
Federal Register at 84 FR 55222 - October 15, 2019, 77 FR 42796 - July 20, 2012, and 75 FR 82132 – December 29, 2010 and under “Privacy Act System
of Records Notices” (available at https://www.transportation.gov/individuals/privacy/privacy-act-system-records-notices).
Disclosure: Submission of all requested data is voluntary; however, failure to provide all the required information would result in the FAA’s inability to
issue a certificate and/or rating.

FAA Form 8610-3 (XX-22)

Detach this supplemental information before using the form below
ii

FAA Form 8610-3, Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65),
Supplemental Information
Your signature on FAA Form 8610-3 acknowledges that you received the Pilot’s Bill of Rights
Written Notification of Investigation at the time of your application.
PILOT’S BILL OF RIGHTS WRITTEN NOTIFICATION OF INVESTIGATION
The information you submit on the attached FAA form 8610-3, Airman Certificate and/or Rating
Application - Repairman (14 CFR Part 65), will be used by the Administrator of the Federal
Aviation Administration as part of the basis for issuing an airman certificate, rating, or
inspection authorization to you under Title 49, United States Code (U.S.C.) section 44703(a), if
the Administrator finds, after investigation, that you are qualified for, and physically able to
perform the duties related to the certificate, rating, or inspection authorization for which you
are applying. Therefore, in accordance with the Pilot’s Bill of Rights, the Administrator is
providing you with this written notification of investigation of your qualifications for an airman
certificate, rating, or inspection authorization:
•

The nature of the Administrator’s investigation, which is precipitated by your submission of
this application, is to determine whether you meet the qualifications for the airman
certificate, rating, or inspection authorization you are applying for under Title 14, Code of
Federal Regulations (CFR) part 65.

•

Any response to an inquiry by a representative of the Administrator by you in connection
with this investigation of your qualifications for an airman certificate, rating or, inspection
authorization may be used as evidence against you.

•

A copy of your airman application file for this date this application was made is available to
you upon your written request addressed to:
Federal Aviation Administration
Airman Certification Branch
P.O. Box 25082
Oklahoma City, OK 73125-0082
If you make a written request for your airman application file, please provide the
following information in your request:
• Full legal name
• Date of birth or airman certificate number
• Date of the application

FAA Form 8610-3 (XX-22)

Detach this supplemental information before using the form below
iii

FAA Form 8610-3, Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65),
Supplemental Information
Instructions for Completing FAA Form 8610-3

GENERAL INFORMATION
•
An electronic, fillable, printable version of FAA Form 8610-3 is available at www.faa.gov.
•
Make all entries using permanent dark blue or black ink, or a typewriter or printer. All signatures must be original, with the name printed or
typewritten below or beside the signature.
•
Unless otherwise specified, enter all dates using eight-digit numeric characters, MM/DD/YYYY (e.g., 03/29/2019).
•
Read all supplemental information provided with this form including the Paperwork Reduction Act Burden statement, the Privacy Act statement,
the Pilot’s Bill of Rights Written Notification of Investigation, and the Instructions for Completing FAA Form 8610-3. Remove and retain the
supplemental information before submitting the application.
IMPORTANT NOTE: The applicant’s signature on FAA Form 8610-3 confirms the applicant has received the Privacy Act statement and the Pilot’s Bill
of Rights Written Notification of Investigation at the time application was made.
All applications must have the application TOP Section, Section I. APPLICANT INFORMATION and Section IV. APPLICANT’S CERTIFICATION completed. See
the instructions below to determine the additional sections/blocks to be completed depending on the certificate requested and the basis for certification.
TOP Section
Original Issuance, Added Rating/Privileges, Other. Mark appropriate box for
either the original issuance of a certificate type, or an added rating. Mark the
“Added Rating/Privileges” box only if you are adding ratings or
privileges/limitations to an existing Repairman certificate. Mark “Other” if
you are making application due to a change of address, name, gender,
citizenship, nationality, date of birth, or other change, and enter the type of
change requested.
Certificate Type and Ratings. Mark the appropriate box for the type of
Repairman certificate and/or rating(s) being applied for. You may only apply
for one type of repairman certificate per application.
Section I. APPLICANT INFORMATION
A. Name. Enter your full legal name. Use commas to separate names, i.e.
Last, First, Middle. If your full legal name is more than 47 characters
including the suffix and spaces, use no more than one middle name for
record purposes. Do not change your name on subsequent applications
unless it is done in accordance with 14 CFR § 65.16.
If you have a middle initial only, enter the initial. If you do not have a middle
name or middle initial, enter “NMN” (no middle name).
Indicate if you are a Jr., II, or III, etc.
B. Date of Birth. Enter your date of birth in the MM/DD/YYYY format.
C. Place of Birth. If you were born in the USA, enter the city and state where
you were born. If the city is unknown, enter the county and state. If you
were born outside the USA, enter the name of the city and country, or
province and country, of where you were born.
D. Height. Enter your height in inches. Example: 5’8” is entered as 68 in. No
fractions, use whole inches only.
E. Weight. Enter your weight in pounds. No fractions, use whole pounds
only.
F. Hair Color. Spell out the color of your hair. Choose from the following:
bald, black, blonde, brown, gray, red or white. If you wear a wig or toupee,
enter the color of your hair under the wig or toupee.
G. Eye Color. Spell out the color of your eyes. Choose from the following:
black, blue, brown, gray, green, or hazel.
H. Sex. Mark either Male or Female.

FAA Form 8610-3 (XX-22)

I. Citizenship/Nationality. Mark the box for USA if you are a U.S. Citizen or
legally naturalized U.S. Citizen. Otherwise, mark “Other” and enter the
country where you are a legal citizen. Only show one citizenship reference
in Block I. Annotate dual citizenship countries in the REMARKS section.
Note: To claim Dual Citizenship, you must present appropriate
citizenship documentation for each country upon application.
J1. Physical Location/Address. Enter your complete residential address
including street number, city, state, and ZIP code. This block cannot be left
blank. If you have a foreign address, the country must be stated.
If a residential address does not exist,, such as when the applicant resides
on a rural route, a boat, or some other manner that requires the use of a
P.O. Box, rural route, or personal mailbox, a map or written directions to
your physical address, 911 address, or Global Positioning System (GPS)
coordinates must be attached to the application or entered in the
Remarks block. Mark box for attached directions, if applicable.
A map or written directions are not required for Army Post Office
(APO)/Fleet Post Office (FPO)/Diplomatic Post Office (DPO) type
addresses.
J2. Mailing Address. Enter your mailing address, if different from block J1.
This address will be printed on the permanent airman certificate.
You may leave the block blank if the “Same as J1” box is marked. A post
office box, rural route, personal mailbox, commercial, or other mail drop
can be used as your preferred mailing address.
To have your airman certificate mailed to an address other than what is
listed in blocks J1 or J2, provide mailing instructions on a separate
attachment or in the remarks section of the form.
K. Other FAA Airman Certificate? Mark yes or no. If yes, state the
certificate type and number. Types of certificates include: pilot, mechanic,
repairman, etc. A student pilot certificate is a pilot certificate
L. Have you ever had a certificate suspended or revoked? Mark yes or no.
If “YES” is marked, refer to §§ 65.11 (c) and (d).
M. Do you read, write, speak and understand the English language. Mark
yes or no. Refer to § 65.101(a)(6).
N. Drugs or substance conviction? Mark yes or no. Only mark yes if you
have actually been convicted. If yes is marked, include the date of final
conviction. Refer to § 65.12 and § 91.19(a).

Detach this supplemental information before using the form below
iv

FAA Form 8610-3, Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65),
Supplemental Information

II. APPLICATION BASIS

Instructions for Completing FAA Form 8610-3, continued.

A. § 65.101 Repairman. Mark this box if you are applying for a § 65.101
Repairman certificate. Enter your experience and/or training in Section III
related to the privileges/limitations applied for.
A1.Specify Repairman Privileges/Limitations Requested. Indicate the
privileges/limitations for which you are applying.

III. RECORD OF EXPERIENCE OR TRAINING. This section applies to § 65.101
repairmen applicants only.
Note: Applicants should provide dates of experience in the eight-digit
(MM/DD/YYYY) numeric format if necessary to count the days to ensure
eligibility based on 18 months of practical experience. These dates can be
handwritten in columns 1 and 2, or annotated in the Remarks block.

Columns 1 through 4. Enter the work experience or training related to the
certificate, privileges, and limitations being applied for. Mark the box if you
have attached a separate sheet annotating additional experience or
B. § 65.104 EXPERIMENTAL AIRCRAFT BUILDER REPAIRMAN. Mark this box
training information.
when applying for a § 65.104 Experimental Aircraft Builder repairman
1. Date From. Enter your employment/training start date in a six-digit
certificate.
(MM/YYYY) numeric format.
Note: The information entered in B1-B4 should match what is stated on the
2. Date To. Enter your employment/training end date in a six-digit
aircraft’s airworthiness certificate.
(MM/YYYY) numeric format.
B1. Make. Insert the make of the aircraft (this is the builder’s name as it
3. Employer/Trainer Name and Location. Enter the name of your
appears on the aircraft data plate).
employer or the name of entity conducting training, and the city and
state of the employer and/or training entity.
B2. Model. Insert the model of the aircraft.
A2. Mark the box to indicate you have attached the required letter of
recommendation from your employer.

B3. Serial Number. Insert the serial number of the aircraft.

4. Type of Work Performed/Training Received. Enter the type of work
performed with the employer, or describe the training received, related to
the privileges and limitations requested.
C. § 65.107 LIGHT-SPORT AIRCRAFT REPAIRMAN. Mark this box when
IV. APPLICANTS CERTIFICATION. You must complete this section at the
applying for a § 65.107 Light-Sport Aircraft repairman certificate. Complete
time
you make application.
blocks C1 through C8, as appropriate.
Applicants Signature. Sign your name.
Note: An applicant may apply for additional ratings, classes, or aircraft
Date. Enter the date you signed the form, using the MM/DD/YYYY
using a separate application for each addition. Mark the “Added
format.
PAGE 2
Rating/Privileges” box in the form’s top section, and complete all other
APPLICANT
INFORMATION.
When
the application is printed on 2 separate
required blocks. All ratings, classes, and aircraft will be included under the
pages
(i.e.
not
printed
double-sided),
enter your name, date of birth, and
same certificate number.
your certificate number relating to this application. Leave the certificate
C1. LSA Class. Enter the class of LSA requested. Selection of the Gyroplane number blank if this is an application for original issuance.
class is only applicable to an Inspection rating. Multiple classes may be
Note: This ensures page 2 of the application is placed with the correct
requested on a single application.
applicant on page 1 if the pages become separated.
C2. LSA Training Course Provider. Enter the name of the LSA course
V. APPLICANTS CERTIFICATION. Only complete this section at the time of
provider, as stated on certificate of completion.
issuance of a temporary certificate.
C3. LSA Course Name. Enter the name of the LSA training course.
A. Certificate suspended or revoked? Mark yes or no. If “YES” is marked,
C4. LSA Course Number. Enter the LSA course number.
refer to § 65.11(c) and (d).
C5. LSA Course Completion Date. Enter the date you completed the LSA
B. Drug or Substance Conviction? Mark yes or no. Only mark yes if you
training course, as shown on the course certificate of completion.
have actually been convicted. If yes is marked, include the date of final
conviction. Refer to § 65.12 and § 91.19(a).
C6. Course Hours. Enter the training hours of the LSA course.
Note: If multiple LSA courses were completed, enter additional course
Applicants Signature. Sign your name.
information for blocks C2 – C5 in the Remarks block or on a separate
Date. Enter the date you signed the form, using the MM/DD/YYYY
attachment.
format.
C7. N Number. Only for Inspection rating: Enter the aircraft registration
REMARKS. You may annotate attachments, dual citizenship, mailing, or
number of the aircraft to be inspected.
other information related to the application, in this block. This block is also
C8. Serial Number. Only for Inspection rating: Enter the serial number of
used by the FAA for annotating additional information.
the aircraft to be inspected.
ATTACHMENTS. Mark appropriate box(s) indicating attachments to the
application. Select “Other” when attachments are not listed in this block,
and annotate the attachment(s) in the Remarks block.
B4. Certification Date. Insert the certification date of the aircraft.

APPLICANT IDENTIFICATION (ID). This is completed by the person verifying
your identity at the time of application and confirmed at certificate
issuance. Changes or corrections can be annotated in the Remarks block.
If the applicant does not have a telephone number or email address, or
chooses not to provide this information, enter “NONE” in the block.
FAA Form 8610-3 (XX-22)

Detach this supplemental information before using the form below
v

OMB Control Number: 2120-0022
Expiration Date: 03/31/2025

TYPE OR PRINT ALL ENTRIES IN DARK INK

Airman Certificate and/or Rating Application – Repairman
(14 CFR Part 65)

☐ § 65.101 REPAIRMAN

☐ ORIGINAL ISSUANCE
☐ ADDED RATING/PRIVILEGES
☐ OTHER ___________________

☐ § 65.104 EXPERIMENTAL AIRCRAFT
BUILDER REPAIRMAN

☐ Maintenance Rating

I. APPLICANT INFORMATION
A. Name (Last, First, Middle)

D. Height (Inches)

☐ § 65.107 LIGHT-SPORT AIRCRAFT REPAIRMAN
☐ Inspection Rating

B. Date of Birth (MM/DD/YYYY)

E. Weight (Pounds)

C. Place of Birth (City and State) or (City and Country)

F. Hair Color (Spell out) G. Eye Color (Spell out) H. Sex ☐ Male
☐ Female

J1. Physical Location/Address (Required)

J2. Mailing Address (will show on certificate)

☐Directions are attached.

I. Citizenship / Nationality: ☐ USA
☐ Other: __________________________________

K. Do you now hold or have you ever held an FAA airman certificate? ☐ No

☐Same as J1.

☐ Yes, Certificate type and number: ____________________________
L. Have you ever had an FAA airman certificate suspended
☐ No ☐ Yes
or revoked?
M. Do you read, write, speak, and understand the English
language?

☐ No ☐ Yes

N. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, depressant or stimulant drugs or substances?
Refer to § 65.12 and §91.19(a).
☐No
☐Yes, Date of Final Conviction (MM/DD/YYYY): __________________________________
II. APPLICATION BASIS Complete Section III, Record of Experience, when application basis is A below. Continue additional information on a separate sheet if necessary.
A1. Specify Repairman Privileges/Limitations Requested:

☐ A. § 65.101 REPAIRMAN
A2. ☐ I have attached a letter from my employer recommending me for the privileges/limitations sought, and certifying that I meet
the requirements of the requested privileges/limitations.
☐ B. § 65.104 EXPERIMENTAL
AIRCRAFT BUILDER REPAIRMAN

B1. Make

C1. LSA Class:

B2. Model

☐Airplane

☐Glider

B3. Serial Number

☐Lighter-Than-Air

C2. LSA Training Course Provider

C4. Course Number:

C3. Course Name

C5. Course Completion Date:

For Inspection Rating Only: C7. N Number:

2. DATE TO (MM/YYYY)

C6. Course Hours:

C8. Serial Number:

III. RECORD OF EXPERIENCE OR TRAINING Continue additional information on a separate sheet if necessary.
1. DATE FROM (MM/YYYY)

☐Powered Parachute

☐Gyroplane (Insp. Rating Only)

☐Weight-Shift-Control
☐ C. § 65.107 LIGHT-SPORT
AIRCRAFT REPAIRMAN

B4. Certification Date

☐ Mark this box if separate sheet attached for additional information.

3. EMPLOYER/TRAINER NAME & LOCATION (Name, City, State)

IV. APPLICANT’S CERTIFICATION This area is completed by the applicant at the time application is made.
I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to be
considered as part of the basis for issuance of any FAA certificate to me. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies
this form. I have also read and understand the Privacy Act statement that accompanies this form.
Applicant’s Signature

FAA Form 8610-3 (XX-22)

Date (MM/DD/YYYY)

Page 1 of 2

APPLICANT INFORMATION (Required if application is printed on 2 pages)
Name (as shown on page 1 of application):

Date of Birth (MM/DD/YYYY):

Certificate Number (if any):

V. APPLICANT’S CERTIFICATION This area is completed by the applicant at the time of issuance of the temporary airman certificate (FAA Form 8060-4).
A. Have you ever had an FAA airman certificate suspended or revoked?

☐ NO

☐ YES

B. Have you ever been convicted for violation of any Federal or state statues relating to narcotic
drugs, marijuana, or depressant or stimulant drugs or substances?

☐ NO
☐ YES, Date of Final Conviction: _________________________

I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to be
considered as a part of the basis for issuance of any FAA certificate to me. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies
this form. I have also read and understand the Privacy Act statement that accompanies this form.
Applicant’s Signature

Date (MM/DD/YYYY)

VI. FAA EXAMINER’S REPORT
I have examined this applicant’s papers, and I have indicated the result as:

☐ APPROVED (Temporary Certificate Issued)

FAA Signature (Print Name and Sign)

☐ DISAPPROVED

Date (MM/DD/YYYY)

FAA Office/Designation No.

REMARKS

ATTACHMENTS

☐ Letter

☐ Temporary Certificate
☐ Other See Remarks block
FAA FILE REVIEW (For FAA Office Use Only)
FAA Signature (Print Name and Sign)

FAA Form 8610-3 (XX-22)

APPLICANT IDENTIFICATION (ID) (Government Issued Photo ID)
Form of ID

State or Country

ID Number

Expiration Date

Telephone No

Email Address

Date (MM/DD/YYYY)

FAA Office

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