Form 8130-15 LIGHT-SPORT CATEGORY AIRCRAFT AND KIT AIRCRAFT STATEMENT

OMB CONTROL NUMBER: 2120-0018
Expiration Date: DD/MM/YYYY

Information for Applicant
LIGHT-SPORT CATEGORY AIRCRAFT AND KIT AIRCRAFT
STATEMENT OF COMPLIANCE
Prescribing Policy:
FAA Order 8130.2, Airworthiness Certification of Aircraft

Paperwork Reduction Act 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 2120-0018 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, 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 21 and Part 22. 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. § 552a. The authority for collecting this information on
FAA Form 8130-15, Light-Sport Category Aircraft/Kit Statement of Compliance, is contained in 49 U.S.C. § 44704 as implemented
by 14 CFR Part 21 and Part 22.
The purpose of this information is for the applicant to certify compliance with applicable FAA accepted industry consensus
standards. In accordance with the Privacy Act System of Records Notice (SORN) DOT/FAA 801, routine uses of this information
include:
(1) Providing aircraft owners and operators information about potential mechanical defects or unsafe conditions, through
airworthiness directives and safety directives.
(2) Locating specific individuals or aircraft for accident investigation, violations, or safety related requirements.
(3) Preparing an Aircraft Registry (in magnetic tape and microfiche form) as required by ICAO agreement, containing information
about aircraft owners (name, address, United State Registration Number, and type of aircraft.
(4) Disclosing to law enforcement as necessary and relevant to an FAA enforcement activity.
(5) Referencing the DOT Prefatory Statement of General Routine Uses available here.
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.

FAA 8130-15 (MM/YYYY) SUPERSEDES PREVIOUS EDITION

Page 1 of 4

OMB CONTROL NUMBER: 2120-0018
Expiration Date: DD/MM/YYYY

Light-Sport Category Aircraft/Kit
Statement of Compliance
INSTRUCTIONS: Refer to FAA Order 8130.2, Airworthiness Certification of Aircraft, Appendix A. If additional space is needed, please use the comment section. This Form
may also be used to to amend the manufacturer's statement of compliance by listing aerial work that the aircraft may conduct. Retain a copy of this form in the aircraft's
permanent records and present the original to an authorized FAA Representative.

1. Manufacturer Name:

2. Manufacturer Address (Street, State, City, Zip):

3. Country of Manufacturer:
7. Aircraft Model:

6. Aircraft Make:

11. First of make or model?
13. Indicate class:

5. Aircraft Serial Number:

4. Date of Manufacturer:

Yes

No

12. Indicate type:

8. MTO Wt (lb/kg):

9. VH (CAS)

10. VS0 or VS1 (CAS) §22.100(a)(3)

Aircraft (§21.190) or

Kit (§21.191(k))
Weight-Shift-Control

Airplane

Rotorcraft

Glider

Powered Parachute

Lighter-Than-Air

Powered Lift

14. Amended per §22.190(e). Use the last page of this form to provide the required additional information.
15. List aerial work operations as outlined in §21.190(d)(3) and, if applicable, §21.190(e), or indicate N/A.

16.Simplified Flight Controls per §22.180

FAA Accepted Standards for Light Sport Category Aircraft
(with dash Number)

Manufacturer's Documentation
(with Revision and Issue Date)

17. Integration Design Performance

18. Integration, Design and Performance

19. Power Plant or Motor System

20. Power Plant or Motor System

21. Required Equipment

22. Required Equipment Listing

23. Quality Assurance

24. Manufacturer's Quality Assurance System

25. Performance Acceptance Test (N?A for Kit)

26. Manufacturer's Production Acceptance Test (N/A for LSA Kit)

27. Aircraft Operating Instruction/Pilot's Operating Handbook

28. Aircraft Operating Instruction/Pilot's Operating Handbook

29. Aircraft Flight Training Supplement

30. Aircraft Flight Training Supplement

31. Maintenance and Inspection Procedures

32. Aircraft Maintenance and Inspection Procedures

33. Continued Operational Safety Program

34. Continued Operational Safety Program

35. Manufacturer's Assembly Instructions (N/A LSA Kit)

36. Manufacturer's Assembly Instructions (N/A LSA Kit)

FAA 8130-15 (MM/YYYY) SUPERSEDES PREVIOUS EDITION

Page 2 of 4

OMB CONTROL NUMBER: 2120-0018
Expiration Date: DD/MM/YYYY

Light-Sport Category Aircraft/Kit
Statement of Compliance
I state the following:
The aircraft make, model, class, date of manufacture identified by serial number,
Federal Regulations, Chapter 1, Sub-chapter C, Part 21, Subpart H: Airworthiness Certificates, §21.190.

, complies with Title 14 of the Code of

The aircraft demonstrates compliance with part 36 and state “No determination has been made by the FAA that the noise levels of this aircraft are or
should be acceptable or unacceptable for operation in any location” (§21.190(c)(2)(iv)).
The aerial work listed has been ground and flight tested to ensure that it can be operated to safely conduct those operations in accordance with the
instructions and limitations provided by the manufacturer (§21.190(d)(3)).
The aircraft meets §22.180 requirements for an aircraft having simplified flight controls ((§21.190(d)(4), N/A if not indicated in block 16)).
The aircraft meets the provisions of the specified consensus standards used to determine the aircraft's compliance with subpart B of part 22 and the
aircraft meets the eligibility, design, production, and airworthiness requirements of subpart B of part 22 in accordance with the consensus standards
and are accepted and approved by the FAA for the airworthiness certification of light-sport category aircraft (§21.190(d)(5)).
The aircraft conforms to the manufacturer's design data using the manufacturer's quality system that meets the identified consensus standard
(§21.190(d)(6)).
The manufacturer will make available to any interested person the documents specified in §21.190(c), (§21.190(d)(7)).
The manufacturer will support the aircraft by implementing and maintaining a documented continued operational safety program that will address
monitoring and resolving in-service safety of flight issues, include provisions for the issuance of safety directives, and include a process for notifying the
FAA and all owners of flight safety issues and include a process for advance notice to the FAA and all owners of a continued operational safety program
discontinuance or provide change (§21.190(d)(8)).
The manufacturer will monitor and correct safety-of-flight issues through the issuance of safety directives and continued operational safety program
that meets the identified consensus standard (§21.190(d)(9)).
At the request of the FAA, the manufacturer will provide unrestricted access to its facilities (§21.190(d)(10)).
The manufacture has established and maintains a quality assurance system that meets § 22.185 (§21.190(d)(11)).
The manufacturer, in accordance with a production acceptance test procedure that meets the applicable consensus standard, has ground and flight
tested the aircraft (N/A for Kit), found the aircraft performance acceptable and determined that the aircraft is in a condition for safe operation (N/A for
Kit).

I hereby certify that the statements of compliance are true to the best of my knowledge and belief. I also confirm that I have been certified and trained
on the requirements for issuing a statement of compliance by an organization that certifies and trains quality assurance staff in accordance with
consensus standards accepted by the FAA.
Name:

Date:
Signature:

Title:

Note: A second signature may be required in accordance with the manufacturer's quality assurance system.

I hereby certify that the statements of compliance are true to the best of my knowledge and belief. I also confirm that I have been certified and trained
on the requirements for issuing a statement of compliance by an organization that certifies and trains quality assurance staff in accordance with
consensus standards accepted by the FAA.
Name:

Date:

Signature:

Title:

FAA 8130-15 (MM/YYYY) SUPERSEDES PREVIOUS EDITION

Page 3 of 4

OMB CONTROL NUMBER: 2120-0018
Expiration Date: DD/MM/YYYY

Light-Sport Category Aircraft/Kit
Statement of Compliance
Aircraft/Kit Serial Number:
Comments and Amendments to the Statement Compliance:

Amended Statement of Compliance (§21.190(e))
I affirm and reaffirm the statement made in the original manufacturer's Statement of Compliance that the make, model, serial number, and date of
manufacture identified on this form correspond to the aircraft manufactured by the original manufacturer. Furthermore, I/We certify that the design
and construction of the aircraft comply with consensus standards accepted and approved by the FAA for the airworthiness certification of light-sport
category aircraft. These standards ensure sufficient structural integrity for safe operation during the specified aerial work operations and that the
aircraft can withstand expected flight and ground loads. The FAA-accepted consensus standards used to make this determination are outlined on this
form."
I hereby certify that the statements of compliance are true to the best of my knowledge and belief. I also confirm that I have been certified and trained
on the requirements for issuing a statement of compliance by an organization that certifies and trains quality assurance staff in accordance with
consensus standards accepted by the FAA.
Name:

Date:
Signature:

Title:

Note: A second signature may be required in accordance with the manufacturer's quality assurance system.
I hereby certify that the statements of compliance are true to the best of my knowledge and belief. I also confirm that I have been certified and trained
on the requirements for issuing a statement of compliance by an organization that certifies and trains quality assurance staff in accordance with
consensus standards accepted by the FAA.
Name:
Title:

FAA 8130-15 (MM/YYYY) SUPERSEDES PREVIOUS EDITION

Date:
Signature:

Page 4 of 4