Fillable Faa Form 8500-7 - Report Of Eye Evaluation (Page 2 of 4) in pdf

REPORT OF EYE EVALUATION

PRIVACY ACT STATEMENT: This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a:

The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709 and 14 C.F.R. Part 6 7.

The principal purpose for which the information is intended to be used is to identify and evaluate your qualifications and

eligibility for the issuance of an airman certificate and/or rating. Submission of the data is mandatory, except for the Social

Security Number, which is voluntary. Failure to provide all required information will result in our being unable to issue you a

certificate and/or rating. The information collected on this form will be included in a Privacy Act System of Records known

as DOT/FAA 847, titled “Aviation Records on Individuals” and will be subject to the routine uses published in the System of

Records Notice (SORN) for DOT/FAA 847 (see ), including:

(a) Providing basic airmen certification and qualification information to the public upon request; examples of basic

information include:

• The type of certificates and ratings held, limitations, date of issuance and 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 airman’s physical status or condition used to determine statistically the validity of FAA

medical standards; and the date, class, and restrictions of the latest physical

• Information relating to an individual’s eligibility for medical certification, requests for special

issuance, and requests for review of certificate denials. (b) Using contact information to inform

airmen of meetings and seminars conducted by the FAA regarding aviation safety.

responsibilities.

(d) 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. (e) Providing information about enforcement actions, or orders

issued thereunder, to Federal agencies, the aviation industry, and the public upon request.

(f) Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury and the U.S.

Department of Justice (DOJ) for collection pursuant to 31 U.S.C. 3711(g).

(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.

(h) 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.

(i) 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 current 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.

(j) Providing information about airmen through the Civil Aviation Registry’s Comprehensive Airmen Information System to

the Department of Health and Human Services, Office of Child Support Enforcement, and the Federal Parent Locator Service

that locates noncustodial 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 paternity, establishing and modifying support orders

and location of obligors. Records listed within the section on Categories of Records are retrieved using Connect: Direct through

the Social Security Administration’s secure environment.

(k) 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.

(l) 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.

(m) 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), DOJ and other authorized Federal agencies, for

their use in managing, tracking and reporting aviation-related security events.

(n) Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for

additional uses (65 F.R. 19477-78) For example, a record from this system of records may be disclosed to the United States

Coast Guard (Coast Guard) and to the Transportation Security Administration (TSA) if information from this system was

shared with either agency when that agency was a component of the Department of Transportation (DOT) before its transfer to

DHS and such disclosure is necessary to accomplish a DOT, TSA or Coast Guard function related to this system of records.

FAA FORM 8500-7 (3-06) Supersedes Previous Edition

Faa Form 8500-7 - Report Of Eye Evaluation Page 2

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