Privacy Act Statement (5 U.S.C. § 552a, as amended):

Authority: Information solicited by the FAA Form 8500-8 "Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate" is collected under the authority of 49 U.S.C. §40101, 40113, 44701-44703, and 44709 (1994) formerly codified in the Federal Aviation Act of 1958, as amended, and Title 14, Code of Federal Regulations (CFR), part 67, Medical Standards and Certification.

Purpose: The purpose of collecting the name, date of birth, mailing address, telephone number, citizenship, occupation, and employer?s information is to process the applicant?s request for an FAA Medical Clearance or Medical Certificate. Providing their social security number is optional and if provided will be used for proper identification of the applicant.

Routine Uses: The information collected will be included in the system of records notice DOT/FAA 856, Airmen Medical Records and will be subject to the published routine uses including:

1. Sharing of information with the National Transportation Safety Board (NTSB) for purposes of investigating accidents and incidents involving certificated airmen;
2. Sharing with the general public information relating to an individual's eligibility for medical certification, requests for exemptions from medical requirements, and requests for review of certificate denials;
3. Sharing personal information of airmen with other federal agencies for the purpose of verifying the accuracy and completeness of medical information provided to FAA;
4. Sharing past medical certification history with AMEs, so they may render the best medical certification decision regarding airmen;
5. 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;
6. Sharing 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 will also contain the names and titles of individuals who, in their commercial capacity, administer the drug and alcohol testing programs of aviation entities; and
7. 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.

Disclosure: Submission of your social security number is voluntary. Your application will be processed even if you do not provide it. However, submission of the other information on the form is mandatory. We will process your application only if you provide the required information.

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 2120-0034. Public reporting for this collection of information is estimated to be approximately 2 hours 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 a certificate by 14 CFR Parts 61 and 67. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110.