Omb No 2120 0003 Form PDF Details

In the world of aviation, safety is paramount, and the importance of thorough, accurate reporting cannot be overstated. Enter the OMB No 2120-0003 form, a critical document facilitated by the Federal Aviation Administration (FAA) under the Department of Transportation. This form, predominantly known as the Malfunction or Defect Report, plays a vital role in the continuous effort to maintain and enhance aviation safety. Designed for meticulous documentation, it covers an array of data points, including aircraft registration number, manufacturer, model/series, and detailed information on the powerplant, propeller, and specific parts causing trouble. This form not only facilitates the reporting of malfunctions or defects encountered but also provides a structured way to describe the circumstances under which they occurred, probable cause, and insightful recommendations to prevent recurrence. Notably, it includes a section that determines whether the report is linked to an aviation accident or incident, thereby ensuring a comprehensive evaluation of safety concerns. The OMB No 2120-0003 form is a mandatory submission, underscoring the FAA's commitment to evaluating certification standards, maintenance programs, and regulatory requirements. By collecting this information, the FAA aims to uphold and advance the safety and reliability of air transportation, making this form a cornerstone of their data collection and analysis efforts.

QuestionAnswer
Form NameOmb No 2120 0003 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesOMB, ATA, faa form 8010 4 example, FAA

Form Preview Example

DEPARTMENT OF TRANSPORTATION

OPER. Control No.

 

8. Comments (Describe the malfunction or defect and the circumstances under which it

 

occurred. State probable cause and recommendations to prevent recurrence.)

FEDERAL AVIATION ADMINISTRATION

ATA Code

 

 

 

 

 

 

 

 

 

 

 

 

 

MALFUNCTION OR DEFECT REPORT

1. A/C Reg. No.

 

Enter pertinent data

MANUFACTURER

MODEL/SERIES

SERIAL NUMBER

 

 

 

 

 

 

2.

 

 

 

 

 

AIRCRAFT

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

POWERPLANT

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

PROPELLER

 

 

 

 

 

 

 

 

 

 

 

5. SPECIFIC PART (of component) CAUSING TROUBLE

Part Name

MFG. Model or Part No.

Serial No.

Part/Defect Location.

 

 

 

 

 

 

 

 

6.APPLIANCE/COMPONENT (Assembly that Includes part)

Comp/Appl Name

Manufacturer

Model or Part No.

Serial Number

 

 

 

 

 

 

Optional Information:

 

 

Part TT

 

Part TSO

 

Part Condition

7. Date Sub.

Check a box below, if this report is related to an aircraft

 

 

 

 

 

 

 

 

 

Accident; Date

 

Incident; Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAA FORM 8010­4 (10­92) SUPERSEDES PREVIOUS EDITIONS

OMB No. 2120­0003

DISTRICT OFFICE

OPERATOR

DESIGNATION

OTHER

 

 

 

 

 

 

 

 

 

COMMUTER

 

 

 

 

 

 

 

 

 

FAA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MFG.

 

 

 

 

 

 

 

)

AIR TAXI

 

 

 

 

 

 

 

(

MECH.

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

OPER.

SUBMITTED BY:

 

 

 

REP.STA.

 

Use this space for continuation of Block 8 (if required).

PAPERWORK REDUCTION ACT STATEMENT: The information collected on this form is used to evaluate certification standards, maintenance programs, and regulatory requirements. The information is required to ensure safety in air transportation. It is estimated that it will take approximately 9 minutes to complete the form. Providing this information is mandatory. No assurance of confidentiality is given. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The control number for this collection of information is 2120­0003.

­

U.S. Department of Transportation

Federal Aviation Administration

Flight Standards Service

Aviation Data Systems Branch

P.O. Box 25082

Oklahoma City, OK 73125­5029

AFS­620

Official Business

Penalty for Private Use $300

BUSINESS REPLY MAIL

FIRST CLASS PERMIT NO. 12438 WASHINGTON, D. C.

Federal Aviation Administration

AFS­620 (Alerts)

P.O. Box 25082

Oklahoma City, OK 73125­5029

NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES

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