PRIVACY ACT STATEMENT: This statement is provided pursuant to the Privacy Act of 1974, 5 USC 552a: T-2026

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The document is a Change of Address Notification form for airman certificate holders, detailing the process for updating their address with the Federal Aviation Administration (FAA). It includes a Privacy Act Statement outlining the collection and use of personal information, emphasizing that submission of this form does not result in a replacement certificate. The form requires personal details such as name, airman certificate number, new address, date of birth, and signature.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the designated field. Ensure that you print clearly for accurate processing.
Input your Airmen Certificate Number. This is crucial for identifying your records within the FAA system.
Provide your new address. If using a P.O. Box, include a physical residential address along with directions or a map.
Fill in your date and place of birth as required. This information helps verify your identity.
Sign and date the form at the bottom to confirm that all information provided is accurate.
Once completed, submit the form by mailing it to the Federal Aviation Administration at the specified address.

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