Appendix A
02/15/2015 AC 21-54 Appendix A Appendix A. Sample Program Letter for a Special Airworthiness Certificate 1. Registered Owner (as shown on Certificate of Aircraft registration) NAME: Brand X Support Services, Inc.
ADDRESS: 123 Airport Street Any Town, USA 00010-0001 2. Aircraft Description a. Aircraft Registration: N12345 b. Aircraft Yr. Mfg.: 1972 c. Aircraft Serial No.: 52 d. Manufacturer Make and Model: Aero Vodochody, L-39 Albatros For aircraft seeking certification for experimental R&D.
3. Describe program purpose for which the aircraft is to be used (14 CFR 21.193(d)(1)).
R&D providing chase for Major Airplane Manufacturer for certification testing of their next bizjet. Aircraft Certification Office X is the project office. The assigned project number is ACOXzzz.
4. Provide the following information as it pertains to your Program Letter.
a. List estimated flight hours required for the R&D program, proficiency flights, and maintenance flights: 100, 10, and 10 hours, respectively.
b. List estimated number of flights required for the R&D program, proficiency flights, and maintenance flights: 50, 5, and 5 flights, respectively.
c. List estimated duration for programs (14 CFR 21.193(d)(2)). 150 days 5. Describe the areas over which the flights are to be conducted, and address of base operation (14 CFR 21.193(d)(3)).
All flights will take place within 150nm of airport KAAA, excluding the airspace over City-X.
The maximum altitude is FL240. The base of operations is Major Airplane Manufacturer Hangar, 12345 Tower Drive, City-X, 00025.
6. Describe the aircraft configuration (attach three-view drawings or three-view dimensioned photographs of the aircraft (14 CFR 21.193(d)(4)) and include a description of how the configuration is different from the other purposes listed). See attached.
For aircraft seeking certification for experimental exhibition.
3a. Describe program purpose for which the aircraft is to be used (14 CFR 21.193(d)(1)).
Exhibition at the following events over the next 8 months: AirVenture - KOSH, August 1, 2013 Billy Bob’s Air Event - KAAA, June 30, 2013 A-1
Appendix A
02/15/2015 AC 21-54 Appendix A 4a. Provide the following information as it pertains to your Program Letter.
a. List estimated flight hours required for the exhibits, proficiency flights, and maintenance flights: 13 hours exhibition, including the flights to and from the events, 8 hours for proficiency, and 4 hours for maintenance.
b. List estimated number of flights required for the exhibits, proficiency flights, and maintenance flights: 6, 4, and 2 flights, respectively.
c. List estimated duration for programs (14 CFR 21.193(d)(2)). 8 months 5a. Describe the areas over which the flights are to be conducted, and address of base operation (14 CFR 21.193(d)(3)).
Proficiency flights will take place within 125nm of AnyTown, USA airport with a maximum altitude of 10,000 feet. The base of operations is the address listed above. Proposed routes to/from the above events are annotated on attached map.
6a. Describe the aircraft configuration (attach three-view drawings or three-view dimensioned photographs of the aircraft (14 CFR 21.193(d)(4) and include a description of how the configuration is different from the other purposes listed). See attached.
7. Date, Name and Title (Print or Type), and Signature.
A-2
Appendix B
02/15/2015 AC 21-54 Appendix B Appendix B. Sample Program Letter for a Special Airworthiness Certificate With Military/State/Public Aircraft Operations 1. Registered Owner (as shown on Certificate of Aircraft registration) NAME: Brand Y Support Services, Inc.
ADDRESS: 123 Airport Street Any Town, USA 00010-0001 2. Aircraft Description a. Registration Marks: N12345 b. Aircraft Yr. Mfg.: 1972 c. Aircraft Serial No.: 52 d. Aircraft Model Designation: Aero Vodochody, L-39 Albatros R&D 3. Describe program purpose for which the aircraft is to be used (14 CFR 21.193(d)(1)).
R&D providing chase for Major Airplane Manufacturer for certification testing of their next bizjet. Aircraft Certification Office X is the project office. The assigned project number is ACOXzzz.
4. Provide the following information as it pertains to your Program Letter.
a. List estimated flight hours required for the R&D program, proficiency flights, and maintenance flights: 90 hours b. List estimated number of flights required for the R&D program, proficiency flights, and maintenance flights: 50, 5, and 5 flights, respectively.
c. List estimated duration for programs (14 CFR 21.193(d)(2)). 150 days 5. Describe the areas over which the flights are to be conducted, and address of base operation (14 CFR 21.193(d)(3)).
The flights will take place within 150nm of airport KAAA, excluding the airspace over City-X. The maximum altitude is FL240. The base of operations is Major Airplane Manufacturer Hangar, 12345 Tower Drive, City-X, 00025.
6. Describe the aircraft configuration (attach three-view drawings or three-view dimensioned photographs of the aircraft (14 CFR 21.193(d)(4)) and include a description of how the configuration is different from the other purposes listed). See attached.
Exhibition 3a. Describe program purpose for which the aircraft is to be used (14 CFR 21.193(d)(1)).
Exhibition at the following events over the next 8 months: AirVenture - KOSH, August 1, 2013 Billy Bob’s Air Event - KAAA, June 30, 2013 B-1
Appendix B
02/15/2015 AC 21-54 Appendix B 4a. Provide the following information as it pertains to your Program Letter.
a. List estimated flight hours required for the exhibits, proficiency flights, and maintenance flights: 13 hours exhibition, including the flights to and from the events, 8 hours for proficiency, and 4 hours for maintenance.
b. List estimated number of flights required for the exhibits, proficiency flights, and maintenance flights: 6, 4, and 2 flights, respectively.
c. List estimated duration for programs (14 CFR 21.193(d)(2)). 8 months 5a. Describe the areas over which the flights are to be conducted, and address of base operation (14 CFR 21.193(d)(3)).
Proficiency flights will take place within 125nm of AnyTown, USA airport with a maximum altitude of 10,000 feet. The base of operations is the address listed above. Proposed routes to/from the above events are annotated on attached map.
6a. Describe the aircraft configuration (attach three-view drawings or three-view dimensioned photographs of the aircraft (14 CFR 21.193(d)(4) and include a description of how the configuration is different from the other purposes listed). See attached.
Military / State / Public Aircraft Operations The aircraft will provide contract support for the U.S. Department of Defense and Country X Army Air Force. The contract calls for towing targets, aerial survey, operating as aggressor for pilot training, aerial gunnery, missile launch, and dropping bombs.
The flight area extends from the Somewhere Province to Greenland. The maximum altitude is FL410. The flight profiles call for a maximum g-force of 10.
A picture of the aircraft as configured for PAO is attached. Note the addition of an external store. We also will enable the ability to release external stores during these operations.
7. Date, Name and Title (Print or Type), and Signature B-2
Appendix C
02/15/2015 AC 21-54 Appendix C Appendix C. Related Publications C.1 FAA ORDERS.
C.1.1 FAA Order 8130.2, Airworthiness Certification of Aircraft and Related Products.
C.1.2 FAA Order 8900.1, Flight Standards Information Management System (FSIMS).
C.2 FAA ADVISORY CIRCULARS (AC).
C.2.1 AC 00-1.1, Public Aircraft Operations.
C.2.2 AC 20-65, U.S. Airworthiness Certificates and Authorizations for Operation of Domestic and Foreign Aircraft.
C.2.3 AC 21-4, Special Flight Permits for Operation of Overweight Aircraft.
C.2.4 AC 21-12, Application for U.S. Airworthiness Certificate, FAA Form 8130-6.
C.2.5 AC 43-9, Maintenance Records.
C.2.6 AC 43-209, Recommended Inspection Procedures for Former Military Aircraft.
C.2.7 AC 45-2, Identification and Registration Marking.
C.2.8 AC 150/5220-9, Aircraft Arresting Systems for Joint Civil/Military Airports.
C.3 OTHER DOCUMENTS.
C.3.1 Title 14 of the Code of Federal Regulations parts 21, 43, 45, 47, 91, and 375 set forth the requirements for certification procedures of products and parts; maintenance, preventive maintenance, rebuilding, and alteration; identification and registration marking of aircraft; aircraft registration; general flight and operating rules; and the navigation requirements of foreign civil aircraft within the United States.
C.3.2 We also encourage you to use the FAA website at http://www.faa.gov/aircraft/air_cert/ for additional information and guidance.
C-1
Appendix D
02/15/2015 AC 21-54 Appendix D Appendix D. Advisory Circular Feedback Information If you have comments or recommendations for improving this advisory circular (AC), or suggestions for new items or subjects to be added, or if you find an error, you may let us know by using this page as a template and 1) emailing it to 9-AWA-AVS-AIR500-Coord@faa.gov or 2) faxing it to the attention of the AIR Directives Management Officer at 202-267-3983.
Subject: (insert AC number and title) Date: (insert date) Comment/Recommendation/Error: (Please fill out all that apply) An error has been noted: Paragraph ____________________ Page ______ Type of error (check all that apply): Editorial:----- Procedural---- - Conceptual____ Description/Comments:______________________________________________ _________________________________________________________________ _________________________________________________________________ Recommend paragraph ______ on page ______ be changed as follows: (attach separate sheets if necessary) _________________________________________________________________ In a future change to this advisory circular, please include coverage on the following subject: (briefly describe what you want added attaching separate sheets if necessary) ________________________________________________________________ Name: __________________________ D-1