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U.S. Department of Transportation
Federal Aviation Administration
Flight Information Entry
(FAA USE ONLY)
Time Started
Specialist Initials
1. Type
3. Aircraft Type
4. True Airspeed
KTS
5. Departure Point
6. Departure Time
Proposed (Z)
Actual (Z)
7. Cruising Altitude
9. Destination Point
10. Est. Time Enroute
Hours
Minutes
11. Remarks
ADS-B Position Source TSO
ADS-B Link TSO
Mask Angle
12. Fuel on Board
Hours
Minutes
13. Alternate Routes
14. Pilot's Name, Address & Telephone Number & Aircraft Home Base
17. Destination Contact/Telephone (optional)
15. Number Aboard
16. Color of Aircraft
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Deviation Request
Pilot-in-Command (PIC):
PIC Telephone Number:
PIC Email Address:
Aircraft Identification:
Reason for Request:
Flight Classification:
ADS-B Equipment Status:
Operational Transponder with Altitude Encoding:
(Note: Any request made without a working transponder will be DENIED)
Comments (required when "Reason for Request" is 'Other'):
 I hereby certify that all information entered on this form is true and accurate.
 
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