Appendix 1 Instructions for Completing FAA Form 8120-11, Suspected Unapproved Parts Report
1. Record the date the part was discovered.
2. Record the part name (or a description of the part).
3. Record the part number or identification number of the part.
4. Record the serial number on the part, if applicable
5. Record the quantity of parts.
6. Record the assembly name and assembly number (where the part was or could be installed).
Example: Part Name: Strut Part Number: PN 12345 Serial Number: 678 Quantity: 1 Assembly Name: Main Landing Gear Assembly Number: PN 90101112 NOTE: Record additional part numbers on page 3 or a blank sheet of paper with the following column headers:
Part Number - Serial Number - Quantity - Assembly Name - Assembly Number
7. Record the type of aircraft the part was (or could be) installed on.
Record the complete name and address of the company or person who produced, repaired, andior sold the part. Do not list a P.O. Box address unless a street address is not available.
Check the box that describes the company or person. Provide the certificate number, if known.
Air Carrier - An FAA-certificated company or person who Supplier - A company or person who fumishes aircraft parts or undertakes directly by lease, or other arrangement, to related services, at any tier, to the producer of a product or part engage in air transportation. thereof.
Mechanic - A person holding an FAA mechanic certificate Production Approval Holder - A company or person holding with airframe andior powerplant ratings. one of the to lowing four types of FAA production approvals production certificate, approved production inspection system.
parts manufacturer approval, or technical standard order authorization.
Repair Station - An FAA-certficated repair station. Manufacturer - The original equipment manufacturer (OEM.)
Distributor - A broker, dealer, reseller or other person or Other-Record other type of business.
agency engaged in the sale of parts.
Owner/Operator - The owner or operator of an aircrait. Unknown . Record a bnet narrative stating why you beleve the part is not approved. Include a description or the part (imprope onfiguration, suspect marking, different material, etc.), where it was obtained, and what type of documentation was supplie with it.
10. Record the complete name and address of the location where the part was found. Check the appropriate block to reflect the all aton of the company or person who discovered the part.
information, if necessary.
14. Check this box if you request confidentiality of your personal infomation recorded in block 13.
15. Check this box if you have provided additional information (photos, invoices, certification statements, etc.)
Forward the completed FAA For 8120-11, Suspected Unapproved Parts Report, to:
Federal Aviation Administration Office of Accident Investigation, Aviation Safety Hotline, Rm 840 800 Independence Avenue, SW, Washington, DC 20591 An electronic copy of FAA Form 8120-11, Suspected Unapproved Parts Report, is available on the FAA website at http://www.faa.gow/aircraft/safety/programs/sups. You may complete the electronic FAA Form 8120-11 and send it to the Aviation Safety Hotline e-mail: S-AWA-AVS-AAL-SafetyHotlinemfaa goy. The Hotline phone number is (800) 255-1111 or
(866) 835-5322.
Privacy Act and Paperwork Reduction Act Statement:
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 OMB control number for this form is 2120-0552. This information is collected by the FAA's Suspected Unapproved Parts (SUP) Program, under the authority of 49 USC 44701. The information wil be used to support SUP investigations and management reports. Submission of this information is voluntary, with questions limited to reduce any burden on the reporter. Completion of this form is estimated to take 30 minutes. Information collected is not available elsewhere and necessary to support the FAR's commitment to promote safety. Information is routinely shared with law enforcement agencies for use in civil and criminal investigations. Information developed from this form is covered under the Privacy Act system of records DOT/FAA 852 and the routine uses of that system will apply. A reporter may request confidentiality of personal Information to the extent permitted by the Freedom of Information Act (5 USC 552) and the Privacy Act (5 FAA Form 8120-11 (07/20/2007) Supersedes Previous Edition Local Reprocuction Authorized Page 2
Appendix 1
FAA Form 8120-11, Suspected Unapproved Parts Report Continuation Sheet, Page ( ) of ( )
Part Name
Part Number Serial Number
Quantity Assembly Name Assembly Number
FAA Form 8120-11 (10/16/2003) Supersedes Previous Edition Page 3 (and 4)