FS-5700-20A Instructions
General - This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals supplying information for
inclusion in a system of records.
Authority - The authority to collect the information on the attached form is contained in 5 USC 552A.
Purpose and Use - This information, along with data you may have supplied previously, and information developed by investigation will be for use by
such as:
1. To determine your pilot qualifications to comply with contract specifications.
2. Transfer to the U.S. Department of Justice in the event of litigation.
3 Transfer, in the event there is indicated violation or potential violation of a statute, regulation, whether civil, criminal, or regulatory in nature, to the
appropriate agency or agencies, whether Federal, State, local, or foreign, charged with the responsibility of investigation or prosecuting such
violation or charged with enforcing or implementing the statute, rule, regulation, order, or license violated or potentially violated.
I. Applicant Information
a. Pilot Name (Last, First) – Self-explanatory.
b. Office Telephone - Self-explanatory.
c. E-mail – Company or email address used for business.
d. Employer – The Company that holds the contract.
e. Previous Employer – Only required if a pilot card was issued to the pilot while employed.
f. PIC HELICOPTER – Provide Pilot-in-Command time as required by the contract. Additional documentation of flight time may be required.
Ldgs=Number of landings.
g. PILOT HISTORY – Self-explanatory.
h. 14 CFR 135 QUALIFICATIONS - Self-explanatory.
i. OTHER FAA 14 CFR DOCUMENTATION – Provide dates completed for FAA required training and/or evaluations. Be prepared to present
documentation to an OAS pilot inspector as required.
j. M M & Series – Make, Model & Series. VTR – Vertical Reference flight time, flight time acquired while maneuvering this MM&S helicopter via
vertical reference. Mtn – Mountainous terrain flight time acquired in this MM&S at and below 1000 feet within designated mountainous areas defined
by 14 CFR 95 Subpart B, 12 mo – Flight time in this MM&S within the previous 12 calendar months, Hours – PIC time in this MM&S. It may be
necessary to provide additional MM&S within a make and model family to document required make and model time.
k. Applicant Remarks – Add anything you feel is pertinent.
l. Self-explanatory – Electronic signatures are acceptable.
m. Company Official must be Director of Operations, Chief Pilot or equivalent. First box must always be checked. The second box is only
required when applicant is
vertical reference longline approved or seeking evaluation. Electronic signatures are acceptable.
II. Inspector Information:
a. Checklist of Documents Verified by the Inspector – A checked box indicates that you, the inspector, looked at the required documents and then
returned them to the applicant. Provide expiration date as required.
b. Check if applicant is approved and attach a copy of the OAS-30B/5700-3A issued to the applicant.
c. Check if applicant is not approved and add any required comments in the remarks section.
d. Electronic signatures are acceptable
e. Add any comments necessary.
U.S. Forest Service
OMB 0596-0021 Exp 12/2021
I. Applicant Information
a. Pilot Name (Last, First)
b. Office Telephone
c. E-mail
d. Employer e. Previous Employer
Address Dates Employed Telephone
City, ST ZIP
Previous Employer
Telephone Dates Employed Telephone
Hire Date
Date of Last Agency Flight Evaluation _________________ OAS USFS
Date of Previous Agency Card _________________ OAS USFS
(Attach a copy)
YES NO Aircraft accidents within the last 5 years.
YES NO FAA violati
ons within the last 5 years.
YES NO OAS or USFS pilot card denied, suspended, or revoked.
(Attach details and explanation for each YES)
Last 12 Months
Last 90 Days
More than 12,500 lbs.
Turbine Engine
Reciprocating Engine
Mountainous Terrain
Date Make, Model & Series Type of Qualification
___________ _________________ VFR IFR IFR W/AP SIC Only
___________ _________________ VFR IFR IFR W/AP SIC Only
___________ _________________ VFR IFR IFR W/AP SIC Only
___________ _________________ VFR IFR IFR W/AP SIC Only
(Attach FAA 8410-3 or equivalent)
NVG Operations
Night Unaided
Offshore Navigation
Platform Ldgs Vessel Ldgs
Vertical Reference
IFR Simulated
IFR Actual
i. OTHER FAA 14 CFR DOCUMENTATION (dates as required)
61.55 SIC Qualification ____________ 61.56 Flight Review _____________
61.57 IFR Currency ____________ 61.58 PIC Proficiency _____________
133 Demonstration ____________ 137 Demonstration _____________
(Attach a copy of endorsements, letters or logbook entries when requested)
M M & Series
VTR Mtn 12 mo Hours
k. Applicant Remarks
l. I certify that the information listed on this form is true and correct. In addition, I certify that I have read the information provided pursuant to Public Law 93-579 (Privacy Act of 1974).
Pilot: __________________________________________________________________________
(Signature) (Date)
m. I certify that I have verified the information listed on this form and that it is true and correct to the best of my knowledge.
I certify that this pilot received a minimum of 10 hours of vertical reference/external load flight training for initial qualification, has received 2 hours of vertical reference longline
training within the past 12 calendar months, and has demonstrated proficiency in accordance the Interagency Helicopter Practical Test Standards.
Company Official: ________________________________________________________________________________________________________
(Print Name and Title) (Signature) (Date)
II. Inspector Information:
Checklist of Documents Verified by the Inspector
Pilot Certificate
Medical Certificate
14 CFR 135 Evaluation
14 CFR 137 Endorsement
14 CFR 133 Endorsement
VTR Training Endorsement
Signature Page Ops & Safety Proc Guide
b. Approved attach OAS-30B/5700-3A c.Disapproved (see remarks)
d. Inspector: ____________________________________________________________________________________________________________
(Print Name) (Agency) (Date) (Signature)
e. Remarks: ____________________________________________________________________________________________________________
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