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Tolerance Specific ICA 12. ADDITIONAL INFORMATION CHECK ALL THAT APPLY: WILL A FLIGHT TEST BE REQUIRED UNDER FAR PART 91.407 (b) ? YES NO PMA PRODUCT YES: ON AIRCRAFT ELIGIBILITY LIST YES: NOT ON AIRCRAFT ELIGIBILITY LIST NO TSO PRODUCT YES NO LIST TSO CERTIFICATION CLEAR ENTIRE FORM RESET PAGE 1 RESET PAGE 2 FIELD APPROVAL CHECKLIST FAA USE ONLY Assigned Inspector: Date Received: NO YES Is a Field Approval Appropriate? If a Field Approval is not performed, what is the proper method for.

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