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Use to request that a specific airspace control means be specified in a future airspace control order. Reference: FM 100-103.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — REQUESTING UNIT____________________________(Name of Unit or Agency Requesting Airspace)

LINE 4 — TYPE________________________________________(Type of Airspace)

LINE 5 — AIRSPACE___________________________________(Name of Airspace)

LINE 6 — PURPOSE____________________________________(Purpose of Special Use Airspace)

LINE 7 — TRANSIT_____________________________________(Transit Instructions)

LINE 8 — FROM_______________________________________(DTG to be Established)

LINE 9 — UNTIL_______________________________________(DTG to be Disestablished)

LINE 10 — AREA_______________________________________(Description of the Area to be Defined (Boundary or Circle))

LINE 11 — COORDINATES______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 12 — WIDTH/RADIUS______________________________(Width or Radius)

LINE 13 — LOWER_____________________________________(Lower Altitude of Designated Area to Nearest 100 Feet or Ground Level)

LINE 14 — UPPER______________________________________(Upper Altitude of Designated Area to Nearest 100 Feet)

LINE 15 — CONTACT___________________________________(Call Sign of Control Agency)

LINE 16 — PRIMARY___________________________________(Primary Frequency or Frequency Designator)

LINE 17 — SECONDARY________________________________(Secondary Frequency or Frequency Designator)

LINE 18 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 19 — AUTHENTICATION___________________________(Report Authentication)

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