Information Collection

Passenger Facility Charge (PFC) Application

IC 25628 under ICR 200701-2120-016 · OMB 2120-0557.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0557 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5500-1 Passenger Facility Charge (PFC) Application	Form
5500-1 Passenger Facility Charge (PFC) Application 5500-1.pdf forms.faa.gov/redirect.asp?fnumber=5500-1&url=forms/faa5500-1.pdf&hit=1	Form

IC Title:

Passenger Facility Charge (PFC) Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 14 CFR 158

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5500-1	Passenger Facility Charge (PFC) Application	5500-1.pdf	http://forms.faa.gov/redirect.asp?fnumber=5500-1&url=forms/faa5500-1.pdf&hit=1	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,400	745	1,655
Annual IC Time Burden (Hours)	24,025	-2,523	26,548
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.