5100-101 Application for Federal Assistance (Attachment to SF-424

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a
collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number
for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be approximately 28 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses are required to retain a benefit under 49 CFR 18.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: Federal Aviation Administration,
ARP-10, 800 Independence Ave SW, Washington DC, 20591.
DEPARTMENT OF TRANSPORTATION – FEDERAL AVIATION ADMINISTRATION

OMB NO. 2120-0569
1/31/2013

PART II

PROJECT APPROVAL INFORMATION

Item 1.
Does this assistance request require State,
local, regional, or other priority rating?

Name of Governing Body
Priority
Yes

No

Item 2.
Does this assistance request require State, local
advisory, educational or health clearances?

Name of Agency or Board
(Attach Documentation)
Yes

No

Item 3.
Does this assistance request require clearinghouse
review in accordance with OMB Circular A-95?

(Attach Comments)

Yes

No
Name of Approving Agency

Item 4.
Does this assistance request require State,
local, regional, or other planning approval?
Yes

No

Item 5.
Is the proposed project covered by an approved
comprehensive plan?

/

/

Check One:

Yes

No

Item 6.
Will the assistance requested serve a
Federal installation?

State
Local
Regional

Location of plan
Name of Federal Installation
Federal Population benefiting from Project

Yes

No

Item 7.
Will the assistance requested be on Federal land
or installation?

Name of Federal Installation
Location of Federal Land
Percent of Project
Yes

No

Item 8.
Will the assistance requested have an impact
or effect on the environment?

See instructions for additional information to be
provided.
Yes

No

Item 9.
Will the assistance requested cause the displacement
of individuals, families, businesses, or farms?
Yes

No

Item 10.
Is there other related Federal assistance on this
project previous, pending, or anticipated?

Number of:
Individuals
Families
Businesses
Farms
See instructions for additional information to be provided.

Yes
FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 59 10-1 and 59 20-1

Date

No
Page 2

INSTRUCTIONS

PART II

Negative answers will not require an explanation unless the Federal agency requests more information at a later date. Provide
supplementary data for all “Yes” answers in the space provided in accordance with the following instructions.
Item 1. – Provide the name of the governing body
establishing the priority system and the priority rating
assigned to this project.
Item 2. – Provide the name of the agency or board which
issued the clearance and attach the documentation of status
or approval.
Item 3. – Attach the clearinghouse comments for the
application in accordance with the instructions contained in
Office of Management and Budget Circular No. A-95. If
comments were submitted previously with a preapplication,
do not submit them again but any additional comments
received from the clearinghouse should be submitted with
this application.
Item 4. – Furnish the name of the approving agency and the
approval date.
Item 5. – Show whether the approved comprehensive plan is
State, local or regional, or if none of these, explain the scope
of the plan. Give the location where the approved plan is
available for examination and state whether this project is in
conformance with the plan.

Item 6. – Show the Federal population residing or working on
the federal installation that will benefit from this project.
Item 7. – Show the percentage of the project work that will be
conducted on federally-owned or leased land. Give the
name of the Federal installation and its location.
Item 8. – Briefly describe the possible beneficial and/or
harmful impact on the environment because of the proposed
project. If an adverse environmental impact is anticipated,
explain what action will be taken to minimize the impact.
Federal agencies will provide separate instructions if
additional data is needed.
Item 9. – State the number of individuals, families,
businesses, or farms this project will displace. Federal
agencies will provide separate instructions if additional data
is needed.
Item 10. – Show the Federal Domestic Assistance Catalog
number, the program name, the type of assistance, the
status, and amount of each project where there is related
previous, pending, or anticipated assistance. Use additional
sheets, if needed.

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION

OMB NO. 2120-0569

PART III - BUDGET INFORMATION
SECTION A - BUDGET SUMMARY
Grant Program,
Function
or Activity

Federal
Catalog No.

(a)

(b)

1.

Estimated Unobligated Funds
Federal
(c)

New or Revised Budget

Non-Federal
(d)

Federal
(e)

Non-Federal
(f)

Total
(g)

$

$

$

$

$

$

$

$

$

$

2.
3.
4.
5.

TOTALS

SECTION B - BUDGET CATEGORIES
6.

Object Class
Categories

Grant Program, Function or Activity

Total

(1)

(2)

(3)

(4)

(5)

$

$

$

$

$

k. TOTALS

$

$

$

$

$

7. Program Income

$

$

$

$

$

a. Personnel
b. Fringe Benefits
c. Travel
d. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
i. Total Direct Charges
j. Indirect Charges

FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1

Page 3

INSTRUCTIONS

PART III

GENERAL INSTRUCTIONS

This form is designed so that application can be made for funds from one or more grant programs. In preparing the budget,
adhere to any existing Federal grantor agency guidelines which prescribe how and whether budgeted amounts should be
separately shown for different functions or activities within the program. For some programs, grantor agencies may require
budgets to be separately shown by function or activity. For other programs, grantor agencies may not require a breakdown by
function or activity. Sections A, B, C, and D should include budget estimates for the whole project except when applying for
assistance which requires Federal authorization in annual or other funding period increments. In the latter case, Sections A,
B, C, and D should provide the budget for the first budget period (usually a year) and Section E should present the need for
Federal assistance in the subsequent budget periods. All applications should contain a breakdown by the object class
categories shown in Lines a-k of Section B.

SECTION A. BUDGET SUMMARY
Lines 1-4, Columns (a) and (b).
For applications pertaining to a single Federal grant pro-gram
(Federal Domestic Assistance Catalog number) and not
requiring a functional or activity breakdown, enter on
Line 1 under Column (a) the catalog program title and the
catalog number in Column (b).
For applications pertaining to a single program requiring
budget amounts by multiple functions of activities, enter the
name of each activity or function on each line in Column (a),
and enter the catalog number in Column (b). For
applications pertaining to multiple programs where none of
the programs requires a breakdown by function or activity,
enter the catalog program title on each line in Column (a)
and the respective catalog number on each line in
Column (b).

For applications pertaining to multiple programs where one or
more programs require a breakdown by function or activity,
prepare a separate sheet for each program requiring the
breakdown. Additional sheets should be used when one
form does not provide adequate space for all breakdown of
data required. However, when more than one sheet is used,
the first page should provide the summary totals by
programs.
Lines 1-4, Columns (c) through (g).

For new applications, leave Columns (c) and (d) blank. For

each line entry in Columns (a) and (b), enter in Columns (e),

(f), and (g) the appropriate amounts of funds needed to

support the project for the first funding period (usually a

year).

For continuing grant program applications, submit these

forms before the end of each funding period as required by
the grantor agency. Enter in Columns (c) and (d) the

estimated amounts of funds that will remain unobligated at

the end of the grant funding period only if the Federal grantor

agency instructions provide for this. Otherwise, leave these

columns blank. Enter in columns (e) and (f) the amounts of

funds needed for the upcoming period. The amount(s) in

Column (g) should be the sum of amounts in Columns (e)

and (f).

For supplemental grants and changes to existing grants, do

not use Columns (c) and (d). Enter in Column (e) the amount

of the increase or decrease of Federal funds and enter in

Column (f) the amount of the increase or decrease of non-

Federal funds. In Column (g) enter the new total budgeted

amount (Federal and non-Federal) which includes the total

previous authorized budgeted amounts plus of minus, as
appropriate, the amounts shown in Columns (e) and (f). The
amount(s) in Column (g) should not equal the sum of
amounts in Columns (e) and (f).
Line 5 - Show the totals for all columns used.

SECTION B. BUDGET CATEGORIES
In the column headings (1) through (4), enter the titles of the same programs, functions, and activities shown on Lines 1-4,
Column (a), Section A. When additional sheets were prepared for Section A, provide similar column headings on each sheet.
For each program, function, or activity, fill in the total requirements for funds (both Federal and non-Federal) by object class
categories.
Lines 6 a-h - Show the estimated amount for each direct
cost budget (object class) category for each column with
program, function, or activity heading.
Line 6i - Show the totals of Lines 6a to 6h in each column.
Line 6j - Show the amount of indirect cost. Refer to Office of
Management and Budget Circular No. A-87.
Line 6k - Enter the total amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total
amount in column (5), Line 6k, should be the same as the
total amount shown in Section A, Column (g), Line 5.

For supplemental grants and changes to grants, the total
amount of the increase or decrease as shown in
Columns (1) - (4), Line 6k should be the same as the sum of
the amounts in Section A, Column (e) and (f) on Line 5.
When additional sheets were prepared, the last two
sentences apply only to the first page with summary totals.
Line 7 - Enter the estimated amount of income, if any,
expected to be generated from this project. Do not add or
subtract this amount from the total project amount. Show
under the program narrative statement the nature and source
of income. The estimated amount of program income may
be considered by the Federal grantor agency in determining
the total amount of the grant.

DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION

OMB NO. 2120-0569

SECTION C - NON-FEDERAL RESOURCES
(a) GRANT PROGRAM

(b) APPLICANT
$

8.

(d) OTHER
SOURCES

(c) STATE
$

$

(e) TOTALS
$

9.
10.
11.
12. TOTALS

SECTION D - FORECASTED CASH NEEDS
Total for 1st Year
13. Federal

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

$

$

$

$

$

$

$

$

$

$

14. Non-Federal
15. TOTAL

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
FUTURE FUNDING PERIODS (YEARS)

(a) GRANT PROGRAM

(b) FIRST

16.

(c) SECOND

(d) THIRD

(e) FOURTH

$

$

$

$

$

$

$

$

17.
18.
19.
20. TOTALS

SECTION F - OTHER BUDGET INFORMATION
(ATTACH ADDITIONAL SHEETS IF NECESSARY)

21. Direct Charges:

22. Indirect Charges:

23. Remarks:

PART IV - PROGRAM NARRATIVE (ATTACH PER INSTRUCTION)
FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1

Page 4

INSTRUCTIONS
PART III (CONTINUED)

SECTION C. SOURCE OF NON-FEDERAL RESOURCES

Line 8-11 - Enter amounts of non-Federal resources that will
be used on the grant. If in-kind contributions are included,
provide a brief explanation on a separate sheet. (See
Attachment F, Office of Management and Budget Circular
No. A-102.)
Column (a) - Enter the program titles identical to Column
(a), Section A, A breakdown by function or activity is not
necessary.
Column (b) - Enter the amount of cash and in-kind
contributions to be made by the applicant as shown in
Section A. (See also Attachment F, Office of Management
and Budget Circular No. A-102).

Column (c) - Enter the State contribution if the applicant is
not a State or State agency. Applicants that are a State or
State agencies should leave this column blank.
Column (d) - Enter the amount of cash and inn-kind
contributions to be made from all other sources.
Column (e) - Enter the totals of Columns (b), (c), and (d).
Line 12 - Enter the total for each of Columns (b)-(e). The
amount in Column (e) should be equal to the amount on
Line 5, Column (f), Section A.

Section D. Forecasted Cash Needs
Line 13 - Enter the amount of cash needed by quarter from
the grantor agency during the first year.

Line 14 - Enter the amount of cash from all other sources
needed by quarter during the first year.
Line 15 - Enter the totals of amounts on Lines 13 and 14.

SECTION E. BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
Lines 16 - 19 - Enter in Column (a) the same grant program
titles shown in Column (a), Section A. A breakdown by
function or activity is not necessary. For new applications
and continuing grant applications, enter in the proper
columns amounts of Federal funds which will be needed to
complete the program or project over the succeeding funding
periods (usually in years). This Section need not be
completed for amendments, changes, or supplements to
funds for the current year of existing grants.

If more than four lines are needed to list the program titles,
submit additional schedules, as needed.
Line 20 - Enter the total for each of the Columns (b) - (e).
When additional schedules are prepared for this Section,
annotate accordingly and show the overall totals on this line.

SECTION F - OTHER BUDGET INFORMATION.
Line 21 - Use this space to explain amounts for individual
direct object cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal
grantor agency.

Line 22 - Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the
funding period, the estimated amount of the base to which
the rate is applied, and the total indirect expense.
Line 23 - Provide any other explanations required herein or
any other comments deemed necessary.

PART IV

PROGRAM NARRATIVE

(Suggested Format)
DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION

OMB NO. 2120-0569

PROJECT:
AIRPORT:
1. Objective:

2. Benefits Anticipated:

3. Approach: (See approved Scope of Work in final Application)

4. Geographic Location:

5. If Applicable, Provide Additional Information:

6: Sponsor’s Representative: (incl. address & tel. no.)

FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1

PAGE 6

INSTRUCTIONS
PART IV

PROGRAM NARRATIVE

Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests
for continuation or refunding and changes on an approved project should respond to item 5b only. Requests for supplemental
assistance should respond to question 5c only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE.
Pinpoint any relevant physical, economic, social, financial,
institutional, or other problems requiring a solution.
Demonstrate the need for assistance and state the principal and
subordinate objectives of the project. Supporting documentation
or other testimonies from concerned interests other than the
applicant may be used. Any relevant data based on planning
studies should be included or footnoted.
2. RESULTS OR BENEFITS EXPECTED.
Identify results and benefits to be derived. For example,
include a description of who will occupy the facility and show
how the facility will be used. For land acquisition or
development projects, explain how the project will benefit the
public.
APPROACH
a. Outline a plan of action pertaining to the scope and
detail of how the proposed work will be accomplished for
each grant program. Cite factors which might accelerate
or decelerate the work and your reason for taking this
approach as opposed to others. Describe any unusual
features of the project such as design or technological
innovations, reductions in cost or time, or extraordinary
social and community involvements.
b. Provide each grant program monthly or quarterly
quantitative projections of the accomplishments to be
achieved, if possible. When accomplishments cannot be
quantified, list the activities in chronological order to
show the schedule of accomplishments and their target
dates.
c. Identify the kinds of data to be collected and maintained,
and discuss the criteria to be used to evaluate the
results and success of the project. Explain the
methodology that will be used to determine if the needs
identified and discussed are being met and if the results
and benefits identified in Item 2 are being achieved.

d. List each organization, cooperator, consultant, or other
key individuals who will work on the project along with a
short description of the nature of their effort or
contribution.
4. GEOGRAPHIC LOCATION.
Give a precise location of the project and area to be served
by the proposed project. Maps or other graphic aids may be
attached.
5. IF APPLICABLE, PROVIDE THE FOLLOWING
INFORMATION:
a. Describe the relationship between this project and other
work planned, anticipated, or underway under the
Federal Assistance listed under Part II, Section A,
Item 10.
b. Explain the reason for all requests for supplemental
assistance and justify the need for additional funding.
c. Discuss accomplishments to date and list in
chronological order a schedule of accomplishments,
progress, or milestones anticipated with the new funding
request. If there have been significant changes in the
project objectives, location, approach or time delays,
explain and justify. For other requests for changes or
amendments, explain the reason for the change(s). If
the scope or objectives have changed or an extension of
time is necessary, explain the circumstances and justify.
If the total budget has been exceeded or if individual
budget items have changed more than the prescribed
limits contained in Attachment K, Office of Management
and Budget Circular No. A-102, explain and justify the
change and its effect on the project.