Aircraft Operators

DEPARTMENT OF HOMELAND SECURITY

OMB 1652-0035

Transportation Security Administration
DCA Access Standard Security Program (DASSP)
Aircraft Operator Application Form

Full company Name: __________________________________________________________________________________________
Address: ____________________________________________________________________________________________________
City: _______________________________________
Corporate Flight Department Location:

State: ________________

Zip Code:__________________

_______________________________________________________________________

Flight Department Mailing Address: ___________________________________________________________________________
City: _______________________________________

State: ________________

Zip Code: _________________

Airport used as base of operation (use airport identifier): ______________________________
Do you presently comply with a TSA Standard Security Program (i.e. TFSSP, AOSSP, or PCSSP)?

Yes

No

If Yes, please specify which program: _____________________________________________________________________________
Security Coordinator:
Name:
Primary

First

Middle

Last

Phone

Email

Alternate
Applicant’s Name: ________________________________________________________________________________________
Applicant Telephone Number (s): _______________________

Email Address: _____________________________________

Applicant’s Signature & Title: ____________________________________________________________________________________
** Completed applications can be emailed to:[email protected] or faxed to (703)603-4030. **

PRIVACY ACT STATEMENT
AUTHORITY: 49 U.S.C. § 114; Pub. L. 108-176. PRINCIPAL PURPOSE(S): To identify individuals eligible to serve as armed security
officers aboard general aviation flights into DCA. ROUTINE USE(S): This information you provide may be shared with aircraft and
airport operators, and the FAA, or for routine uses identified in TSA system of records, DHS/TSA 002, Transportation Security Threat
Assessment System. DISCLOSURE: Voluntary; failure to furnish the requested information may result in delays in processing or
denial of your nomination.
PAPERWORK REDUCTION ACT BURDEN STATEMENT
This is a mandatory collection of information if you wish to fly into or from Ronald Reagan National Airport (DCA) in Washington, DC or
act as a gateway fixed base operator for aircraft inbound to DCA. The total average burden per response associated with this collection
is estimated to be approximately 45 m inutes. An agency may not conduct or sponsor, and a per son is not required to respond to a
collection of information unless it displays a valid 0MB control number. The control number assigned to theis collection is OMB 16520035, which will expire on March 31, 2016.
www.tsa.gov

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