Aircraft Operators

DEPARTMENT OF HOMELAND SECURITY

OMB 1652-0035
3/31/2016

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 1.135 hours. An agency may not conduct or sponsor, and a person 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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