FAA-5280-1 Application For Certificate

U.S. Department
Of Transportation
Federal Aviation
Administration

FAA Form 5280-1, Application for Airport Operating Certificate
Paperwork Reduction Act Burden Statement
A federal agency man 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 2120-0675.
Public reporting for this collection of information is estimated to be approximately 22 hours per response,
depending on complexity, 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 to this collection of information are mandatory under 14 CFR Part 139. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration,
10101 Hillwood Parkway, Fort Worth, TX 76177-1524.

OMB CONTROL NUMBER: 2120-0675
OMB EXPIRATION DATE: 11/30/2018

APPLICATION FOR AIRPORT OPERATING CERTIFICATE

FAA USE ONLY
Site Number

Department of Transportation
Federal Aviation Administration
Complete all sections of the form as indicated. Submit original and three copies of the form and two copies of the Airport Certification Manual (ACM)
to the headquarters of the appropriate FAA Regional Office.
Type of Submission (Check One):
Original

Amendment

Exemption

A. Location of Airport
1. Name of Airport:

2. Address (Number, Street, P.O. Box):

3. City:

4. County:
7b. Longitude:

7a. Latitude:

°

'

"

°

'

"

5. State:

8. Airport is:
a. State Licensed
b. State Inspected

Yes
Yes

6. Zip Code:

No
No

B. Ownership
1.

Municipality

State

Military

Corporation

County

Other (Explain)

Port Authority

Airport Authority

2. Airport is:

Mil/Civ Joint Use
Shared Use

3. Name of Owner:

4. Name of Manager/Operator:

Number/Street/P.O. Box:

Number/Street/P.O. Box:

City:
County:

State:

Civil

Zip:

City:
County:

State:

Zip:

C. Operative Data
1. Certificate Applied for:
Class I

Class II

Class III

Class IV

2. Fire Fighting Equipment (Check Current Index and ensure equipment is
listed in ACM):
A

B

C

D

E

3. Air Carriers to be Served (UA, DL, CO, AA, etc.):

4. Largest Air Carrier Aircraft to be Served (737, DC-9, etc.):

5. ARFF Exemption Applied for:

6. Other Exemptions Applied for:

Yes
D. Remarks.

No
Check here and use additional sheets of paper.

E. Certification
This application, including the Airport Certification Manual, is submitted in order to obtain an Airport Operating Certificate or Time-Limited Airport
Operating Certificate. I certify, under penalty of 18 U.S. Code, Section 1001, and other applicable provisions of law that the statements and
information in the application form and manual are complete and true to the best of my knowledge.
Applicant Signature
Applicant Address/Number/Street/P.O. Box:

Applicant Name (typed):

City:

Applicant Title:

Date Submitted:

State:

Zip:

Telephone No.:

FAA Use Only
1. Date Application Received:

2. Date Proposed for Inspection:

3. Date Inspection Completed:

Signature

Title :

Signature

Title :

4. Recommended for:

Date:

Certificate
Disapproval
5. Remarks

FAA Form 5280-1 (11/18) SUPERSEDES PREVIOUS EDITION