Aircraft & Fixed Based Operators

OMB 1652-0035

Exp. 07/31/2019

DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration

FIXED BASED OPERATOR STANDARD SECURITY PROGRAM FIXED BASED OPERATOR APPLICATION

Instructions: This form is to be completed by a Company Representative to apply for entrance into the DASSP Aircraft Operator or FBOSSP. Complete TSA form 4XX-A to submit a DASSP Aircraft Operator application or TSA form 4XX-B to submit a FBOSSP application. These applications are required as part of the Enhanced Security Procedures for DCA operations. Please email completed applications to [email protected] or fax to (703) 603-4030.
Section I. Company Information
Full Company Name:
Airport Identifier:
Address:
City:	State:		Zip Code:
Corporate Headquarters Location:
Corporate Headquarters Mailing Address:
City:	State:		Zip Code:
Section II. Security Coordinator Information
Primary Coordinator:
Full Name (First, Middle, Last):
Phone Number:		Email Address:
Alternate Security Coordinator:
Full Name (First, Middle, Last):
Phone Number:		Email Address:
Section III. Applicant Information
Full Name:
Phone Number:		Email Address:
Signature & Title:

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 5 minutes. 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 this collection is 0MB 1652— 0035, which will expire on July 31, 2019. Send comments regarding this burden estimate or collection to: TSA-11, Attention: PRA 1652-0035, Enhanced Security Procedures at Ronald Reagan Washington National Airport (DCA), 601 South 12th Street, Arlington, VA 20598-6011.

TSA Form 4XX-B (7/19) [File: 5000.xx] Page 1 of 1