5100-100 Application for Federal Assistance (Development and Equi

U.S. Department
of Transportation
Federal Aviation
Administration

FAA Form 5100-100, Application for Federal Assistance
(Development and Equipment Projects)
Paperwork Reduction Act Burden 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 to this collection of
information are required under 49 U.S.C. Section 47105 to retain a benefit and to meet the reporting
requirements of 2 CFR 200; no assurance of confidentiality is provided. 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: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information
Collection Clearance Officer, ASP-110.

INSTRUCTIONS FOR FORM 5100-100
PART I – Application for Federal Assistance
Part I of the Application for Federal Assistance consists of a completed Standard Form (SF) 424. The
remaining parts of Form 5100-100 (Parts II, IIII and IV) represent continuation pages that the Sponsor
must attach to the associated SF-424 form. The signature of the Sponsor’s authorized representative on
the SF-424 form represents acceptance of the representations and certifications made within the
corresponding FAA 5100-100 form.

PART II – Project Approval Information
This information is necessary for the Federal Aviation Administration to evaluate this request for Federal
assistance. Responses do not require an explanation unless explicitly requested by the question.
SECTION A. STATUTORY CONDITIONS
Item 1 – Indicate whether the Sponsor maintains an active registration in the Federal System for Award
Management (SAM). Pursuant to 2 CFR §25.200(b), a Sponsor must maintain an active registration in
the Central Contractor Registration repository (housed within SAM) with current information at the time of
the application and during the active period of the Federal award.
Item 2 – Indicate whether the Sponsor can commence the project within the same fiscal year the grant is
made or within 6 months of when the grant is made, whichever is later. Attach explanation for negative
responses. This information is considered when allocating discretionary funds. (49 U.S.C. § 47115(d)(2))

Item 3 – Indicate whether the Sponsor can complete the project without unreasonable delays. If
applicable, provide listing of foreseeable events (winter shutdown, land acquisition issues, nonaeronautical events, etc.) that have potential to delay completion of the project. (49 USC § 47106(a))
Item 4 – Indicate whether the environmental review (i.e. environmental assessment, mitigated FONSI,
etc.) identified impacts or effects on the environment that require mitigating measures that lessen the
impact or effect on the environment. If yes, provide a summary listing of mitigating measures.
(49 U.S.C. § 47106(c))
Item 5 – Indicate whether the project covered by this request is also covered by an approved Passenger
Facility Charge (PFC) application or other Federal assistance program by selecting all applicable check
boxes (49 U.S.C. § 40117(d) and 2 CFR § 200.403). If the approved PFC application only addresses the
Sponsor’s AIP matching share, select the appropriate check box.
If the project, or portions thereof, is covered by another Federal assistance program, identify the Federal
assistance program by name and the Catalog of Federal Domestic Assistance (CFDA) number.
Item 6 – Indicate whether the Sponsor intends to seek reimbursement of Sponsor indirect costs as
defined by 2 CFR §200.414 and 2 CFR Appendix VII to Part 200. This information request does not
include the indirect costs claimed by a for-profit entity (e.g. consultant).




The de minimis rate may only be used if the Sponsor has not previously received a negotiated
Indirect Cost Rata (ICR) and does not exceed the limitations prescribed in Appendix VII to Part
200.
A Sponsor with an existing approved negotiated ICR must identify the ICR value, the name of the
cognizant agency that approved the ICR and the date of approval.

Limitations of use: Per policy, Sponsor’s may only apply an approved ICR to allowable direct salary
expenses that are reasonable and necessary to carry-out the project.
SECTION B. CERTIFICATION REGARDING LOBBYING
This section addresses the Sponsor’s declaration regarding lobbying activities. The declaration made in
the section are under signature of the authorized representative as identified in box 21 of form SF-424, to
which this form is attached.
Title 31 U.S.C. § 1352 establishes that no appropriated funds may be expended by a recipient of a
Federal grant to pay any person for influencing or attempting to influence an officer or employee of any
agency, Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this covered Federal assistance action. Pursuant to 40 CFR part 20, this
certification attests that the Sponsor has not made, and will not make, any payment prohibited payment
by 31 U.S.C. § 1352.

FAA Form 5100-100

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SECTION C. REPRESENTATIONS AND CERTIFICATION
1. Compatible Land Use (49 U.S.C. § 47107(a)(10)) – Identify actions the Sponsor has taken to
assure land uses in close proximity to the airport are compatible with normal airport operations.
2. Defaults – Confirm that Sponsor is not in default on any obligation to the United States or any
agency of the United States government.
3. Possible Disabilities – Confirm that Sponsor has no facts or circumstances (i.e. legal, financial
or otherwise) that might adversely affect the Sponsor in completing the project and carrying out
the provisions of the associated Grant Assurances.
4. Consistency with Local Plans (49 U.S.C. § 47106(a)) – Confirm project is consistent with plans
(existing at the time the project is approved) of public agencies authorized by the State in which
the airport is located to plan.
5. Consideration of Local Interests (49 U.S.C. § 47106(b)) – Confirm the Sponsor has given fair
consideration to the community in and near the project.
6. Consultation with Users (49 U.S.C. § 47105(a)) - Confirm the Sponsor has consulted with
airport users that will be affected by the project.
7. Public Hearings (49 U.S.C. § 47106(c)) – For projects involving the location of an airport,
runway or major runway extension, confirm the Sponsor:
a. Provided an opportunity for a public hearing to consider economic, social and
environmental effects of the project.
b. Has voting representation from the communities in which the project is located; or has
advised the communities that they have the right to petition the Secretary about the
proposed project.
8. Air and Water Quality Standards - Confirm Sponsor will comply with applicable air and water
quality standards.
9. Exclusive Rights (49 U.S.C. § 47107(a) – Identify all instances of exclusive rights to conduct
aeronautical services at the airport.
10. Land (49 U.S.C. § 47106(b)) –
a. Identify property interests specific to the development project and/or land acquisition. The
declaration of property interest is to be based upon a title opinion submitted by an
attorney. When identifying the property interest, use the same parcel numbers as used to
identify the property on the associated Exhibit A property map.
Example: “Sponsor maintains property interest as depicted within the property table on
the Exhibit A property map dated __/__/__ originally filed with AIP Project ###.”
b. Complete this subpart if the Sponsor proposes a project for which they have not yet
obtained appropriate property interests. Note that the work may not commence until
Sponsor obtains acceptable property interests. Identify such property by parcel number
that corresponds to the associated Exhibit A property map.
c.

Complete this subpart when acquiring property interests under the grant. Identify such
property by parcel number that corresponds to the associated Exhibit A property map.

FAA Form 5100-100

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PART III – Budget Information
SECTION A. GENERAL
1. Federal Domestic Assistance Catalog Number - Show the Federal Domestic Assistance Catalog
Number from which the assistance is requested.
2. Functional or Other Breakout: Indicate “Airport Improvement Program”. Prepare a separate set of
Part III forms for other Federal program categories.
SECTION B. CALCULATION OF FEDERAL GRANT
When applying for a new grant, use the Total Amount Column only. Use all columns when requesting
revisions of previously awarded amounts.
Line 1 - Enter amounts needed for administration expenses, which may include such items as: legal fees,
mailing/shipping expenses, audit fees and documented Sponsor employee time that is necessary to
administer the grant.
Line 2 - Enter amounts pertaining to allowable preliminary expenses. These include such expenses as
independent fee estimate preparation, advertising expenses and permits.
Line 3 - Enter amounts directly associated with the acquisition of land, existing structures, and related
right-of-way.
Line 4 - Enter fees for architectural engineering basic services.
Line 5 - Enter amounts for architectural engineering special services (e.g. surveys, tests and borings).
Line 6 - Enter fees for inspection, testing and monitoring of construction and related programs.
Line 7 - Enter amounts associated with the development of land where the primary purpose of the grant
is land improvement. Site work normally associated with major construction should be excluded from this
category and shown on line 11.
Line 8 - Enter the dollar amounts needed to provide relocation advisory assistance, and the net amounts
for replacement (last resort) housing. Do not include relocation administration expenses on this Line;
include them on Line 1.
Line 9 - Enter the estimated amount of relocation payments to be made to displaced persons, business
concerns, and non-profit organizations for moving expenses and replacement housing.
Line 10 - Enter the cost of demolition or removal of improvements on developed land. Reduce the costs
on this line by the amount of expected proceeds from the sale of salvage, if so instructed by the Federal
grantor agency. Otherwise, show the proceeds on Line 15.
Line 11 - Enter amounts for the actual construction of, addition to or restoration of a facility. Include in this
category the amounts of project improvements such as grading, drainage, paving, marking, lighting,
buildings, seeding/sodding, etc.
Line 12 - Enter amounts for equipment. Examples include ARFF vehicles, SRE equipment, AWOS
equipment, interactive training, NAVAID equipment, etc.)
Line 13 - Enter miscellaneous amounts for items not specifically covered by previous categories.

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Line 14 - Enter the sum of Lines 1-13.
Line 15 - Enter the estimated amount of program income that will be earned during the grant period and
applied to the program. Examples include vehicle trade-in value, sale of millings resulting from project,
credits passed on from contractor, etc. This line may be used to indicate applied liquidated damages.
Line 16 - Enter the difference between Line 14 and Line 15.
Line 17 - Enter the aggregate amount for those items, which are a part of the project but not subject to
Federal participation. Refer to Section C, exclusions.
Line 18 – Enter the subtotal sum of Lines 16 and 17. (This is the amount to which the matching share
ratio prescribed in program legislation is applied.)
Line 19 - Indicate the total amount of the Federal assistance requested. This value is determined by
multiplying the grant participation rate by the amount indicated in line 18.
Line 20 – Indicate the amount of the Grantee’s share (from Section D).
Line 21 – Indicate the amount of other shares (from Section D)
Line 22 – Indicate sum of Lines 19, 20 and 21.
SECTION C. EXCLUSIONS
Line 23 a-g - Identify and list those costs which are part of the project cost but are not subject to Federal
participation because of program legislation or Federal grantor agency instructions. The total amount on
Line g should agree with the amount shown on Line 17 of Section B.
SECTION D. PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
Line 24 a-g - Show the source of the grantee’s share. If cash is not immediately available, specify the
actions completed to date and those actions remaining to make cash available under Section E Remarks. Indicate also the period of time that will be required after execution of the grant agreement to
obtain the funds. If there is a non-cash contribution, explain what this contribution will consist of.
Line 24h - Indicate total of Lines 24 a-g. This amount must equal the amount in Section B, Line 20.
Line 25a - Show the amount that will be contributed by a State or state agency, only if the applicant is not
a State or state agency. If there is a non-cash or other contribution, explain what the contribution will
consist of under Section E - Remarks.
Line 25b - Show the amount that will be contributed from other sources. If there is a non-cash
contribution, explain what the contribution will consist of under Section E - Remarks.
Line 25c - Show the total of Lines 28a and 28b. This amount must be the same as the amount shown in
Section B, Line 21.
Line 26 - Enter the totals of Lines 24h and 25c.
SECTION E. OTHER REMARKS
Make any remarks pertinent to the project and provide any other information required by these
instructions or the grantor agency. Attach additional sheets, if necessary.

FAA Form 5100-100

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PART IV – Program Narrative
Prepare the program narrative statement in accordance with the following instructions for all new grant
programs. Requests for supplemental assistance should be responsive to Item 5b only. Requests for
continuation or refunding or other changes of an approved project should be responsive to Item 5c only.
1. OBJECTIVES AND NEED FOR THIS ASSISTANCE
Provide a short and concise description of the proposed improvement. Include a narrative on why this
improvement is needed.
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.
3. APPROACH
a. Outline a plan of action pertaining to the scope and detail of how the Sponsor proposes to
accomplish the work.
b. 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
construction approach, reductions in cost or time or extraordinary social and community
involvements.
c.

Provide projections of project milestone dates. As a minimum, identify target dates for defining
project costs (i.e. bid opening or completion of negotiations), anticipated issuance of notice-toproceed and anticipated project completion date.

d. Identify monitoring and oversight mechanisms the Sponsor proposes to implement.
e. List key individuals and entities such as consultant, Sponsor personnel and contractor who will
work on the project. Provide a short description of the nature of their effort or contribution.
4. GEOGRAPHIC LOCATION
Identify location of the project. This will typically be the name of the airport.
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 5.
b. Explain the reason for all requests for supplemental assistance and justify the need for additional
funding.
c.

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, budget, or objectives have changed or an extension of time is necessary,
explain the circumstances and justify.

6. SPONSOR’S REPRESENTATIVE
Identify contact information of Sponsor’s representative.

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OMB CONTROL NUMBER: 2120-0569
EXPIRATION DATE: 8/31/2019

U.S. Department of Transportation
Federal Aviation Administration

Application for Federal Assistance (Development and Equipment Projects)
PART II – PROJECT APPROVAL INFORMATION
Part II - SECTION A
The term “Sponsor” refers to the applicant name provided in box 8 of the associated SF-424 form.
Item 1.
Does Sponsor maintain an active registration in the System for Award Management
(www.SAM.gov)?

Yes

No

Item 2.
Can Sponsor commence the work identified in the application in the fiscal year the
grant is made or within six months after the grant is made, whichever is later?

Yes

No

N/A

Yes

No

N/A

Item 4.
Will the project(s) covered by this request have impacts or effects on the
environment that require mitigating measures? If yes, attach a summary listing of
mitigating measures to this application and identify the name and date of the
environmental document(s).

Yes

No

N/A

Item 5.
Is the project covered by this request included in an approved Passenger Facility
Charge (PFC) application or other Federal assistance program? If yes, please
identify other funding sources by checking all applicable boxes.

Yes

No

N/A

No

N/A

Item 3.
Are there any foreseeable events that would delay completion of the project? If yes,
provide attachment to this form that lists the events.

The project is included in an approved PFC application.
If included in an approved PFC application,
does the application only address AIP matching share?

Yes

No

The project is included in another Federal Assistance program. Its CFDA number is below.
Item 6.
Will the requested Federal assistance include Sponsor indirect costs as described in
2 CFR Appendix VII to Part 200, States and Local Government and Indian Tribe
Indirect Cost Proposals?

Yes

If the request for Federal assistance includes a claim for allowable indirect costs, select the applicable indirect cost rate
the Sponsor proposes to apply:
De Minimis rate of 10% as permitted by 2 CFR § 200.414.
Negotiated Rate equal to
on

% as approved by
(Date) (2 CFR part 200, appendix VII).

(the Cognizant Agency)

Note: Refer to the instructions for limitations of application associated with claiming Sponsor indirect costs.

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OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 8/31/2019

PART II - SECTION B
Certification Regarding Lobbying
The declarations made on this page are under the signature of the authorized representative as identified in box 21 of
form SF-424, to which this form is attached. The term “Sponsor” refers to the applicant name provided in box 8 of the
associated SF-424 form.
The Authorized Representative certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Sponsor, to any person
for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract,
grant, loan, or cooperative agreement, the Authorized Representative shall complete and submit Standard
Form-LLL, ‘‘Disclosure Form to Report Lobbying,’’ in accordance with its instructions.
(3) The Authorized Representative shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans,
and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

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OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 8/31/2019

PART II – SECTION C
The Sponsor hereby represents and certifies as follows:
1. Compatible Land Use – The Sponsor has taken the following actions to assure compatible usage of land adjacent
to or in the vicinity of the airport:

2. Defaults – The Sponsor is not in default on any obligation to the United States or any agency of the United States
Government relative to the development, operation, or maintenance of any airport, except as stated herewith:

3. Possible Disabilities – There are no facts or circumstances (including the existence of effective or proposed leases,
use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other
legal proceedings) which in reasonable probability might make it impossible for the Sponsor to carry out and complete
the Project or carry out the provisions of the Grant Assurances, either by limiting its legal or financial ability or
otherwise, except as follows:

4. Consistency with Local Plans – The project is reasonably consistent with plans existing at the time of submission
of this application) of public agencies that are authorized by the State in which the project is located to plan for the
development of the area surrounding the airport.

5. Consideration of Local Interest – It has given fair consideration to the interest of communities in or near where the
project may be located.

6. Consultation with Users – In making a decision to undertake an airport development project under Title 49, United
States Code, it has consulted with airport users that will potentially be affected by the project (§ 47105(a)(2)).

7. Public Hearings – In projects involving the location of an airport, an airport runway or a major runway extension, it
has afforded the opportunity for public hearings for the purpose of considering the economic, social, and environmental
effects of the airport or runway location and its consistency with goals and objectives of such planning as has been
carried out by the community and it shall, when requested by the Secretary, submit a copy of the transcript of such
hearings to the Secretary. Further, for such projects, it has on its management board either voting representation from
the communities where the project is located or has advised the communities that they have the right to petition the
Secretary concerning a proposed project.

8. Air and Water Quality Standards – In projects involving airport location, a major runway extension, or runway
location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary
that the project will be located, designed, constructed, and operated so as to comply with applicable and air and water
quality standards. In any case where such standards have not been approved and where applicable air and water
quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification
shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days
after the project application has been received by the Secretary.

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OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 8/31/2019

PART II – SECTION C (Continued)
9. Exclusive Rights – There is no grant of an exclusive right for the conduct of any aeronautical activity at any airport
owned or controlled by the Sponsor except as follows:

10. Land – (a) The sponsor holds the following property interest in the following areas of land, which are to be developed
or used as part of or in connection with the Airport subject to the following exceptions, encumbrances, and adverse
interests, all of which areas are identified on the aforementioned property map designated as Exhibit “A”. [1]

The Sponsor further certifies that the above is based on a title examination by a qualified attorney or title company and
that such attorney or title company has determined that the Sponsor holds the above property interests.
(b) The Sponsor will acquire within a reasonable time, but in any event prior to the start of any construction work
under the Project, the following property interest in the following areas of land on which such construction work is to be
performed, all of which areas are identified on the aforementioned property map designated as Exhibit “A”. [1]

(c) The Sponsor will acquire within a reasonable time, and if feasible prior to the completion of all construction
work under the Project, the following property interest in the following areas of land which are to be developed or used
as part of or in connection with the Airport as it will be upon completion of the Project, all of which areas are identified on
the aforementioned property map designated as Exhibit “A”. [1]

1

State the character of property interest in each area and list and identify for each all exceptions, encumbrances, and adverse
interests of every kind and nature, including liens, easements, leases, etc. The separate areas of land need only be identified here by
the area numbers shown on the property map.
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OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 8/31/2019

PART III – BUDGET INFORMATION – CONSTRUCTION
SECTION A – GENERAL
1. Federal Domestic Assistance Catalog Number:
2. Functional or Other Breakout:

SECTION B – CALCULATION OF FEDERAL GRANT
Cost Classification
1.

Administration expense

2.

Preliminary expense

3.

Land, structures, right-of-way

4.

Architectural engineering basic fees

5.

Other Architectural engineering fees

6.

Project inspection fees

7.

Land development

8.

Relocation Expenses

9.

Relocation payments to Individuals and Businesses

Latest Approved
Amount
(Use only for
revisions)

Adjustment
+ or (-) Amount
(Use only for
revisions)

Total
Amount
Required

10. Demolition and removal
11. Construction and project improvement
12. Equipment
13. Miscellaneous
14. Subtotal (Lines 1 through 13)
15. Estimated Income (if applicable)
16. Net Project Amount (Line 14 minus 15)
17. Less: Ineligible Exclusions (Section C, line 23 g.)
18. Subtotal (Lines 16 through 17)
19. Federal Share requested of Line 18
20. Grantee share
21. Other shares
22. TOTAL PROJECT (Lines 19, 20 & 21)

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OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 8/31/2019

SECTION C – EXCLUSIONS
Amount Ineligible for
Participation

23. Classification (Description of non-participating work)
a.
b.
c.
d.
e.
f.
g.

Total

SECTION D – PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE
24. Grantee Share – Fund Categories

Amount

a. Securities
b. Mortgages
c. Appropriations (by Applicant)
d. Bonds
e. Tax Levies
f. Non-Cash
g. Other (Explain):
h. TOTAL - Grantee share
Amount

25. Other Shares
a. State
b. Other
c. TOTAL - Other Shares
26. TOTAL NON-FEDERAL FINANCING

SECTION E – REMARKS

(Attach sheets if additional space is required)

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OMB CONTROL NUMBER: 2120-0569
OMB EXPIRATION DATE: 8/31/2019

PART IV – PROGRAM NARRATIVE
(Suggested Format)

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: (include address & telephone number)

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