FBO Application (5.20.2022)

OMB 1652-0035
11/30/2022

DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration
Fixed Based Operator Standard Security Program (FBOSSP)
Fixed Based Operator Application Form

Full Company Name:__________________________________________________________________________________________
Airport Identifier: ___________________________
Address:
____________________________________________________________________________________________________ City:
_______________________________________

State: ________________

Zip Code:__________________

Corporate Headquarters Location: ____________________________________________________________________________
Corporate Headquarters Mailing Address:

_____________________________________________________________________

City: _______________________________________
Security Coordinator:
_________________
Name:
Primary

First

State: ________________
Middle

Last

Zip Code:
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. **

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 60 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 OMB control number. The control number assigned to this collection
is OMB 1652-0035, which will expire on November 30, 2022. TSA-11, Attention: PRA 1652-0035, 6595 Springfield Center Drive,
Springfield, VA 20598-6011.
www.tsa.gov

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