5100-137 Buy American Preferences-Final Assembly Questionnaire

U.S. Department
of Transportation
Federal Aviation
Administration

FAA Form 5100-137, Buy American Preferences – Final Assembly
Questionnaire
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 8 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. 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.

FAA Form 5100-137

U.S. Department of Transportation
Federal Aviation Administration

OMB CONTROL NUMBER: 2120-0569
EXPIRATION DATE: 6/30/2023

-­ CONFIDENTIAL –
NOT SUBJECT TO DISCLOSURE UNDER EXEMPTION # 4
OF THE FREEDOM OF INFORMATION ACT

Buy American Preferences – Final Assembly Questionnaire
To assist the Federal Aviation Administration (FAA) in making the determination of whether final assembly
of the product occurs in the United States, please complete and submit this questionnaire when
requesting a Buy American Waiver under 49 USC § 50101(b)(3)(A).
Company Name:
FAA Eligible Item:

Date:
FAA Item Number (if applicable):

Address of Final Assembly Location:
1. Provide a description of the assembly process occurring at the specified final location in the United
States.
a. Describe the final assembly process and its various operations.

b. How long does the final assembly process take to complete?
2. Provide a description of the resources used to conduct the assembly of the product at the specified
location in the United States.
a. How many employees are involved in the final assembly process and what is the general skill
level of those employees?

b. What type of equipment is used during the final assembly process?

c.

What is a rough estimate of the associated cost to conduct final assembly of the product at the
specified location in the United States?

The undersigned certifies that this information is true and accurate to the best of their knowledge. A false
certification represents a violation of 18 U.S.C § 1001 and 49 U.S.C § 47126. Signatory has the burden of
proof to establish compliance.
Signature:
Name:

Submit by Email
FAA Form 5100-137 (8/20) SUPERSEDES PREVIOUS EDITION