5100-139 LOI Application Financial Template
Airports Grants Program
faa-form-5100-139-loi-application-financial-template-2020.xlsx
Airports Grants Program - Financial Management
OMB: 2120-0569
Document [xlsx]
Download: xlsx | pdf
Program-Level Data Entry
Alternative Disbursement Sched
Project-Level Data Entry
Summary Analytical Sheet
Overview
PRABSProgram-Level Data Entry
Alternative Disbursement Sched
Project-Level Data Entry
Summary Analytical Sheet
Sheet 1: PRABS
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DEPARTMENT OF TRANSPORTATION | OMB CONTROL NUMBER 2120-0569 | |||||
| FEDERAL AVIATION ADMINISTRATION | EXPIRATION DATE: 6/30/2023 | ||||||
| Letter of Intent Application Financial Template | |||||||
| 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 meet the reporting requirements of 49 CFR 18; 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: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524. |
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| FAA FORM 5100-139 (8/20) SUPERSEDES PREVIOUS EDITION | |||||||
| Send form by Email | |||||||
| Email hyperlink data -- do not delete | |||||||
| To | |||||||
| Subj | Submission of Form 5100-139 | ||||||
| Body | [Add your FAA regional or ADO point of contact’s email address before submitting and delete this message.See%0Ahttps://www.faa.gov/airports/news_information/contact_info/regional/ ] | ||||||
Sheet 2: Program-Level Data Entry
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| Department of Transportation | |||||||||||||||||||
| Federal Aviation Administration | |||||||||||||||||||
| FAA Form 5100-139, Letter of Intent Application Financial Template | Order 5100.38C | ||||||||||||||||||
| Program-Level Data Entry sheet | |||||||||||||||||||
| Sponsors requesting Letters of Intent (LOI) are required to submit the information shown, in substantially the same format as this template. Sponsors are strongly encouraged to use this template, as it may help to expedite the review and approval process. Regardless, Sponsors should review the instructions contained in Chapter 6 of Order 5100.38D carefully, because those instructions contain specific parameters for what to include on certain key lines of this template. | |||||||||||||||||||
| Airport Sponsor Information | |||||||||||||||||||
| 1 | Airport name: | [Enter airport name] | |||||||||||||||||
| 2 | LOCID: | [Enter three-letter identifier] | |||||||||||||||||
| 3 | City, State: | [Enter city, state] | |||||||||||||||||
| 4 | Hub category: | [Enter Large, Medium, Small or Nonhub] | |||||||||||||||||
| 5 | Airport owner/operator: | [Enter airport owner/operator] | |||||||||||||||||
| 6 | Submnission date: | [Enter submission date] | |||||||||||||||||
| Capital Costs and Annual Cashflow Requirements - Proposed Action | |||||||||||||||||||
| No. | Cost category | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | |
| 7 | Professional Services | $0 | n/a | ||||||||||||||||
| 8 | Land Acquisition | 0 | n/a | ||||||||||||||||
| 9 | Runway | [Enter designation] | 0 | n/a | |||||||||||||||
| 10 | Runway | [Enter designation] | 0 | n/a | |||||||||||||||
| 11 | Runway | [Enter designation] | 0 | n/a | |||||||||||||||
| 12 | Runway | [Enter designation] | 0 | n/a | |||||||||||||||
| 13 | Other Airside | 0 | n/a | ||||||||||||||||
| 14 | Terminal | 0 | n/a | ||||||||||||||||
| 15 | Landside | 0 | n/a | ||||||||||||||||
| 16 | Infrastructure | 0 | n/a | ||||||||||||||||
| Summary | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Cumulative Needs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Capital Funding Sources - Proposed Action | |||||||||||||||||||
| Federal and State Grants | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | ||
| 17 | Entitlements - Grants Awarded | $0 | n/a | ||||||||||||||||
| 18 | Entitlements - Future Grants | 0 | n/a | ||||||||||||||||
| 19 | Discretionary - LOI Request | 0 | n/a | ||||||||||||||||
| 20 | Discretionary - Other - Awarded | 0 | n/a | ||||||||||||||||
| 21 | Discretionary - Other - Future Grants | 0 | n/a | ||||||||||||||||
| 22 | Discretionary - Noise - Awarded | 0 | n/a | ||||||||||||||||
| 23 | Discretionary - Noise - Future Grants | 0 | n/a | ||||||||||||||||
| 24 | State Apportionment - Grants Awarded | 0 | n/a | ||||||||||||||||
| 25 | State Apportionment - Future Grants | 0 | n/a | ||||||||||||||||
| 26 | Other Federal (non-AIP) - Grants Awarded | 0 | n/a | ||||||||||||||||
| 27 | Other Federal (non-AIP) - Future Grants | 0 | n/a | ||||||||||||||||
| 28 | State - Grants Awarded | 0 | n/a | ||||||||||||||||
| 29 | State - Future Grants | 0 | n/a | ||||||||||||||||
| Subtotal - Federal/State Grants | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Passenger Facility Charges | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | ||
| 30 | PFCs - $3.00 Application Approved | $0 | n/a | ||||||||||||||||
| 31 | PFCs - $3.00 Application Submitted | 0 | n/a | ||||||||||||||||
| 32 | PFCs - $3.00 Future Application(s) | 0 | n/a | ||||||||||||||||
| 33 | PFCs - $4.50 Application Approved | 0 | n/a | ||||||||||||||||
| 34 | PFCs - $4.50 Application Submitted | 0 | n/a | ||||||||||||||||
| 35 | PFCs - $4.50 Future Application(s) | 0 | n/a | ||||||||||||||||
| 36 | PFCs - Future Level | [assumed level] | 0 | n/a | |||||||||||||||
| Subtotal - PFCs | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Debt | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | ||
| 37 | Revenue Bonds - MII Approved | $0 | n/a | ||||||||||||||||
| 38 | Revenue Bonds - MII pending | 0 | n/a | ||||||||||||||||
| 39 | General Obligation - Authority in Place | 0 | n/a | ||||||||||||||||
| 40 | General Obligation - Authority Pending | 0 | n/a | ||||||||||||||||
| 41 | Other Debt - Authority in Place | 0 | n/a | ||||||||||||||||
| 42 | Other Debt - Authority Pending | 0 | n/a | ||||||||||||||||
| Subtotal - Debt | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| 43 | Airport Funds | $0 | n/a | ||||||||||||||||
| 44 | Tenant or Third-Party Funds | $0 | n/a | ||||||||||||||||
| Total - All Funding Sources | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Cumulative Sources | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Unmet Funding Needs | Total | Prior Years | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 | |||
| $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Summary Funding Sources | |||||||||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||||||||
| Other AIP funds | $0 | ||||||||||||||||||
| Other Federal funding | $0 | ||||||||||||||||||
| State grants | $0 | ||||||||||||||||||
| PFCs | $0 | ||||||||||||||||||
| Bonds | $0 | ||||||||||||||||||
| Other | $0 | ||||||||||||||||||
| Total | $0 | ||||||||||||||||||
| Funding Status | |||||||||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||||||||
| Grants awarded | $0 | ||||||||||||||||||
| Approved PFCs | $0 | ||||||||||||||||||
| Approved bonds | $0 | ||||||||||||||||||
| Future grants | $0 | ||||||||||||||||||
| Future PFCs | $0 | ||||||||||||||||||
| Future bonds | $0 | ||||||||||||||||||
| Other | $0 | ||||||||||||||||||
| Total | $0 | ||||||||||||||||||
| Capital Costs and Annual Cashflow Requirements - Other Capital Plans | |||||||||||||||||||
| Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | |||
| 45 | Professional Services | $0 | n/a | ||||||||||||||||
| 46 | Land Acquisition | 0 | n/a | ||||||||||||||||
| 47 | Runways | 0 | n/a | ||||||||||||||||
| 48 | Other Airside | 0 | n/a | ||||||||||||||||
| 49 | Terminal | 0 | n/a | ||||||||||||||||
| 50 | Landside | 0 | n/a | ||||||||||||||||
| 51 | Infrastructure | 0 | n/a | ||||||||||||||||
| Summary | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Cumulative Needs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Capital Funding Sources - Other Capital Plans | |||||||||||||||||||
| Federal and State Grants | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | ||
| 52 | Entitlements - Grants Awarded | $0 | n/a | ||||||||||||||||
| 53 | Entitlements - Future Grants | 0 | n/a | ||||||||||||||||
| 54 | Discretionary - LOI Request | 0 | n/a | ||||||||||||||||
| 55 | Discretionary - Other - Awarded | 0 | n/a | ||||||||||||||||
| 56 | Discretionary - Other - Future Grants | 0 | n/a | ||||||||||||||||
| 57 | Discretionary - Noise - Awarded | 0 | n/a | ||||||||||||||||
| 58 | Discretionary - Noise - Future Grants | 0 | n/a | ||||||||||||||||
| 59 | State Apportionment - Grants Awarded | 0 | n/a | ||||||||||||||||
| 60 | State Apportionment - Future Grants | 0 | n/a | ||||||||||||||||
| 61 | Other Federal (non-AIP) - Grants Awarded | 0 | n/a | ||||||||||||||||
| 62 | Other Federal (non-AIP) - Future Grants | 0 | n/a | ||||||||||||||||
| 63 | State - Grants Awarded | 0 | n/a | ||||||||||||||||
| 64 | State - Future Grants | 0 | n/a | ||||||||||||||||
| Subtotal - Federal/State Grants | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Passenger Facility Charges | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | ||
| 65 | PFCs - $3.00 Application Approved | $0 | n/a | ||||||||||||||||
| 66 | PFCs - $3.00 Application Submitted | 0 | n/a | ||||||||||||||||
| 67 | PFCs - $3.00 Future Application(s) | 0 | n/a | ||||||||||||||||
| 68 | PFCs - $4.50 Application Approved | 0 | n/a | ||||||||||||||||
| 69 | PFCs - $4.50 Application Submitted | 0 | n/a | ||||||||||||||||
| 70 | PFCs - $4.50 Future Application(s) | 0 | n/a | ||||||||||||||||
| 71 | PFCs - Future Level | [assumed level] | 0 | n/a | |||||||||||||||
| Subtotal - PFCs | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Debt | Total | As % | Prior Years | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | FFY-2029 | FFY-2030 | FFY-2031 | FFY-2032 | FFY-2033 | ||
| 72 | Revenue Bonds - MII Approved | $0 | n/a | ||||||||||||||||
| 73 | Revenue Bonds - MII pending | 0 | n/a | ||||||||||||||||
| 74 | General Obligation - Authority in Place | 0 | n/a | ||||||||||||||||
| 75 | General Obligation - Authority Pending | 0 | n/a | ||||||||||||||||
| 76 | Other Debt - Authority in Place | 0 | n/a | ||||||||||||||||
| 77 | Other Debt - Authority Pending | 0 | n/a | ||||||||||||||||
| Subtotal - Debt | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| 78 | Airport Funds | $0 | n/a | ||||||||||||||||
| 79 | Tenant or Third-Party Funds | 0 | n/a | ||||||||||||||||
| Total - All Funding Sources | $0 | n/a | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Cumulative Sources | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Unmet Funding Needs | Total | Prior Years | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 | |||
| $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Summary Funding Sources | |||||||||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||||||||
| Other AIP funds | $0 | ||||||||||||||||||
| Other Federal funding | $0 | ||||||||||||||||||
| State grants | 0 | ||||||||||||||||||
| PFCs | $0 | ||||||||||||||||||
| Bonds | $0 | ||||||||||||||||||
| Other | $0 | ||||||||||||||||||
| Total | $0 | ||||||||||||||||||
| Funding Status | |||||||||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||||||||
| Grants awarded | $0 | ||||||||||||||||||
| Approved PFCs | $0 | ||||||||||||||||||
| Approved bonds | $0 | ||||||||||||||||||
| Future grants | $0 | ||||||||||||||||||
| Future PFCs | $0 | ||||||||||||||||||
| Future bonds | $0 | ||||||||||||||||||
| Other | $0 | ||||||||||||||||||
| Total | $0 | ||||||||||||||||||
| Capital Costs and Annual Cashflow Requirements - Other Capital Plans | |||||||||||||||||||
| Totals | as % | Prior Years | FFY-2015 | FFY-2016 | FFY-2017 | FFY-2018 | FFY-2019 | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | |||
| Professional Services | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Land Acquisition | 0 | #DIV/0! | 0 | 0 | 0 | $0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Runways | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Other Airside | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Terminal | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Landside | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Infrastructure | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Summary | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Cumulative Needs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Capital Funding Sources - Other Capital Plans | |||||||||||||||||||
| Federal and State Grants | Totals | as % | Prior Years | FFY-2015 | FFY-2016 | FFY-2017 | FFY-2018 | FFY-2019 | FFY-2020 | FFY-2021 | FFY-2022 | FFY-2023 | FFY-2024 | FFY-2025 | FFY-2026 | FFY-2027 | FFY-2028 | ||
| Entitlements - Grants Awarded | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Entitlements - Future Grants | 0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Discretionary - LOI Request | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Discretionary - Other - Awarded | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Discretionary - Other - Future Grants | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Discretionary - Noise - Awarded | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Discretionary - Noise - Future Grants | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| State Apportionment - Grants Awarded | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| State Apportionment - Future Grants | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Other Federal (non-AIP) - Grants Awarded | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Other Federal (non-AIP) - Future Grants | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| State - Grants Awarded | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| State - Future Grants | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Subtotal - Federal/State Grants | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Passenger Facility Charges | |||||||||||||||||||
| PFCs - $3.00 Application Approved | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| PFCs - $3.00 Application Submitted | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| PFCs - $3.00 Future Application(s) | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| PFCs - $4.50 Application Approved | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| PFCs - $4.50 Application Submitted | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| PFCs - $4.50 Future Application(s) | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| PFCs - Future Level | [assumed level] | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Subtotal - PFCs | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Debt | |||||||||||||||||||
| Revenue Bonds - MII Approved | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Revenue Bonds - MII pending | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| General Obligation - Authority in Place | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| General Obligation - Authority Pending | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Other Debt - Authority in Place | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Other Debt - Authority Pending | 0 | #DIV/0! | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Subtotal - Debt | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Airport Funds | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Tenant or Third-Party Funds | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Total - All Funding Sources | $0 | #DIV/0! | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Cumulative Sources | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Unmet Funding Needs | Totals | Prior Years | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | |||
| $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| Summary Funding Sources | |||||||||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||||||||
| Other AIP funds | $0 | ||||||||||||||||||
| Other Federal funding | $0 | ||||||||||||||||||
| State grants | 0 | ||||||||||||||||||
| PFCs | $0 | ||||||||||||||||||
| Bonds | $0 | ||||||||||||||||||
| Other | $0 | ||||||||||||||||||
| Total | $0 | ||||||||||||||||||
| Funding Status | |||||||||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||||||||
| Grants awarded | $0 | ||||||||||||||||||
| Approved PFCs | $0 | ||||||||||||||||||
| Approved bonds | $0 | ||||||||||||||||||
| Future grants | $0 | ||||||||||||||||||
| Future PFCs | $0 | ||||||||||||||||||
| Future bonds | $0 | ||||||||||||||||||
| Other | $0 | ||||||||||||||||||
| Total | $0 | ||||||||||||||||||
Sheet 3: Alternative Disbursement Sched
| Letter of Intent Application Financial Template | |||||||||||||||
| Data Entry Sheet #2 (Alternate Disbursement Schedule) | |||||||||||||||
| Airport Sponsor Information | |||||||||||||||
| [Enter airport name] | |||||||||||||||
| [Enter three-letter identifier] | |||||||||||||||
| [Enter city, state] | |||||||||||||||
| [Enter Large, Medium, Small or Nonhub] | |||||||||||||||
| [Enter airport owner/operator] | |||||||||||||||
| [Enter submission date] | |||||||||||||||
| Alternative Disbursement Proposal(s) | |||||||||||||||
| OFFICIAL REQUEST | Totals | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 |
| Discretionary - LOI disbursement schedule | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| ALTERNATIVE A | Totals | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 |
| Discretionary - LOI disbursement schedule | $0 | ||||||||||||||
| Change (if any) in LOI Discretionary funding | $0 | ||||||||||||||
| Impact on costs and/or other funding sources | [Enter explanation] | ||||||||||||||
| ALTERNATIVE B | Totals | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 |
| Discretionary - LOI disbursement schedule | $0 | ||||||||||||||
| Change (if any) in LOI Discretionary funding | 0 | ||||||||||||||
| Impact on costs and/or other funding sources | [Enter explanation] | ||||||||||||||
| ALTERNATIVE C | Totals | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 |
| Discretionary - LOI disbursement schedule | $0 | ||||||||||||||
| Change (if any) in LOI Discretionary funding | $0 | ||||||||||||||
| Impact on costs and/or other funding sources | [Enter explanation] | ||||||||||||||
| ALTERNATIVE D | Totals | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 |
| Discretionary - LOI disbursement schedule | $0 | ||||||||||||||
| Change (if any) in LOI Discretionary funding | $0 | ||||||||||||||
| Impact on costs and/or other funding sources | [Enter explanation] | ||||||||||||||
| FAA Form 5100-139 (8/20) SUPERSEDES PREVIOUS EDITION | |||||||||||||||
Sheet 4: Project-Level Data Entry
| Letter of Intent Application Financial Template | ||||||||||||||
| Data Entry Sheet #3 (Project-Level Data Entry) | ||||||||||||||
| Airport Sponsor Information | ||||||||||||||
| [Enter airport name] | ||||||||||||||
| [Enter three-letter identifier] | ||||||||||||||
| [Enter city, state] | ||||||||||||||
| [Enter Large, Medium, Small or Nonhub] | ||||||||||||||
| [Enter airport owner/operator] | ||||||||||||||
| [Enter submission date] | ||||||||||||||
| Individual Project Components | ||||||||||||||
| Project Component | Cost | Part of Proposed Action? (Y/N) | Include in BCA? (Y/N) | Justification for Requested Exclusion | LOI Project | Proposed Action | Overall Capital Plan | Professional Services | Land Acquisition | Runways | Other Airside | Terminal | Landside | Infrastructure |
| Example: Taxiway F Rehabilitation | $1,800,000 | N | N | Will occur with or without Night Vision Program | $0 | $0 | $1,800,000 | |||||||
| Example: EIS - Night Vision Program | $4,600,000 | Y | N | Costs incurred regardless of outcome, and already funded | $0 | $4,600,000 | $4,600,000 | |||||||
| [Enter data by project] | $0 | $0 | $0 | |||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| $0 | $0 | $0 | ||||||||||||
| Summary | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | |||
| FAA Form 5100-139 (8/20) SUPERSEDES PREVIOUS EDITION |
Sheet 5: Summary Analytical Sheet
| Letter of Intent Application Financial Template | |||||||||||||
| Summary Analytical Sheet | |||||||||||||
| Airport Sponsor Information | |||||||||||||
| 1 | [Enter airport name] | ||||||||||||
| 2 | [Enter three-letter identifier] | ||||||||||||
| 3 | [Enter city, state] | ||||||||||||
| 4 | [Enter Large, Medium, Small or Nonhub] | ||||||||||||
| 5 | [Enter airport owner/operator] | ||||||||||||
| 6 | [Enter submission date] | ||||||||||||
|
|||||||||||||
|
|||||||||||||
|
|||||||||||||
| FAA Form 5100-139 (8/20) SUPERSEDES PREVIOUS EDITION | |||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||
| Other AIP funds | $0 | ||||||||||||
| Other Federal funding | $0 | ||||||||||||
| State grants | 0 | ||||||||||||
| PFCs | $0 | ||||||||||||
| Bonds | $0 | ||||||||||||
| Other | $0 | ||||||||||||
| $0 | |||||||||||||
| Funding Status | |||||||||||||
| Discretionary - LOI Request | $0 | ||||||||||||
| Grants awarded | $0 | ||||||||||||
| Approved PFCs | $0 | ||||||||||||
| Approved bonds | $0 | ||||||||||||
| Future PFCs | $0 | ||||||||||||
| Future bonds | $0 | ||||||||||||
| Other | $0 | ||||||||||||
| Total | $0 | ||||||||||||
| $0 | |||||||||||||
| 0 | |||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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