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

Overview

PRABS
Program-Level Data Entry
Alternative Disbursement Sched
Project-Level Data Entry
Summary Analytical Sheet


Sheet 1: PRABS


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.
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




















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






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