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FAA Form 5100-139, Letter of Intent Financial Template
ICR 202304-2120-002 · OMB 2120-0569 · Object 130900501.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | FAA Form 5100-139, Letter of Intent Financial Template |
| Subject | Airport Improvement Program (AIP) |
| Keywords | airport, financial, aip |
| Author | Airport Financial Assistance Division (APP-500) 202-267-3831 |
| Last Modified By | Calc |
| File Modified | 2023-06-01 |
| File Created | 2026-10-24 |
| Conversion State | complete |
Extracted Text
DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION OMB CONTROL NUMBER 2120-0569 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%0Ah this message.See%0Ahttps://www.faa.gov/airports/news_information/contact_info/regional/ ] 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 2 3 4 5 6 Airport name: LOCID: City, State: Hub category: Airport owner/operator: Submnission date: [Enter airport name] [Enter three-letter identifier] [Enter city, state] [Enter Large, Medium, Small or Nonhub] [Enter airport owner/operator] [Enter submission date] Capital Costs and Annual Cashflow Requirements - Proposed Action No. Cost category 7 Professional Services 8 Land Acquisition 9 Runway 10 Runway 11 Runway 12 Runway 13 Other Airside 14 Terminal 15 Landside 16 Infrastructure Summary [Enter designation] [Enter designation] [Enter designation] [Enter designation] Total $0 0 0 0 0 0 0 0 0 0 $0 As % n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Prior Years Cumulative Needs 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 $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 Capital Funding Sources - Proposed Action Federal and State Grants 17 18 19 20 21 22 23 24 25 26 27 28 29 Entitlements - Grants Awarded Entitlements - Future Grants Discretionary - LOI Request Discretionary - Other - Awarded Discretionary - Other - Future Grants Discretionary - Noise - Awarded Discretionary - Noise - Future Grants State Apportionment - Grants Awarded State Apportionment - Future Grants Other Federal (non-AIP) - Grants Awarded Other Federal (non-AIP) - Future Grants State - Grants Awarded State - Future Grants Subtotal - Federal/State Grants Passenger Facility Charges 30 31 32 33 34 35 36 PFCs - $3.00 Application Approved PFCs - $3.00 Application Submitted PFCs - $3.00 Future Application(s) PFCs - $4.50 Application Approved PFCs - $4.50 Application Submitted PFCs - $4.50 Future Application(s) PFCs - Future Level [assumed level] Subtotal - PFCs As % $0 0 0 0 0 0 0 0 0 0 0 0 0 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a $0 n/a Total As % $0 0 0 0 0 0 0 n/a n/a n/a n/a n/a n/a n/a $0 n/a Total As % Revenue Bonds - MII Approved Revenue Bonds - MII pending General Obligation - Authority in Place General Obligation - Authority Pending Other Debt - Authority in Place Other Debt - Authority Pending $0 0 0 0 0 0 n/a n/a n/a n/a n/a n/a Subtotal - Debt $0 n/a Debt 37 38 39 40 41 42 Total FAA Form 5100-139 (1/17) SUPERSEDES PREVIOUS EDITION Prior Years FFY-2020 $0 Prior Years FFY-2021 $0 FFY-2020 $0 Prior Years $0 FFY-2021 $0 FFY-2020 $0 FFY-2022 $0 FFY-2022 $0 FFY-2021 $0 FFY-2023 $0 FFY-2023 $0 FFY-2022 $0 FFY-2024 $0 FFY-2024 $0 FFY-2023 $0 FFY-2025 $0 FFY-2025 $0 FFY-2024 $0 FFY-2026 $0 FFY-2026 $0 FFY-2025 $0 FFY-2027 $0 FFY-2027 $0 FFY-2026 $0 FFY-2028 $0 FFY-2028 $0 FFY-2027 $0 FFY-2029 $0 FFY-2029 $0 FFY-2028 $0 FFY-2030 $0 FFY-2030 $0 FFY-2029 $0 FFY-2031 $0 FFY-2031 $0 FFY-2030 $0 FFY-2032 $0 FFY-2032 $0 FFY-2031 $0 FFY-2033 $0 FFY-2032 $0 $0 FFY-2033 $0 FFY-2033 $0 $0 43 Airport Funds 44 Tenant or Third-Party Funds $0 $0 n/a n/a Total - All Funding Sources $0 n/a $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 Total 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 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Cumulative Sources Unmet Funding Needs Summary Funding Sources Discretionary - LOI Request Other AIP funds Other Federal funding State grants PFCs Bonds Other Total $0 $0 $0 $0 $0 $0 $0 $0 Funding Status Discretionary - LOI Request Grants awarded Approved PFCs Approved bonds Future grants Future PFCs Future bonds Other Total $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Capital Costs and Annual Cashflow Requirements - Other Capital Plans 45 46 47 48 49 50 51 Professional Services Land Acquisition Runways Other Airside Terminal Landside Infrastructure Summary Cumulative Needs Total $0 0 0 0 0 0 0 $0 As % n/a n/a n/a n/a n/a n/a n/a n/a 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 $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 Capital Funding Sources - Other Capital Plans 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 Federal and State Grants Entitlements - Grants Awarded Entitlements - Future Grants Discretionary - LOI Request Discretionary - Other - Awarded Discretionary - Other - Future Grants Discretionary - Noise - Awarded Discretionary - Noise - Future Grants State Apportionment - Grants Awarded State Apportionment - Future Grants Other Federal (non-AIP) - Grants Awarded Other Federal (non-AIP) - Future Grants State - Grants Awarded State - Future Grants Subtotal - Federal/State Grants Total $0 0 0 0 0 0 0 0 0 0 0 0 0 $0 As % n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Prior Years Passenger Facility Charges Total As % Prior Years PFCs - $3.00 Application Approved PFCs - $3.00 Application Submitted PFCs - $3.00 Future Application(s) PFCs - $4.50 Application Approved PFCs - $4.50 Application Submitted PFCs - $4.50 Future Application(s) PFCs - Future Level [assumed level] Subtotal - PFCs $0 0 0 0 0 0 0 $0 n/a n/a n/a n/a n/a n/a n/a n/a Debt Revenue Bonds - MII Approved Revenue Bonds - MII pending General Obligation - Authority in Place General Obligation - Authority Pending Other Debt - Authority in Place Total $0 0 0 0 0 As % n/a n/a n/a n/a n/a FAA Form 5100-139 (1/17) SUPERSEDES PREVIOUS EDITION FFY-2020 $0 $0 FFY-2020 $0 Prior Years FFY-2021 $0 FFY-2021 $0 FFY-2020 FFY-2022 $0 FFY-2022 $0 FFY-2021 FFY-2023 $0 FFY-2023 $0 FFY-2022 FFY-2024 $0 FFY-2024 $0 FFY-2023 FFY-2025 $0 FFY-2025 $0 FFY-2024 FFY-2026 $0 FFY-2026 $0 FFY-2025 FFY-2027 $0 FFY-2027 $0 FFY-2026 FFY-2028 $0 FFY-2028 $0 FFY-2027 FFY-2029 $0 FFY-2029 $0 FFY-2028 FFY-2030 $0 FFY-2030 $0 FFY-2029 FFY-2031 $0 FFY-2031 $0 FFY-2030 FFY-2032 $0 FFY-2032 $0 FFY-2031 FFY-2033 $0 FFY-2033 $0 FFY-2032 $0 FFY-2033 77 Other Debt - Authority Pending Subtotal - Debt 0 $0 n/a n/a 78 Airport Funds 79 Tenant or Third-Party Funds $0 0 n/a n/a Total - All Funding Sources $0 n/a Cumulative Sources Unmet Funding Needs Total $0 FAA Form 5100-139 (1/17) SUPERSEDES PREVIOUS EDITION $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 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 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Prior Years $0 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 Discretionary - LOI disbursement schedule ALTERNATIVE A Discretionary - LOI disbursement schedule Change (if any) in LOI Discretionary funding Impact on costs and/or other funding sources ALTERNATIVE B Discretionary - LOI disbursement schedule Change (if any) in LOI Discretionary funding Impact on costs and/or other funding sources ALTERNATIVE C Discretionary - LOI disbursement schedule Change (if any) in LOI Discretionary funding Impact on costs and/or other funding sources ALTERNATIVE D 2020 $0 Totals 2021 $0 2022 $0 2023 $0 2024 $0 2025 $0 2026 $0 2027 $0 2028 $0 2029 $0 2030 $0 2031 $0 2032 $0 2033 $0 $0 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 $0 $0 [Enter explanation] Totals $0 0 [Enter explanation] Totals $0 $0 [Enter explanation] Totals 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 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 Part of Include Proposed in BCA? Justification for Requested Exclusion Action? (Y/N) (Y/N) Cost Example: Taxiway F Rehabilitation Example: EIS - Night Vision Program [Enter data by project] $1,800,000 $4,600,000 Summary FAA Form 5100-139 (8/20) SUPERSEDES PREVIOUS EDITION $0 N Y N N Will occur with or without Night Vision Program Costs incurred regardless of outcome, and already funded LOI Project Proposed Action Overall Capital Plan $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $4,600,000 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,800,000 $4,600,000 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Professional Services $0 Land Acquisition $0 Runways Other Airside $0 $0 Terminal Landside $0 Infrastructure $0 $0 Letter of Intent Application Financial Template Summary Analytical Sheet Airport Sponsor Information 1 2 3 4 5 6 [Enter airport name] [Enter three-letter identifier] [Enter city, state] [Enter Large, Medium, Small or Nonhub] [Enter airport owner/operator] [Enter submission date] Summary Funding Sources - Proposed Action Funding Status - Proposed Action Summary Funding Sources - Other Capital Plans Funding Status - Other Capital Plans Funding Status - Overall Capital Plans Summary Funding Sources - Overall Capital Plans FAA Form 5100-139 (8/20) SUPERSEDES PREVIOUS EDITION Discretiona AIP f Other Feder State grant PFCs Bonds Other Funding Status Discretiona Grants awa Approved b PFC Future bon Other Total $0 0 $0 $0 $0 $0 $0 $0 0