5100-139 LOI Application Financial Template

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Overview

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

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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/ ]

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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

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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

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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