5500-1 Attachment B

OMB Control Number: 2120-0557

Paperwork Reduction Act 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 2120-0557. Public reporting for this collection of information is estimated to be approximately 51 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. All responses to this collection of information are required to obtain FAA approval of authority to collect PFC revenue (49 U.S.C. 40117(h)). 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.

Expiration Date: 11/30/2024

FORM 5500-1, ATTACHMENT B TEMPLATE

PASSENGER FACILITY CHARGE (PFC) APPLICATION

APPLICATION PROJECT INFORMATION

The information that a public agency must file when applying for authority to impose a PFC and for authority to use PFC revenue on a project is specified in 14 CFR Part 158. In accordance with section 158.27, a public agency that chooses to apply for authority to impose a PFC and for authority to use PFC revenue on a project must do so by using FAA Form 5500-1, PFC Application (latest edition) and all applicable attachments. Public agencies may use this Attachment B template for all FAA Form 5500-1 submissions if the applicable regulation requires the submission of project information in addition to the form.

The Attachment B template may be obtained on the FAA Airports Internet website or by contacting the local FAA Airports office to obtain an electronic version. A public agency submitting an application in hard copy should also submit one copy of each Attachment B electronically.

The following are instructions for completing the form. Complete a separate Attachment B for each proposed project. The paragraph of 14 CFR Part 158 pertaining to the information required is provided in parenthesis.

All areas highlighted in gray are for FAA Use Only. When completing this form, these highlighted areas may aid public agencies in determining the type of information that the FAA will be evaluating when making determinations for each project.

Note: Public agencies seeking PFC authorization under the FAA’s Notice of Intent review process may use the Attachment H template to provide project information.

1) PROJECT TITLE [158.25(b)(16)]:

Use a title that describes the project and differentiates it from other projects in this application or in your PFC program. Do not use "AIP Reimbursement" as a project title.

2) PROJECT NUMBER:

Indicate project number used by public agency to identify this project, if applicable.

3) USE AIRPORT OF PROJECT:

Identify the airport where this project is physically located.

4) TYPE OF APPROVAL REQUESTED [158.25(a)]:

Check the box to indicate the type of approval being requested.
If the project has impose authority from a previous application and this application is for use, provide the application number of the impose authority.

5) LEVEL OF COLLECTION [158.5]

Select the level of collection requested for the project, $1, $2, $3, $4 or $4.50 PFC level.

6) FINANCING PLAN [158.25(b)(13)]:

Use the format provided in the Attachment B template. If the project was previously approved for authority to IMPOSE, and costs or method of financing have changed, provide the original financing plan and a current financing plan. Note that PFC "Pay-as-you-go" is defined as PFC funds used to pay costs directly as opposed to paying debt service on bonds or other debt instruments.

For each project proposing PFC funding in excess of $10,000,000, public agencies are required to provide detailed basis of cost information (beyond what is provided in the Attachment B form). Ideally, this information will consist of the document(s) the public agency used to determine the amount shown in this section. It is the FAA’s intention for the public agency to use existing information rather than creating new documents and analysis. The FAA assumes the public agency has done sufficient plans and designs to substantiate the cost associate with the projects. Further, the FAA expects the detailed cost information to clearly show the costs associated with each major work element of the project. The public agency should also clearly indicate whether the information is based on conceptual design or feasibility studies, construction design, contract, appraisal, or actual costs. The FAA’s authority for requiring public agencies to submit detailed basis of cost information is found in section 158.25(b)(16) which states that the public agency must provide “Such additional information as the Administrator may require,” in the application.

7) BACK-UP FINANCING PLAN [158.25(b)(16)]:

If proposed AIP discretionary funds are included in the Financing Plan (No. 6 above), provide a Back-up Financing Plan (using the format in No. 6), or a project phasing plan, in the event the discretionary funds are not available for the project. This also applies if the public agency is requesting a Letter of Intent (LOI) to fund a portion of the project, whether the proposed LOI does or doesn’t include discretionary funds.

8) ESTIMATED PROJECT IMPLEMENTATION and COMPLETION DATES [158.25(b)(14)(iv)]:

List projected dates of project implementation and completion, either actual or estimated. Also indicate any pending actions upon which the project implementation is dependent, such as local government approval, or completion of a related project.

Use the following table to identify the Implementation Date of a project:

Type of Project	Implementation Date
Construction (includes construction projects combined with design and/or land acquisition	Date of notice to proceed or start of physical construction for the PFC project or an element thereof
Equipment/Vehicle (Refurbish)	Date of award of contract to refurbish the vehicle or equipment
Equipment/Vehicle (New)	Date of award of contract or delivery date for new equipment
Land	Date of signing of contract/agreement for the purchase of the parcel
Planning	Date of notice to proceed or commencement of work
Project formulation costs (includes appraisals, engineering, title searches, etc.) as a separate project(s)	Date of notice to proceed or commencement of work

If the proposed project contains both design and construction work, the project implementation date is the date of the notice to proceed (or start of physical construction) for the construction project.

9) PROJECT DESCRIPTION [158.25(b)(6)]:

Provide a detailed description of the project. Sufficient detail should be given so a person not familiar with the airport will be able to understand the project. Do not combine dissimilar projects, as you will be required to break the costs out later, e.g., snow removal equipment and security fencing or a runway and parallel taxiway. Where appropriate, include a sketch showing the location of the work.

In the case of a project for gates and related areas undertaken to enable additional air service by an air carrier with less than 50 percent of the annual passenger boardings at an airport under 158.15(b)(6), the public agency must show how the project will enable additional air service by an air carrier with less than 50 percent of the annual passenger boardings at the airport. This discussion should be included in the discussion on existing conditions that limit competition as required in §158.25(b)(7)

For a USE project, where the impose authority was previously approved, highlight any changes from the originally approved impose description. Note that material changes to a project, such as increasing the length of a taxiway, are acceptable when applying for USE approval. However, changing a taxiway project to extension of a runway is not a material change, it is a new project. Such changes require the submittal of the project as a new IMPOSE and USE project.

For terminal development projects constructing or rehabilitating gates, ticket counters or baggage facilities, if the facilities will have a preferential lease, submit a copy of the lease with the application. The FAA’s authority for requiring public agencies to submit a copy of the lease with the application is found in section 158.25(b)(16) which states that the public agency must provide “Such additional information as the Administrator may require,” in the application.

For terminal development projects to construct and/or rehabilitate gates, ticket counters or baggage facilities: 1) indicate the number of gates, ticket counters, or baggage facilities at the airport prior to the implementation of this project; 2) indicate the number of gates, ticket counters, or baggage facilities being constructed or rehabilitated in this project; 3) indicate the net addition of gates, ticket counters, or baggage facilities at the airport after accounting for loss if decommissioning any of the existing facilities.

The number of gates refers to the sum total of gates for all terminals at that airport. The number is not per terminal or concourse. When counting gates, if the airport has gates which are split e.g. there is one entry door from the terminal and a jet bridge which leads to two aircraft parking positions, Gate 41A and 41B, these count as two gates. A gate with no jet bridge used to board various turbo prop and small RJ aircraft parked on the ramp near it would be counted as one gate.

The number of ticket counters refers to the sum total of ticket counters in all the terminals. The number is not per terminal. The ticket counter is the counter area behind which the air carrier employee mans the ticketing/baggage position. It is not measured in linear feet, but in the number of stations. This does not include kiosks or self-use terminals located in front of the ticket counters. If the airport has 3 terminals and one terminal has 50 ticket counter positions, a second has 25 ticket counter positions and the third has 10 ticket counter positions, the number to be entered into the terminal data would be 85 ticket counters.

The number of baggage facilities refers to the sum total of baggage carousels in all the terminals. The number is not per terminal or concourse and not measured in linear feet. If the airport has 5 terminals and 3 terminals have 10 carousels each, 1 has 5 carousels and 1 has 4 carousels, the number to be entered into the terminal data would be 39 baggage carousels.

Form terminal and surface transportation projects indicate whether the public agency has made adequate provision for financing the airside needs of the airport, including runways, taxiways, aprons, and aircraft gates.

10) PROJECT OBJECTIVE [158.25(b)(7)]:

Provide information on the extent to which the project achieves one or more of the following objectives:

a) Preserve or enhance safety, security, or capacity of the national air transportation system;

b) Reduce noise or mitigate noise impacts resulting from the airport; or,

c) Furnish opportunities for enhanced competition between or among air carriers.

State how the project accomplishes the specific objective listed above. For example, this runway widening project enhances safety by bringing the runway into compliance with AC XXXX.

The public agency should not list an objective(s)in this section without explaining or demonstrating how this project meets that objective(s).

11) PROJECT JUSTIFICATION [158.25(b)(7)]:

Provide sufficient details to demonstrate the need for the project. This section explains why the project is needed, and should be a narrative description. For example:

security equipment should reference the TSA and 49 CFR Part 1542 requirements;

safety equipment: safety fencing should reference discouraging access of wildlife to the runway and taxiways; ARFF equipment should reference the airport index minimum requirements and whether the equipment replaces or is a new requirement, and if new why it is required; pavement rehabilitation should mention age and condition of current pavement.

AIP reimbursement projects will use the same justification as was used in the AIP application, however simply stating that the project is in an AIP grant is not satisfactory justification; and snow removal equipment should reference the airport approved snow removal plan, whether the equipment replaces or is new, and if new, why it is required.

If the proposed project involves terminal development, including gates and related areas, discuss any existing conditions limiting competition between or among air carriers and foreign air carriers at the airport, any initiatives proposed to foster opportunities for enhanced competition between and among such carriers, the expected results of such initiatives, and the role of the project in these initiatives. This discussion may be included as an additional attachment.

For projects such as runway extensions and new runways, project justification depends on AIP project eligibility. Further discussion and documentation is required in such cases. Referenced documents should be attached. For example, runway extensions need a justification in terms of numbers and types of operations which require a longer runway. Also, land acquisitions need a discussion of the proposed use for the property, and the justification for that proposed use, to the extent available.

For ground transportation projects such as new access roads or rail projects, forecast and existing traffic counts or documentation of existing access congestion should be provided.

12) FOR AN IMPOSE ONLY PROJECT: Estimate date that USE application will be submitted to the FAA [158.25(b)(14)(iii)].

13) CONSULTATION WITH AIR CARRIERS [158.25(b)(11)]:

Carriers Certifying Agreement [158.25(b)(11)(iii)]: List all air carriers which certified agreement with this project following consultation.

Carriers Certifying Disagreement [158.25(b)(11)(iii)]: List all air carriers which certified disagreement with this project following consultation.

Recap of Disagreements [158.25(b)(11)(v)]: Provide a recap of each disagreement. Identify the air carrier(s) asserting each disagreement and address each disagreement.

Public Agency Reasons for Proceeding [158.25(b)(11)(v)]: The public agency shall provide the reasons for proceeding with the project in the face of this disagreement. Be specific.

14) PUBLIC NOTICE AND COMMENT [158.25(b)(11)]:

List of Comments Received from the Public Notice [158.25(b)(11)(iii)]: List all comments received from the public notice.

List of Parties Certifying Agreement [158.25(b)(11)(iii)]: List all respondents to the public notice which certified agreement with this project following publication of the public notice.

Recap of Disagreements [158.25(b)(11)(v)]: Provide a recap of each disagreement. Identify the respondent(s) asserting each disagreement and address each disagreement.

Public Agency Reasons for Proceeding [158.25(b)(11)(v)]: The public agency shall provide the reasons for proceeding with the project in the face of this disagreement. Be specific.

The above instructions should not be submitted with the Attachment B below in the application.

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PFC APPLICATION NUMBER:

ATTACHMENT B: PROJECT INFORMATION

1. Project Title:

2. Project Number (if applicable):

3. Use Airport of Project:

4. Type of Approval Requested:

[ ] Impose Only:

[ ] Concurrent:
[ ] Use Only:

Link to application:

5. Level of Collection:

[ ] $1.00

[ ] $2.00

[ ] $3.00

[ ] $4.00

[ ] $4.50

6. Financing Plan:

PFC Funds: Pay-as-you-go $

Bond Capital $

Bond Financing & Interest $

Subtotal PFC Funds*: $

If amount is over $10 million, include cost details sufficient to identify eligible and ineligible costs.

Existing Airport Grant Funds:

Grant # Grant Funds in Project $

Subtotal Existing Airport Grant Funds: $

Anticipated Airport Grant Funds (List Each Year Separately):

Fiscal Year: Entitlement $ Discretionary $ Total $

Subtotal Anticipated Airport Grant Funds: $

Other Funds:

State Grants $

Local Funds $

Other (please specify) $

Subtotal Other Funds: $

Total Project Cost: $

For FAA Use

a. Does the project include a proposed LOI?

[ ] YES

[ ] NO

If YES, does the Region support?

[ ]YES

[ ] NO.

If YES, list the schedule for implementation:

b. For any proposed AIP discretionary funds, does the Region intend to support?

[ ] YES

[ ] NO

c. For any proposed AIP funds, is the request within the planning levels for the Region's five year CIP?

[ ] YES

[ ] NO

d. What percentage of the total project cost is funded through AIP?

List the source(s) of data used to make this finding.

e. Terminal and surface transportation projects requesting a PFC funding level of $4.00 and $4.50. The public agency has made adequate provision for financing the airside needs of the airport, including runways, taxiways, aprons, and aircraft gates.

[ ] YES

[ ] NO

[ ] N/A

List the source(s) of data used to make this finding.

PFC Share of Total Cost Analysis

7. Back-up Financing Plan: If proposed AIP discretionary funds or a proposed LOI are included in the Financing Plan, provide a Back-up Financing Plan or a project phasing plan in the event the funds are not available for the project.

For FAA Use

If required to use a back-up financing/phasing plan, indicate the need to obtain additional approvals to obtain an alternate source of financing. Indicate the additional PFC duration of collection required if PFC’s are to be used to fund the difference. Recap any discussion from previous item regarding likelihood of public agency obtaining the funding it proposes.

8. Estimated Project Implementation Date (Month and Year):

Estimated Project Completion Date (Month and Year):

For FAA Use

For Impose and Use or Use Only projects, will the project begin within 2 years of PFC application Due date (120-day)?

[ ] Yes

[ ] No

For Impose Only project, will the project begin within 5 years of the charge effective date or PFC application Due date, whichever is first?

[ ] Yes

[ ] No

Is this project dependent upon another action to occur before its implementation or completion? Explain.

9. Project Description:

If applicable for terminal projects,

Prior to implementation of this project,
Number of ticket counters:
Number of gates:
Number of baggage facilities:

At completion of this project,
Number of ticket counters:
Number of gates:
Number of baggage facilities:

Net change due to this project:
Number of ticket counters:
Number of gates:
Number of baggage facilities:

FOR FAA USE

Comment upon and/or Clarify Project Description. Include source citation if clarification information is not from PFC application.

If project involves the construction of a new runway or modification of an existing runway, have the requirements of Order 5200.8, with regard to runway safety areas been met? If not, is the runway grandfathered or has a modification been approve, or is there a likelihood the requirements will be met, or should the project be disapproved.

If the project involves terminal work, confirm information regarding ticket counters, gates, and baggage facilities for construction and/or rehabilitation above has been completed.

10. Project Objective:

FOR FAA USE

__ Safety, Preserve [ ] Enhance [ ]

__ Security, Preserve [ ] Enhance [ ]

__ Capacity, Preserve [ ] Enhance [ ]

__ Furnish opportunity for enhanced competition between or among air carriers at the airport

__ Mitigate noise impacts resulting from aircraft operations at the airport

__ Project does not meet any PFC objectives (explain)

Finding

Current deficiency. List the source(s) of data used to make this finding if it is not a part of the PFC application.

Address adequacy of issues.

11. Project Justification:

FOR FAA USE

Define how the project accomplishes PFC Objective(s)

Explain how project is cost-effective compared to other reasonable and timely means to accomplish this objective(s)

Based on informed opinion or published FAA guidance, specify how the cost of the project is reasonable compared to the capacity, safety, security, noise and/or competition benefits attributable to the project. Include citation for any documents that are not a part of this PFC application.

If analysis is based on a source other than this PFC application, list the source(s) of data and attach the relevant documentation used to make this finding.

Discuss any non-economical benefits which are not captured above.

Project Eligibility:

Indicate project eligibility by checking the appropriate category below.

[ ] Development eligible under AIP criteria (paragraph ___ of Order 5100.38_ or

PGL ____);

[ ] Planning eligible under AIP criteria (paragraph ___ of Order 5100.38_ or PGL ____);

[ ] Noise compatibility planning as described in 49 U.S.C. 47505;

[ ] Noise compatibility measures eligible under 49 U.S.C. 47504.

[ ] Project approved in an approved Part 150 noise compatibility plan;

Title and Date of Part 150:

[ ] Project included in a local study.

Title and Date of local study:

[ ] Terminal development as described in 49 U.S.C. 40117(a)(3)(C);

[ ] Shell of a gate as described in 49 U.S.C 40117(a)(3)(F) (air carrier ___________,

percentage of annual boardings _______);

[ ] PFC Program Update Letter ______

[ ] Project does not meet PFC eligibility (explain).

If analysis is based on a source other than this PFC application, list the source(s) of data and attach the relevant documentation used to make this finding.

Are any work elements or portions of the overall project ineligible? Provide associated costs.

12. For an Impose Only project, estimated date Use application will be submitted to the FAA (Month and Year):

For FAA Use

Is the date within 3 years of the estimated charge effective date or approval date, whichever is sooner?

[ ] Yes

[ ] No

Which actions are needed before the use application can be submitted? What is the estimated schedule for each action?

13. List of Carriers Certifying Agreement:

List of Carriers Certifying Disagreement:

Recap of Disagreements:

Public Agency Reasons for Proceeding:

14. List of Comments Received from the Public Notice:

List of Parties Certifying Agreement.

Recap of Disagreements

Public Agency Reasons for Proceeding:

For FAA Use

Provide an analysis of each issue/disagreement raised by the air carriers and/or the public. Provide citations for any documents not included in the PFC application that are relied on by the FAA for its analysis.

If a Federal Register notice is published, discuss and analyze any new issues raised. (If the comments from the consultation are repeated, state that.)

ADO/RO ANALYSIS:

Does the ADO/RO find the total costs of this project to be reasonable? Did the ADO/RO use comparable projects to make this finding? If so, list projects.

If the amount requested if over $10 million, was the level of detail sufficient to identify eligible and ineligible costs. Summarize ineligible costs.

Is the duration of collection adequate for the amount requested?

ADO/RO RECOMMENDATION:

[ ] Approve.

[ ] Partially Approve. Summarize findings from earlier in the Attachment B discussing issues that lead to determination.

[ ] Disapprove. Summarize findings from earlier in the Attachment B discussing issues that lead to determination.

Application Reviewed by:

__________________________ ________________ ______________

Name Routing Symbol Date

Item(s) reviewed.

__________________________ ________________ ______________

Name Routing Symbol Date

Item(s) reviewed

1/2022