5500-1 Attachment H

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Overview

PRABS
Instructions
Summary Information
Project Description
Disagreement
Grants and other funding
Environmental & Non-AIP Just
FAA Findings & Comments

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Sheet 1: PRABS

		DEPARTMENT OF TRANSPORTATION	OMB CONTROL NUMBER 2120-0557
		FEDERAL AVIATION ADMINISTRATION	EXPIRATION DATE: 11/30/2024
	FAA Form 5500-1, Attachment H

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Sheet 2: Instructions

	Instructions for Form 5100-1, Attachment H

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Sheet 3: Summary Information

Form 5500-1, Attachment H Project Information

Break projects into major components and fill in all unlocked (shaded) areas and form controls.

Public Agency:

Public Agency full name

Impose Airport

Full Airport Name and LocID

Location:

City, State

Application Number:

Completed by FAA

Prj. No.

Project Title

PFC Level

Use Arpt.

PFC Revenue Requested (Whole Dollars)

Detailed Cost Needed?

Total of all AIP funds regardless of type (e.g. discretionary, entitlements). FAA Federal Financial Grants

Total cost of other funds that are neither AIP or PFC-related. Such as state match, airport funds, etc.. Other Revenue (Dollars)

Total project cost (sum of all fund sources). Total Project Cost (Dollars)

Choose a project type from the drop-down menu. Project Type

Choose a P F C Objective from the drop-down menu PFC Objective

Pay-as-you-go

Bond Capital

Financing

Total PFC

1

$-

No

#REF!

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2

$-

No

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3

$-

No

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4

$-

No

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5

$-

No

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6

$-

No

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7

$-

No

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8

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No

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9

$-

No

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10

$-

No

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11

$-

No

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12

$-

No

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13

$-

No

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14

$-

No

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15

$-

No

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16

$-

No

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17

$-

No

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18

$-

No

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19

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No

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20

$-

No

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Notice Total:

$0

$0

$0

$-

NA

NA

NA

NA

NA

NA

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Sheet 4: Project Description

Form 5500-1, Attachment H Project Information				Page 2: Fill in unlocked (shaded) areas
Prj. No.	Project Title	[Optional] Public agency numbering/ identification system. Public Agency No.	Detailed Project Description	Physical Dates		Required only for terminal projects. Terminal Information
				Project Start	Project End	Pre-PFC Action			Plan to be expanded or constructed. Post-PFC Action
						Ticket counters. Tkt Cntr	Gates	Baggage facilities. Bag Fac.	Tkt Cntr	Gates	Bag Fac.
1	0
2	0
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19	0
20
Submit this worksheet with FAA Form 5500.1
If you have any questions about this worksheet, please contact your local Airports District Office

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Sheet 5: Disagreement

Form 5500-1, Attachment H Project Information				Page 3: Fill in unlocked (shaded) areas and form controls
Prj. No.	Project Title	From public notice and/or carrier notice/consultation. Any Disagree	If there is any disagreement, you must list the source (each carrier and/or public entity) and describe their disagreement here. Describe Disagreement and Source	Public Agency Reason For Proceeding
1	0
2	0
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19	0
20
Submit this worksheet with FAA Form 5500.1
If you have any questions about this worksheet, please contact your local Airports District Office

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Sheet 6: Grants and other funding

Form 5500-1, Attachment H Project Information
Grant Data by Grant Type and other funding
Prj. No.	Grant 1			Grant 2			Grant 3			Other Funds		Other Funds		Other Funds			FAA Federal Financial Grants Total	Other Funds Total
	Grant Amount	Grant Number	Grant Type	Grant Amount	Grant Number	Grant Type	Grant Amount	Grant Number	Grant Type	Amount	Other type	Amount	Other type	Amount	Other type	Specify
1																	#REF!	$-
2																	#REF!	$-
3																	#REF!	$-
4																	#REF!	$-
5																	#REF!	$-
6																	#REF!	$-
7																	#REF!	$-
8																	#REF!	$-
9																	#REF!	$-
10																	#REF!	$-
11																	#REF!	$-
12																	#REF!	$-
13																	#REF!	$-
14																	#REF!	$-
15																	#REF!	$-
16																	#REF!	$-
17																	#REF!	$-
18																	#REF!	$-
19																	#REF!	$-
20																	#REF!	$-

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Sheet 7: Environmental & Non-AIP Just

Form 5500-1, Attachment H Project Information			Page 4: Fill in unlocked (shaded) areas and form controls
Prj. No.	Project Title	Project Justification	Choose the appropriate environmental finding. NEPA Approval	Date of environmental finding. Approval Date	Choose the appropriate airspace finding. Airspace Finding	Airspace Case Number	Finding Date	Is project on approved ALP? ALP Approval	Approval Date
1	0
2	0
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5
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7
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9
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11
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18
19	0
20
Submit this worksheet with FAA Form 5500.1
If you have any questions about this worksheet, please contact your local Airports District Office

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Sheet 8: FAA Findings & Comments

				Page 5: For FAA Use Only
Form 5500-1, Attachment H Project Information
	Public Agency:	Public Agency full name
	Impose Airport	Full Airport Name and LocID
	Location:	City, State
	Application Number:	Completed by FAA
	Use Airport(s):	Err:509
Prj. No.	Project Title	PFC Level	Meets 158.17(a)(3)	Each project requested with a charge level above $3 meets 14 CFR 158.17(a)(3)	Other FAA Comments
1	0
2	0
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19	0
20