Form 5500-1 Attachment H

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Overview

Summary Information
Project Description
Disagreement
Environmental & Non-AIP Just
FAA Findings & Comments

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Sheet 1: Summary Information

ATTACHMENT H						Fill in all shaded areas, and break projects into major components.			ARP:
Public Agency:			Public Agency full name
Location:			City, State
Impose Airport			Full Airport Name
Use Airport(s):			Full Airport Name
Default is $4.50. Use pull down menu to select other levels.
Prj No.	Project Title	PFC	PFC Revenue Requested				Total of all AIP funds regardless of type (e.g. discretionary, entitlements). AIP	If there are AIP funds, the shortened grant number must be provided. Format is abbreviated grant number (028). Grant No.	Total cost of other funds that are neither AIP or PFC-related. Such as state match, airport funds, etc.. Other	Total project cost (sum of all fund sources). Total	Use pull down menu to select project type. Project Type	Select one from pull down menu. PFC Objective
		Level	Pay-as-you-go	Bond Capital	Financing	Total PFC	Funds		Revenue	Project Cost
1	Project Name	$	$	$-	$-	$-	$0		$0	$0
2	Project Name	$	$	$	$	$-	$0		$0	$0
3						$-	$0		$0	$0
4						$-	$0		$0	$0
5						$-				$0
6						$-				$0
7						$-				$0
8						$-				$0
9						$-				$0
10						$-				$0
11						$-				$0
12						$-				$0
13						$-				$0
14						$-				$0
15						$-				$0
16						$-				$0
17						$-				$0
18						$-				$0
19						$-				$0
20						$-				$0
	Notice Total:		$0	$0	$0	$-
	By definition, the following aeronautic activities are excluded (and do not need to be listed): Sightseeing, military charters, fire jumping, most life-flight/medivac Proposed Excluded Class(es) of Carrier:

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Sheet 2: Project Description

ATTACHMENT H				Page 2	Fill in all shaded areas
Public Agency:			Public Agency full name
Location:			City, State
						Required only for terminal projects. Terminal Information
				Physical Dates		Pre-PFC Action			Plan to be expanded or constructed. Post-PFC Action
Prj No.	Project Title	Public agency numbering/ identification system. Optional use. Public Agency No.	Detailed Project Description	Project Start	Project End	Ticket counters. Tkt Cntr	Gates	Baggage facilities. Bag Fac.	Tkt Cntr	Gates	Bag Fac.
1	Project Name
2	Project Name
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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 3: Disagreement

ATTACHMENT H				Page 3: Fill in all shaded areas
Public Agency:		Public Agency full name
Location:		City, State
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	Project Name
2	Project Name
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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 4: Environmental & Non-AIP Just

ATTACHMENT H			Page 4: Fill in shaded area
Public Agency:		Public Agency full name
Location:		City, State
Prj No.	Project Title	Project Justification	Select appropriate environmental finding. NEPA Finding	Date of environmental finding. Finding Date	Select appropriate airspace finding. Airspace Finding	Finding Date	Case Number	Is project on approved ALP? ALP Finding	Finding Date
1	Project Name			mm/dd/yyyy
2	Project Name
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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: FAA Findings & Comments

ATTACHMENT H					Page 5: For FAA Use
Public Agency:			Public Agency full name
Location:			City, State
Prj No.	Project Title	PFC Level	Each project project above $3 meets 158.17(a)(2) and (3), plus comments		Other FAA Comments
1	Project Name	$
2	Project Name	$
3
4
5		$0.00
6		$0.00
7		$0.00
8		$0.00
9		$0.00
10		$0.00
11		$0.00
12		$0.00
13		$0.00
14		$0.00
15		$0.00
16		$0.00
17		$0.00
18		$0.00
20		$0.00