OMB No: 2138-0013, Expiration Date: 10/31/2011
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 current valid OMB Control Number. The OMB Control Number for this information collection is 2138-0013. Public reporting for Schedule B-12, Statement of Changes in Financial Position, is estimated to be approximately 5 hours per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory. This report is released to the public unless the respondent receives confidentiality. 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, Bernie Stankus, OAI/BTS/RITA, RTS-42, 1200 New Jersey Avenue, SE, Washington, D.C. 20590 or e-mail – firstname.lastname@example.org.
Air Carrier: _____________________
Period Ended: _____________________
BTS Form 41 Schedule B-12
Formerly the Civil Aeronautics Board's CAB Form 41 Schedule B-12