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Form 41, Schedule P-12(a) - Fuel Consumption by Type of Service and Entity

Form 41, Schedule P-12(a) - Fuel Consumption by Type of Service and Entity

OMB: No. 2138-0013 Expires: 10/31/2011

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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 P-12(a), Fuel Consumption by Type of Service and Entity, is estimated to be approximately 4 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 monthly report is withheld from the public until the quarterly Form 41 reports pertaining to the monthly reports are released. 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 – bernard.stankus@dot.gov.

Air Carrier      _____________________

Operation      _____________________

Month Ended _____________________

Service / Entity Gallons Cost Gal. Not Paid For
Schedule Service Domestic      
Intra Alaska      
Domestic (Excluding Intra Alaska)      
Domestic Subtotal 0 0 0
Scheduled Service International      
Atlantic      
Pacific      
Latin America      
International Subtotal 0 0 0
Total Scheduled Service 0 0 0
Nonscheduled Service Domestic      
Intra Alaska      
Domestic (Excluding Intra Alaska)      
MAC Operations      
Domestic Subtotal 0 0 0
Nonscheduled Service Int'l      
Atlantic      
Pacific      
Latin America      
MAC Operations      
International Subtotal 0 0 0
Total Nonscheduled Service 0 0 0

BTS Form 41 Schedule P-12a (rev. 03/01/2007)