Form 41, Schedule T-100(f) - Foreign Air Carrier Traffic Data by Nonstop Segment and On-Flight Market

OMB No: 2138-0040, Expiration Date: 1/31/2012

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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 2138-0040. Public reporting for Schedule T-100(f) Report of Traffic and Capacity, is estimated to be approximately 2 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. Detailed T-100 market and segment containing foreign points are withheld from public release for 6 months. 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.

A-1.Air Carrier Name    _____________________ Code:    _____________________

A-2.Report Date (Year) _____________________ (Month) _____________________

* Service Class Codes are:
F - Scheduled Passenger / Cargo G - Scheduled All-Cargo L - Nonscheduled Civilian Passenger / Cargo Charter P - Nonscheduled Civilian All-Cargo Charter Q - Used only if authorized by DOT

BTS Form 41 for Schedule T-100(f)

FOREIGN AIR CARRIER CERTIFICATION

Carrier Name:

Address:

Homeland*:

Carrier Code:

Report Date (Year/Month):

Completed T-100(f) forms should be submitted to:
U.S. Department of Transportation
BTS, K14, Room 4125
400 Seventh Street, SW
Washington, DC 20590-0001

I, the undersigned, do certify that this report has been prepared under my direction in accordance with the regulations in 14 CFR Part 217. I affirm that, to the best of my knowledge and belief, this is a true, correct and complete report.

Signature:                                                                                                          Date:

Name (Print or Type):

Title:

Telephone Number:                                                                  Fax Number:

Name of Person Who Prepared Report:
Telephone Number:                                                                  Fax Number:

* Homeland is the name of the country under the laws of which air carrier organized.

BTS Form 41 Certification for Schedule T-100(f)