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Form 298-C, Schedule F-1 - Report of Financial Data

Form 298-C, Schedule F-1 - Report of Financial Data

OMB No: 2138-0009, Expiraton Date: 9/30/2011

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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 2138-0009. Public reporting for Form 298-C, Schedule F-1, Report of Financial Data 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 report is withheld from public release for 3 years. 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, Room 4125, 1200 New Jersey Avenue, SE, Washington, D.C. 20590 or e-mail – bernard.stankus@dot.gov.

Air Carrier (Corporate Name): _____________________

Carrier Code: _____________________

Carrier Entity Code: _____________________

Quarter Ended: _____________________

Year: _____________________

FINANCIAL

(1) Total Operating Revenues                                               _____________________

(2) Total Operating Expenses                                               _____________________

(3) Net Income                                                                          _____________________

(4) Passenger Revenues - Scheduled Service                 _____________________

PASSENGER FACILITY CHARGE ACTIVITY FOR THIS QUARTERLY PERIOD

Total PFC Liability at Beginning of Period:                           _____________________

Total Amount Collected in Trust for Public Agencies:        _____________________

Total Amount Remitted to Public Agencies:                         _____________________

Adjustments (Collection Compensation, PFC Refunds):  _____________________

TOTAL PFC LIABILITY AT END OF PERIOD:                        _____________________

Certification*

I certify that this RITA-BTS Form 298-C report and the monthly T-100 Traffic reports have been prepared by me or under my supervision; I have carefully examined these reports and, to the best of my knowledge and belief, they are complete and accurate.

Certifying Official: _____________________

Signature*: _____________________

Certifying Official's Email: _____________________

Date: _____________________

Title: _____________________

* Title 18, U.S.C. Sec. 1001, Crimes and Criminal Procedure, makes it a criminal offense, subject to a maximum fine of $10,000 or imprisonment for not more than 5 years or both, to knowingly and willfully make or cause to be made any false or fraudulent statements or representations in any matter within jurisdiction of any agency of the United States. When reporting by Email or other E-Filing system, the "Signature" requirement is satisfied when the certifying official submits reports using their email account or when accessing an E-Filing system as an authorized user.

For information regarding the 298-C Financial Reporting, please call the Office of Airline Information at 202-366-9059 or send your inquiry by email to: 298c.Support@dot.gov