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Form EF - ICAO Financial Supplement

Form EF - ICAO Financial Supplement

OMB No.: 2138-0039, Expiration Date: 5/31/2012

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Paperwork Reduction Act Burden Statement for Audit Reports
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 2138-0039.  Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information.  All responses to this collection of information are mandatory. 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, E34, 1200 New Jersey Avenue, SE, Washington, D.C. 20590-0001 or e-mail – Bernard.stankus@dot.gov.

Air Carrier:______________________________ As at 12/31/______

ITEM 1. BALANCE SHEET 1/  
Asset Accounts (Excludes Nonoperating)  
Allowance for Depreciation $___________________
- Flight Equipment $___________________
- Ground Property and Equipment $___________________
Flight Equipment Airworthiness Allowance $___________________
Flight Equipment Under Capital Lease  
- Total Amount $___________________
- Accumulated Amortization $___________________
ITEM 2. COSTS, INCOME AND CAPITAL DATA 1/  
Total En-route Facilities Charges 2/ by DOT Reporting Entity:  
International $___________________
Atlantic $___________________
Latin American $___________________
Pacific $___________________
Equity in Income of Investor Controller Companies Account 87.0 (See Sec. 14-87 of 14 CFR Part 241) $___________________
Reconciling items for Retained Earnings from end of prior calendar year to end of this calendar year $___________________
Total adjustments to previous year retained earnings total. List each below and indicate whether credit or (debit) amount $___________________
Description  
Adj. 1 ______________________________________ $___________________
Adj. 2 ______________________________________ $___________________
Adj. 3 ______________________________________ $___________________
Dividends (cash or stock) $___________________
ITEM 3. (Discontinued.)  
ITEM 4. PERSONNEL, EXPENSE, ACCOUNT 33 TRAFFIC SOLICITORS $___________________

Note Item 4:
This item applies to all domestic and international air carriers providing scheduled service with over $100 million in annual system operating revenues. Also, it corresponds with the number of employees reported on Form 41, Schedule P-10, see Sections 12 and 24 of 14 CFR Part 241.

- Footnotes -

1/ This report applies to all air carriers providing international scheduled or charter services with annual system operating revenues of over $100 million. International applies to any flight stage where either the take-off or the landing, or both, are not within the 50 states, District of Columbia, Commonwealth of Puerto Rico, territories or possessions of the United States or areas administered by the U.S. under trusteeship. Transborder operations involving Canada, Mexico and points in the Caribbean outside of Puerto Rico and the U.S. Virgin Islands are considered to be international.

2/ Includes fees levied against the airline for the provision of enroute facilities and services. Examples are charges for communications facilities, navigation aids, air traffic service, meteorological services and other ancillary aviation services provided by foreign governments or governmental associates such as EUROCONTROL in Europe, ASECNA in Africa, and COCESNA in Central America.