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Part II Project Approval Information Section A (Application For Federal Assistance-Construction Programs) FAA 5100-100 - Official Federal Forms
| Part II Project Approval Information Section A (Application For Federal Assistance-Construction Programs) Form. This is a national form and can be used in Federal Aviation Administration (FAA) . |
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DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 11/30/2007 PART II PROJECT APPROVAL INFORMATION SECTION A Item 1. Does this assistance request require State, local, regional, or other priority rating? Yes Item 2. Does this assistance request require State, local advisory, educational or health clearances? Yes Item 3. Does this assistance request require clearinghouse review in accordance with OMB Circular A-95? Yes Item 4. Does this assistance request require State, local, regional, or other planning approval? Yes Item 5. Is the proposed project covered by an approved comprehensive plan? Yes Item 6. Will the assistance requested serve a Federal installation? Yes Item 7. Will the assistance requested be on Federal land or installation? Yes Item 8. Will the assistance requested have an impact or effect on the environment? Yes Item 9. Will the assistance requested cause the displacement of individuals, families, businesses, or farms? Yes Item 10. Is there other related Federal assistance on this project previous, pending, or anticipated? Yes FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-100 (9-03) Name of Governing Body Priority No Name of Agency or Board (Attach Documentation) No (Attach Comments) No Name of Approving Agency Date / / State Local Regional No Check One: No Location of plan Name of Federal Installation Federal Population benefiting from Project No Name of Federal Installation Location of Federal Land Percent of Project No See instructions for additional information to be provided. No Number of: Individuals Families Businesses Farms See instructions for additional information to be provided. No No Page 2 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS PART II SECTION A Negative answers will not require an explanation unless the Federal agency requests more information at a later date. Provide supplementary data for all "Yes" answers in the space provided in accordance with the following instructions. Item 1. Provide the name of the governing body establishing the priority system and the priority rating assigned to this project. Item 2. Provide the name of the agency or board which issued the clearance and attach the documentation of status or approval. Item 3. Attach the clearinghouse comments for the application in accordance with the instructions contained in Office of Management and Budget Circular No. A-95. If comments were submitted previously with a preapplication, do not submit them again but any additional comments received from the clearinghouse should be submitted with this application. Item 4. Furnish the name of the approving agency and the approval date. Item 5. Show whether the approved comprehensive plan is State, local or regional, or if none of these, explain the scope of the plan. Give the location where the approved plan is available for examination and state whether this project is in conformance with the plan. Item 6. Show the Federal population residing or working on the federal installation who will benefit from this project. Item 7. Show the percentage of the project work that will be conducted on federally owned or leased land. Give the name of the Federal installation and its location. Item 8. Briefly describe the possible beneficial and/or harmful impact on the environment because of the proposed project. If an adverse environmental impact is anticipated, explain what action will be taken to minimize the impact. Federal agencies will provide separate instructions if additional data is needed. Item 9. State the number of individuals, families, businesses, or farms this project will displace. Federal agencies will provide separate instructions if additional data is needed. Item 10. Show the Federal Domestic Assistance Catalog number, the program name, the type of assistance, the status and amount of each project where there is related previous, pending, or anticipated assistance. Use additional sheets, if needed. Paperwork Reduction Act Statement: The information collected on this form allows sponsors of public use airports or public agencies to apply for one or more projects in a form prescribed by the Secretary of Transportation. Title 49, United States Code (U.S.C.), Section 47105, identifies the information required to apply for this program. The forms prescribed to meet this requirement are developed to provide a comprehensive format that allows sponsors to provide the data needed to evaluate the request for funds. The burden for each response is estimated to be 28 hours. Approved applications benefit the sponsor by providing Federal funding to protect the Federal interest in safety, efficiency, and utility of the Nation's airport system. No assurance of confidentiality can be given since these become public records. If you wish to make any comments concerning the accuracy of this burden estimate or any suggestions for reducing this burden, send to Federal Aviation Administration, ARP-10, 800 Independence AVE, SW, Washington, DC 20591. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number, which is 2120-0569 for this collection. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20 American LegalNet, Inc. www.FormsWorkflow.com DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 PART II SECTION C The Sponsor hereby represents and certifies as follows: 1. Compatible Land Use. The Sponsor has taken the following actions to assure compatible usage of land adjacent to or in the vicinity of the airport: 2. Defaults. The Sponsor is not in default on any obligation to the United States or any agency of the United States Government relative to the development, operation, or maintenance of any airport, except as stated herewith: 3. Possible Disabilities. There are no facts or circumstances (including the existence of effective or proposed leases, use agreements or other legal instruments affecting use of the Airport or the existence of pending litigation or other legal proceedings) which in reasonable probability might make it impossible for the Sponsor to carry out and complete the Project or carry out the provisions of Part V of this Application,
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