Form 41, Schedule 2787 - Passenger Origin Destination Survey Report
OMB No.: 2139-0001, Expiration Date: 12/31/2008
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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 2139-0001. Public reporting for this collection of information is estimated to be approximately 60 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. 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, 400 7th Street, SW, Washington, D.C. 20590 or e-mail – bernard.stankus@dot.gov.
Reporting Air Carrier Code [For example, "B6" for JetBlue]: _____________________
Reporting Period [For example: "YYD" or "051" for the First Quarter of 2005]: _____________________
| City Code (1) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (2) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (3) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (4) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (5) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (6) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (7) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (8) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (9) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (10) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (11) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (12) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (13) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (14) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (15) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (16) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (17) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (18) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (19) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (20) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (21) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (22) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (23) |
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| Operating Carrier |
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| Ticketed Carrier |
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| Carrier Fare Basis Summary Code |
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| City Code (24) |
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| Amount of Fare, plus Tax, Fees and Charges (in U.S. Dollars) |
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