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Passenger Civil Aviation Security Service Fees
(September 11th Security Fees)
Quarterly Reports Airline Point of Contact (POC) Designation Form
Purpose: Use this form to designate an individual as Point of Contact (POC) for activities related to the quarterly reporting of September 11th Security Fees to the U.S. Department of Transportation, Bureau of Transportation Statistics (BTS). The BTS recognizes the POC as the carrier’s authority to assign or approve individuals who are permitted to report on the carrier’s behalf. The POC will also be responsible for managing the reporting carrier’s user accounts to access the web-based September 11th Security Fee Reporting Application to include immediately requesting removal of user account privileges as appropriate.
POC Information
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Name (Last, First, M.I.)
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Title or Dept.
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Email Address
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Telephone no.
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Fax no.
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Mailing Address
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Carrier Name
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Scope of Authorization: Subject to the limitations that follow,
the POC is authorized to grant individuals access to the Transportation Security
Administration (TSA) September 11th Security Fee Reporting Application to submit
quarterly security fee reports for the carrier named above. This authorization
contains no implied authorization to access any other computer system of the U.S.
Government, and will be revoked on separation, retirement, reassignment of duties,
change of organization or when determined by the Information Systems Security
Officer to be in the best interest of the Government.
WARNING: Only Authorized Users May Use These Systems. To protect
these systems from unauthorized use and to ensure that these systems are functioning
properly, system administrators monitor these systems. Individuals using these
systems without authority, or in excess of their authority, are subject to having
all of their activities on these systems monitored and recorded by system personnel.
In the course of monitoring individuals improperly using these systems, or in
the course of system maintenance, the activities of authorized users may also
be monitored. Anyone using these systems expressly consents to such monitoring
and is advised that if such monitoring reveals possible evidence of criminal activity,
management may authorize system personnel to provide the evidence of such monitoring
to law enforcement officials.
Name: __________________________________________
POC’s Signature
Date: __________________________
Send the completed form to:
Office of Airline Information (K-14) ATTN: Clay Moritz
Bureau of Transportation Statistics, Room 4125
400 7th Street SW
Washington, DC 20590
Fax to: (+1) 202-366-3383
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For BTS use only
Name: __________________________________________________
Clay Moritz, Airline Information Security Officer
Date: __________________________
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