Form 298-C, Schedule F-1 - Report of Financial Data
OMB No: 2138-0009, Expiraton Date: 5/31/2008
Word
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
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