DEPARTMENT OF TRANSPORTATION – FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 11/30/2007 PART II PROJECT APPROVAL INFORMATION Item 1. Does this assistance request require State, local, regional, or other priority rating? Name of Governing Body Priority Yes No Item 2. Does this assistance request require State, local advisory, educational or health clearances? Name of Agency or Board (Attach Documentation) Yes No Item 3. Does this assistance request require clearinghouse review in accordance with OMB Circular A-95? (Attach Comments) Yes No Item 4. Does this assistance request require State, local, regional, or other planning approval? Name of Approving Agency Yes No Item 5. Is the proposed project covered by an approved comprehensive plan? / / Check One: Yes No Item 6. Will the assistance requested serve a Federal installation? State Local Regional Location of plan Name of Federal Installation Federal Population benefiting from Project Yes No Item 7. Will the assistance requested be on Federal land or installation? Name of Federal Installation Location of Federal Land Percent of Project Yes No Item 8. Will the assistance requested have an impact or effect on the environment? See instructions for additional information to be provided. Yes No Item 9. Will the assistance requested cause the displacement of individuals, families, businesses, or farms? Yes No Item 10. Is there other related Federal assistance on this project previous, pending, or anticipated? Number of: Individuals Families Businesses Farms See instructions for additional information to be provided. Yes FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 59 10-1 and 59 20-1 Date No Page 2 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS PART II 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 6. – Show the Federal population residing or working on the federal installation that 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 4. – Furnish the name of the approving agency and the approval date. 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 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 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 III - BUDGET INFORMATION SECTION A - BUDGET SUMMARY Grant Program, Function or Activity Federal Catalog No. (a) (b) 1. Estimated Unobligated Funds Federal (c) New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $ $ $ $ $ $ $ $ $ $ 2. 3. 4. 5. TOTALS SECTION B - BUDGET CATEGORIES 6. Object Class Categories Grant Program, Function or Activity Total (1) (2) (3) (4) (5) $ $ $ $ $ k. TOTALS $ $ $ $ $ 7. Program Income $ $ $ $ $ a. Personnel b. Fringe Benefits c. Travel d. Equipment e. Supplies f. Contractual g. Construction h. Other i. Total Direct Charges j. Indirect Charges FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 Page 3 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS PART III GENERAL INSTRUCTIONS This form is designed so that application can be made for funds from one or more grant programs. In preparing the budget, adhere to any existing Federal grantor agency guidelines which prescribe how and whether budgeted amounts should be separately shown for different functions or activities within the program. For some programs, grantor agencies may require budgets to be separately shown by function or activity. For other programs, grantor agencies may not require a breakdown by function or activity. Sections A, B, C, and D should include budget estimates for the whole project except when applying for assistance which requires Federal authorization in annual or other funding period increments. In the latter case, Sections A, B, C, and D should provide the budget for the first budget period (usually a year) and Section E should present the need for Federal assistance in the subsequent budget periods. All applications should contain a breakdown by the object class categories shown in Lines a-k of Section B. SECTION A. BUDGET SUMMARY Lines 1-4, Columns (a) and (b). For applications pertaining to a single Federal grant pro-gram (Federal Domestic Assistance Catalog number) and not requiring a functional or activity breakdown, enter on Line 1 under Column (a) the catalog program title and the catalog number in Column (b). For applications pertaining to a single program requiring budget amounts by multiple functions of activities, enter the name of each activity or function on each line in Column (a), and enter the catalog number in Column (b). For applications pertaining to multiple programs where none of the programs requires a breakdown by function or activity, enter the catalog program title on each line in Column (a) and the respective catalog number on each line in Column (b). For applications pertaining to multiple programs where one or more programs require a breakdown by function or activity, prepare a separate sheet for each program requiring the breakdown. Additional sheets should be used when one form does not provide adequate space for all breakdown of data required. However, when more than one sheet is used, the first page should provide the summary totals by programs. Lines 1-4, Columns (c) through (g). For new applications, leave Columns (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year). For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds that will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f). For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non- Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus of minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f). Line 5 - Show the totals for all columns used. SECTION B. BUDGET CATEGORIES In the column headings (1) through (4), enter the titles of the same programs, functions, and activities shown on Lines 1-4, Column (a), Section A. When additional sheets were prepared for Section A, provide similar column headings on each sheet. For each program, function, or activity, fill in the total requirements for funds (both Federal and non-Federal) by object class categories. Lines 6 a-h - Show the estimated amount for each direct cost budget (object class) category for each column with program, function, or activity heading. Line 6i - Show the totals of Lines 6a to 6h in each column. Line 6j - Show the amount of indirect cost. Refer to Office of Management and Budget Circular No. A-87. Line 6k - Enter the total amounts on Lines 6i and 6j. For all applications for new grants and continuation grants the total amount in column (5), Line 6k, should be the same as the total amount shown in Section A, Column (g), Line 5. For supplemental grants and changes to grants, the total amount of the increase or decrease as shown in Columns (1) - (4), Line 6k should be the same as the sum of the amounts in Section A, Column (e) and (f) on Line 5. When additional sheets were prepared, the last two sentences apply only to the first page with summary totals. Line 7 - Enter the estimated amount of income, if any, expected to be generated from this project. Do not add or subtract this amount from the total project amount. Show under the program narrative statement the nature and source of income. The estimated amount of program income may be considered by the Federal grantor agency in determining the total amount of the grant. American LegalNet, Inc. www.FormsWorkflow.com DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 SECTION C - NON-FEDERAL RESOURCES (a) GRANT PROGRAM (b) APPLICANT $ 8. (d) OTHER SOURCES (c) STATE $ $ (e) TOTALS $ 9. 10. 11. 12. TOTALS SECTION D - FORECASTED CASH NEEDS Total for 1st Year 13. Federal 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $ $ $ $ $ $ $ $ $ $ 14. Non-Federal 15. TOTAL SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (a) GRANT PROGRAM (b) FIRST (c) SECOND (d) THIRD (e) FOURTH $ $ $ $ $ 16. $ $ $ 17. 18. 19. 20. TOTALS SECTION F - OTHER BUDGET INFORMATION (ATTACH ADDITIONAL SHEETS IF NECESSARY) 21. Direct Charges: 22. Indirect Charges: 23. Remarks: PART IV - PROGRAM NARRATIVE (ATTACH PER INSTRUCTION) FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 Page 4 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS PART III (CONTINUED) SECTION C. SOURCE OF NON-FEDERAL RESOURCES Line 8-11 - Enter amounts of non-Federal resources that will be used on the grant. If in-kind contributions are included, provide a brief explanation on a separate sheet. (See Attachment F, Office of Management and Budget Circular No. A-102.) Column (a) - Enter the program titles identical to Column (a), Section A, A breakdown by function or activity is not necessary. Column (b) - Enter the amount of cash and in-kind contributions to be made by the applicant as shown in Section A. (See also Attachment F, Office of Management and Budget Circular No. A-102). Column (c) - Enter the State contribution if the applicant is not a State or State agency. Applicants that are a State or State agencies should leave this column blank. Column (d) - Enter the amount of cash and inn-kind contributions to be made from all other sources. Column (e) - Enter the totals of Columns (b), (c), and (d). Line 12 - Enter the total for each of Columns (b)-(e). The amount in Column (e) should be equal to the amount on Line 5, Column (f), Section A. Section D. Forecasted Cash Needs Line 13 - Enter the amount of cash needed by quarter from the grantor agency during the first year. Line 14 - Enter the amount of cash from all other sources needed by quarter during the first year. Line 15 - Enter the totals of amounts on Lines 13 and 14. SECTION E. BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT Lines 16 - 19 - Enter in Column (a) the same grant program titles shown in Column (a), Section A. A breakdown by function or activity is not necessary. For new applications and continuing grant applications, enter in the proper columns amounts of Federal funds which will be needed to complete the program or project over the succeeding funding periods (usually in years). This Section need not be completed for amendments, changes, or supplements to funds for the current year of existing grants. If more than four lines are needed to list the program titles, submit additional schedules, as needed. Line 20 - Enter the total for each of the Columns (b) - (e). When additional schedules are prepared for this Section, annotate accordingly and show the overall totals on this line. SECTION F - OTHER BUDGET INFORMATION. Line 21 - Use this space to explain amounts for individual direct object cost categories that may appear to be out of the ordinary or to explain the details as required by the Federal grantor agency. Line 22 - Enter the type of indirect rate (provisional, predetermined, final or fixed) that will be in effect during the funding period, the estimated amount of the base to which the rate is applied, and the total indirect expense. Line 23 - Provide any other explanations required herein or any other comments deemed necessary. American LegalNet, Inc. www.FormsWorkflow.com PART IV PROGRAM NARRATIVE (Suggested Format) DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 PROJECT: AIRPORT: 1. Objective: 2. Benefits Anticipated: 3. Approach: (See approved Scope of Work in final Application) 4. Geographic Location: 5. If Applicable, Provide Additional Information: 6: Sponsor’s Representative: (incl. address & tel. no.) FAA Form 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 PAGE 6 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS PART IV PROGRAM NARRATIVE Prepare the program narrative statement in accordance with the following instructions for all new grant programs. Requests for continuation or refunding and changes on an approved project should respond to item 5b only. Requests for supplemental assistance should respond to question 5c only. 1. OBJECTIVES AND NEED FOR THIS ASSISTANCE. Pinpoint any relevant physical, economic, social, financial, institutional, or other problems requiring a solution. Demonstrate the need for assistance and state the principal and subordinate objectives of the project. Supporting documentation or other testimonies from concerned interests other than the applicant may be used. Any relevant data based on planning studies should be included or footnoted. 2. RESULTS OR BENEFITS EXPECTED. Identify results and benefits to be derived. For example, include a description of who will occupy the facility and show how the facility will be used. For land acquisition or development projects, explain how the project will benefit the public. APPROACH a. Outline a plan of action pertaining to the scope and detail of how the proposed work will be accomplished for each grant program. Cite factors which might accelerate or decelerate the work and your reason for taking this approach as opposed to others. Describe any unusual features of the project such as design or technological innovations, reductions in cost or time, or extraordinary social and community involvements. b. Provide each grant program monthly or quarterly quantitative projections of the accomplishments to be achieved, if possible. When accomplishments cannot be quantified, list the activities in chronological order to show the schedule of accomplishments and their target dates. c. Identify the kinds of data to be collected and maintained, and discuss the criteria to be used to evaluate the results and success of the project. Explain the methodology that will be used to determine if the needs identified and discussed are being met and if the results and benefits identified in Item 2 are being achieved. d. List each organization, cooperator, consultant, or other key individuals who will work on the project along with a short description of the nature of their effort or contribution. 4. GEOGRAPHIC LOCATION. Give a precise location of the project and area to be served by the proposed project. Maps or other graphic aids may be attached. 5. IF APPLICABLE, PROVIDE THE FOLLOWING INFORMATION: a. Describe the relationship between this project and other work planned, anticipated, or underway under the Federal Assistance listed under Part II, Section A, Item 10. b. Explain the reason for all requests for supplemental assistance and justify the need for additional funding. c. Discuss accomplishments to date and list in chronological order a schedule of accomplishments, progress, or milestones anticipated with the new funding request. If there have been significant changes in the project objectives, location, approach or time delays, explain and justify. For other requests for changes or amendments, explain the reason for the change(s). If the scope or objectives have changed or an extension of time is necessary, explain the circumstances and justify. If the total budget has been exceeded or if individual budget items have changed more than the prescribed limits contained in Attachment K, Office of Management and Budget Circular No. A-102, explain and justify the change and its effect on the project. American LegalNet, Inc. www.FormsWorkflow.com