> Estimated reporting burden for this report varies from 1 to 5 hours
> per quarterly response with the average time being 2 hours. Comments
> regarding the burden estimate or any other aspect of this collection,
> including suggestions for reducing burden should be sent in with the
> report; and to the Office of Information and Regulatory Affairs, OMB
> Washington D.C. 20503

Approved by OMB

OMB No. 2138-0009

Expires: 06/30/2005

BTS Form 298-C, Schedule F-1 Air Carrier (Corporate name including
DBA's)

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**REPORT OF FINANCIAL DATA**

![](media/image1.png) Quarter Ended
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U.S. Department of Transportation

Bureau of Transportation Statistics

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[Financial]{.underline}

\(1\) Total Operating Revenues
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\(2\) Total Operating Expenses
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\(3\) Net Income
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\(4\) Passenger Revenues-Scheduled Service
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[PASSENGER FACILITY CHARGE ACTIVITY FOR THE QUARTERLY PERIOD
ENDING]{.underline}: \_\_\_\_\_\_\_

Total PFC Liability at Beginning of Period
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Total Amount Collected in Trust for Public Agencies
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Total Amount Remitted to Public Agencies
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Adjustments (Collection compensation, PFC refunds)
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TOTAL PFC LIABILITY AT END OF PERIOD
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CERTIFICATION\*

I certify that this 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.

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(Signature) (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.

**OMB NO: 2138-0009\
EXPIRATION DATE: 5/31/2008**

**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.