Form F-183 Extension of Credit to Polticial Candidates

PART 374A - Form 183

Report of Extension of Credit to Political Candidates

OMB NO: 2138-0016
EXPIRATION DATE: 9/30/2012

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 2138-0016. Public reporting for Form 183, Report of Extension of Credit to Political Candidates, is estimated to be approximately 1 hour per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory, as authorized by 14 CFR, Part 374a. 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, Jeff Gorham, OAI/BTS/RITA, RTS-42, Room E34, 1200 New Jersey Avenue, SE, Washington, D.C. 20590 or e-mail – jeff.gorham@dot.gov.

REQUIREMENTS

RECORD DESCRIPTION: Form 183 - Report of Extension of Credit to Political Candidates

The report and a certification statement are required. Certification must be by an appropriate official of the reporting carrier. The report and certification statement will include:

Reporting Period (Month/Year):

Air Carrier Code:

Air Carrier Name:

Name of Candidate:

Name of Account	Total Receivable	Credit Limitation	Unpaid Balance	Age of Unpaid Balance In Days	Security type of collateral and $amount

I, (Name) and (Title), of the above named carrier, certify that the above Report of Extension of Credit to Political Candidates has been examined by me and is to the best of my knowledge and belief, true, correct, as defined in PART 374a (14 CFR 374a) and is a complete report for the period stated.

Date:

Signature: (this may be electronic or signed with document scanned into a pdf)

Name (Please Print or Type):

RECORD FORMAT:

Once signed, the Form 183 - Report of Extension of Credit to Political Candidates must be published as an electronic “portable document format” file format, for uploading to the eSubmit application.

The portable document format file MUST BE indicated when naming the file, by using the letters [PDF] or [pdf] following the file name, as the file name extension. You must have Adobe Reader software downloaded on your computer in order to “save as/print” your document as a ‘pdf’ file.

While the file name is flexible and may be determined by the individual air carrier, the portable document format (pdf) file format is required, as outlined in the rule entitled, Submitting Airline Data via the Internet.

Suggested file name: CC201003- Form183PoliticalCreditRpt-Cert.pdf