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Form 41 Schedule 2787

U.S. DEPARTMENT OF TRANSPORTATION

RESEARCH AND INNOVATIVE TECHNOLOGY ADMINISTRATION - BUREAU OF TRANSPORTATION STATISTICS

BTS FORM 41 SCHEDULE 2787 PASSENGER ORIGIN DESTINATION SURVEY REPORT
Reporting Air Carrier Code [For example, "B6" for JetBlue]
Reporting Period: [For example: "YYD" or "051" for the First Quarter of 2005]
No. of Passengers
City Code (1)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (2)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (3)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (4)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (5)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (6)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (7)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (8)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (9)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (10)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (11)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (12)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (13)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (14)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (15)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (16)

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Form 41 Schedule 2787

Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (17)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (18)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (19)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (20)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (21)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (22)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (23)
Operating Carrier
Ticketed Carrier
Carrier Fare Basis Summary Code
City Code (24)
BLANK
Amount of Fare, plus Tax, Fees and Charges (in U.S. Dollars)

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OMB NO: 2139-0001
EXPIRATION DATE: 12/31/2008

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 2139-
0001. Public reporting for this collection of information is estimated to be approximately 60 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. 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, 400 7th Street, SW, Washington, D.C. 20590 or e-mail –
bernard.stankus@dot.gov.