Systems and Procedures
A Division of The Corporate Controller's Office
IN

FLY AMERICA ACT WAIVER CHECKLIST
FORM INSTRUCTIONS

Form Instructions

You must complete this form if foreign air travel on a non-U.S. carrier is financed by the U.S. government or will be claimed as a cost under a federal award.

To document a waiver of the restrictions of the Fly America Act under 41 CFR Part 301-10, check the applicable statement(s). This form should be completed prior to purchasing airline tickets to alleviate any concerns about the allowability of flights taken. Cost and/or personal convenience are NOT included in the exception criteria used to determine the non-availability of a U.S. flag air carrier.

The form should then be signed and attached to the ERS report where the airfare is reported, along with all other supporting documentation.

Select one of the following seven appropriate statements. For statements one and seven, you must also select one of the clarifying statements:

  1. Use of foreign air carrier is a matter of necessity because of: (must check one of the clarifying statements:

    1. U.S. flag air carrier cannot provide the air transportation needed, e.g. (select one of four sub-statements:

      1. Use of foreign air carrier is necessary for medical reasons
      2. Use of foreign air carrier is required to avoid unreasonable risk to traveler’s safety. (See 41 CFR 301-10, 138(b)(2) for supporting evidence needed).
      3. Seat on U.S. air carrier in authorized class of service is unavailable; seat on foreign air carrier in authorized class of service is available.
      4. Other (Provide detailed explanation as an attachment to this document).

    2. Use of U.S. flag air carrier will not accomplish the Department’s mission (Provide detailed justification as an attachment).

  2. Bilateral or multilateral air transportation agreement. U.S. is a party and Department of Transportation determines agreement meets requirements of Fly America Act (see Open Skies Agreements). For questions related to Open Skies Agreements, please contact the travel agency that is booking the flight. For reservations made through Travel OnLion (Concur), please contact the Anthony Travel at 814-258-6111/888-827-3331 or pennstate@anthonytravel.com.
  3. No U.S. flag air carrier provides service on a particular leg of your route (travelers can only use foreign air carrier to or from the nearest interchange point to connect with a U.S. carrier).
  4. A U.S. flag air carrier involuntarily reroutes traveler on a foreign air carrier.
  5. Service on a foreign air carrier is three hours or less, and use of U.S. flag air carrier doubles en route travel time.
  6. Air travel is between the U.S. and another country and use of a U.S. carrier on a nonstop flight extends travel time by 24 hours or more.
  7. Any other air travel. (You must check at least one of the following statement to qualify for a waiver in this section.)

    1. Use of a U.S. carrier increases the number of aircraft changes outside the U.S. by two or more.
    2. Use of a U.S. carrier extends travel time by six hours or more.
    3. Use of a U.S. carrier requires a connecting time of four hours or more at an overseas interchange point.

  8. Foreign Carrier – Enter the name of the Foreign Carrier.
  9. Flight Numbers – Enter the flight numbers.
  10. Travel From – Enter the location traveling from.
  11. Travel To – Enter the travel destination.
  12. Travel Dates – Enter the travel dates.
  13. Travel Agent Signature – If a Travel Agent made travel arrangement, Travel Agent signature is required.
  14. Date – If Travel Agent signs this form, they must also include the date of signature.
  15. Name of Agent – Enter the name of the Travel Agent whose signature appears above.
  16. Agency – Enter the name of the Travel Agency, if applicable..
  17. Check Box – Check this box if traveler booked travel independently.
  18. Traveler Signature – Travel must sign this form.
  19. Date – Enter the date the Traveler signs the form.
  20. Traveler Name – Enter the Name of the Traveler.
  21. Email – Enter the travelers’ email address.
  22. Phone – Enter the travelers’ work phone number..
Image of Fly America Act Waiver Checklist Form