2019-ER-Supplmental-Form.pdf

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Public Transportation Emergency Relief Funds for Transit Systems Affected by Major Declared Disasters Occuring in Calendar Year 2018
Opportunity number
FTA-2020-002-TPM-ER
Issued by

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2019 ER Supplmental Form Update

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PKG00256989-instructions.docx DOCX document
2019-26068 FRN.pdf PDF

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v1.2 Public Transportation Emergency Relief Program Page of Applicant and Proposal Profile Public Transportation Emergency Relief Program This application form collects information from Federal Transit Administration grant recipients that provide or fund public transportation service in areas affected by major declared disasters occurring in calendar year 2018 Section I. Applicant Information Is this a resubmission due to an invalid/error message from FTA?

Applicant Type:

(pick one) Is this a request on behalf of a subrecipient?

Section II. Project and Expense Information List and describe all supporting materials and documents included with proposal:

Project Budget Description

QTY

Federal Amount Total Cost Local Match Operating or Capital?

If the expense has already been incurred, please provide date:

Grand Total:

Matching Funds Information Is there a past expense incurred?

Congressional Districts Affected by the Project Congressional District Section III. Additional Questions

1. Have you requested or received insurance payments for any of the expenses described above?

2. Have you requested or received reimbursement from FEMA for any of the expenses described?

*Provide a description of the purpose of the public transportation service provided, which may include: evacuations, returning evacuees to their homes, rescue operations, temporary public transportation service, the costs to move rolling stock out of harm's way, and any costs related to reestablishing, expanding, or relocating public transportation service before, during, or after the hurricane. The application must include the dates, hours, number of buses, ferries, and/or trains, and information relating to fares charged. Only net operating costs may be reimbursed.

9.0.0.2.20120627.2.874785

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Grants.gov Tracking Number (13 characters):
Organization Legal Name (200 characters):
FTA Recipient ID Number (4 characters):
FEMA Disaster Number (100 characters):
State:
Tribe:
Direct Recipient of 5307 Urbanized Area Formula Program:
Other:
If Other, Specify (100 characters):
Project Location (100):
Counties Affected (500 characters):
If yes, subrecipient name (1000 characters):
Project Title (200 characters):
Executive Summary of Request (1000 characters):
Project Statement of Work (500 characters):
List all supporting materials and documents included with proposal (1000 characters):
Item Description (100 characters):
Quantity:
Federal Amount:
Remove Congressional District Item:
Total Cost:
Local Match:
Operating or Capital? (100 characters):
If the expense has already been incurred, please provide date::
Insert Project Budget Item:
Grand Total - Federal Amount:
Grand Total - Local Match:
Grand Total - Total Cost:
Matching Funds Amount:
Source of Matching Funds (4000 characters):
Supporting Documentation of Local Match (4000 characters):
If yes, explain past expense (1000 characters):
Congressional District:
Insert Congressional District Item:
If yes, please describe (include amount) (1000 characters):
Yes:
No:
If yes, please describe (include amount) (1000 characters):
Summary of emergency or permanent repair capital expenses (4000 characters):
Summary of emergency response operating (4000 characters):

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