2022 One Call Grant Application Narrative Template.docx

NOFO# 693JK322NF0005

[Insert Your Organization Name Here] One Call Grant Application Template

Use this template to fill out the required text elements of your application as outlined in the Funding Opportunity Announcement Section D.

1. Complete page 2. This page must include your organization name and an authorized signature (this document can be converted to Adobe PDF and signed electronically if your organization has that capability, you can contact us if you need assistance.)

2. Applicant Eligibility responses are required. For any ‘no’ answer, provide a detailed explanation.

3. Project Requests by Priority are required.

a. If you are not requesting funding a priority you can delete those pages.

b. If you have multiple projects under a priority each one must be listed separately (copy/paste the entire template page).

4. Detailed Budget Narrative per project is required.

5. You must attach a signed/scanned copy of this document to your grants.gov forms package.

6. You must submit a signed copy of your application electronically through Grants.gov.

2022 One Call Grant Application

The ____ {your organization name} __________hereby applies to the Department of Transportation for Federal funds appropriated for the support of Programs established under 49 U.S.C. Section 60134 et seq.

The State agency plans to carry out the Program, as described in the "Priority Project Requests". To accomplish the program, the state agency proposes to expend funds as set forth in the "One Call Grant Estimated Budget."

Authorized Signature:____________________________

Title:_____________________________________

Date:_____________________________________

Indicate the One Call Enforcement Authority for your State and/or Agency:

2022 One Call Grant Applicant Eligibility

Changes to Section 6103 of the Pipeline Safety, Regulatory Certainty, and Job Creation Act of 2006, effective 01/03/2014, will affect States eligibility in applying for the One Call Grant. The State agency submitting the application is required to answer the following questions and provide data to clearly demonstrate compliance with these requirements. Failure to provide the requested information may void the application.

a) Does the State one-call notification program allow all underground facility operators, including all government operators, to participate as appropriate*? (list any pipeline exemptions) (Required – Yes or No, please provide a link to your state statute to support your answer)

b) Does the State one-call notification program allow all excavators, including all government and contract excavators, to participate as appropriate*? (Required – Yes or No, please provide a link to your state statute to support your answer)

c) Does the State one-call notification program provide for flexible and effective enforcement under State law? (Please provide citation to the state statute for enforcement and identify the enforcement authority.) (Required – Yes or No, please provide a link to your state statute to support your answer)

d) Does the State one-call notification program require that the one-call notification system requirements of the program are applicable without exemptions to municipalities, State agencies, or their contractors? (If you are currently determined to be ineligible by PHMSA based on this requirement, you do not qualify for this grant!) (Required – Yes or No, please provide a link to your state statute to support your answer)

e) Does the State one-call notification program provide for consideration of the gravity of the offense and risk to the public in determining appropriate enforcement? (Required – Yes or No, please provide a link to your state statute to support your answer)

f) Does the State one-call notification program provide for no cost underground facilities locate requests, excluding design, for all individuals planning excavation activities? (Required – Yes or No, please provide a link to your state statute to support your answer)

g) Does the State one-call notification program provide for voluntary participation of underground facilities owners or an activity of a type of excavator which have been determined by the State to be de minimis risk to public safety? (Required – Yes or No, please provide a link to your state statute to support your answer)

h) To the extent the State has determined it to be appropriate and necessary; has the State provided for administrative or civil penalties commensurate with the seriousness of a violation of the State one-call notification program by an excavator or facility owner? (Required – Yes or No, please provide a link to your state statute to support your answer)

Priority 1 Request:

1.1 Enter the title of this project: type or insert text here

1.2 Enter the Priority/SubCategory number from Appendix B: type or insert text here

1.4 Has this activity been performed previously? If yes, what were the results? Provide sufficient details about the effectiveness of this project in order to support the approval of this project for another year:

type or insert text here

1.5 What do you plan to do with the requested funds for this project? If you have entered costs under the "Other" budget category, you must explain those costs here:

type or insert text here

1.6 Estimated budget for this element:

1.7 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: type or insert text here Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

Detailed Supplies Listing if applicable:

Description, Quantity, Price per unit, total price

Priority 2 Request:

2.1 Enter the title of this project: type or insert text here

2.2 Enter the Priority/SubCategory number from Appendix B: type or insert text here

2.4 Has this activity been performed previously? If yes, what were the results? Provide sufficient details about the effectiveness of this project in order to support the approval of this project for another year: type or insert text here

2.5 What do you plan to do with the requested funds for this project? If you have entered costs under the "Other" budget category, you must explain those costs here: type or insert text here

2.6 Estimated budget for this element:

2.7 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: type or insert text here Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

Priority 3 Request:

3.1 Enter the title of this project: type or insert text here

3.2 Enter the Priority/SubCategory number from Appendix B: type or insert text here

3.4 Has this activity been performed previously? If yes, what were the results? Provide sufficient details about the effectiveness of this project in order to support the approval of this project for another year: type or insert text here

3.5 What do you plan to do with the requested funds for this project? If you have entered costs under the "Other" budget category, you must explain those costs here: type or insert text here

3.6 Estimated budget for this element:

3.7 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: type or insert text here Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

Total Budget Request:

Add up each priority item budget and insert the total for each category below

DIRECT COSTS

Personnel ..............................................................................................................................$ Fringe Benefits .....................................................................................................................$ Travel ...................................................................................................................................$ Equipment ............................................................................................................................$ Supplies ................................................................................................................................$ Contractual ...........................................................................................................................$ Other .....................................................................................................................................$ Total Direct ..........................................................................................................................$

INDIRECT COSTS

Indirect Charges ....................................................................................................................$

TOTAL COSTS FOR THIS REQUEST……………………………………………………$