2020 TTPSF Application Form.pdf

TTP Safety Fund Application Form FY2020 Page 1

FY20 TRIBAL TRANSPORTATION PROGRAM SAFETY FUND (TTPSF)

APPLICATION FORM

INSTRUCTIONS

Select a category in Step 1 to begin. This form must be completed and submitted electronically.

Submit this application form along with all supporting documentation by following further instructions online at: https://highways.dot.gov/federal-lands/programs-tribal/safety/funds

Do not submit a scanned image of this form except as directed in Step 7.

If you have questions about the TTPSF please send an email to TTPSF@dot.gov or call Adam Larsen at 360-619-7751.

STEP 1. SELECT CATEGORY

Choose the category that is most applicable to the project. The questions presented in this form will change based on your selection:

STEP 2. ENTER APPLICANT INFORMATION

Applicant Identifier Find your six-character code here.

DUNS Number Must be registered at www.sam.gov

Official Name of Tribe

Street Address

City

State

Zip Code http://flh.fhwa.dot.gov/programs/ttp/documents/bia-6codes.pdf http://www.sam.gov/ https://highways.dot.gov/federal-lands/programs-tribal/safety/funds

TTP Safety Fund Application Form FY2020 Page 2

Contact Person for this Project

Full Name

Title

Organizational Affiliation (Department)

Telephone Number

Email Address

Additional Email Address This optional field can be used to list an additional email address that may be contacted about this project.

Status of Prior TTPSF Awards Describe the status of projects funded by TTPSF awards in prior years. For completed projects please provide an evaluation of the project’s success in improving transportation safety. Include an additional page if needed.

Is the applicant delinquent on any Federal debt?

If yes, include an explanation as supporting documentation when uploading this application.

Project Abstract In a maximum of five sentences, summarize project work that would be completed under the project, the hazardous road location or feature or the highway safety problem that the project would address, and whether the project is a complete project or part of a larger project with prior investment. The project abstract must succinctly describe how this specific request for TTPSF would be used to complete the project.

Expected Outcome In a maximum of three sentences, describe the expected outcome of this project including any anticipated crash reduction.

STEP 4. ADDRESS SELECTION CRITERIA

On the following pages please provide a summary response to each selection criteria question. A more detailed response to the selection criteria should be provided in the project narrative. In addition to addressing these selection criteria questions, a project narrative is required for all applications (except for applications to develop or update of transportation safety plans).

Applicants should carefully review the selection criteria descriptions in the Notice of Funding Opportunity. For a guide describing how the selection criteria will be evaluated, please visit the TTPSF Web Page. A project application must meet the highly qualified (HQ) standards for all criteria to be ranked as highly qualified. A project application must meet either qualified (Q) or HQ standards for all criteria to be ranked as qualified. If a project application meets the not qualified (NQ) standards for any of the selection criteria, the project will be ranked not qualified.

Note: The category selected in step 1 modifies the questions presented in steps 4-6.

TTP Safety Fund Application Form FY2020 http://flh.fhwa.dot.gov/programs/ttp/safety/ttpsf.htm

TTP Safety Fund Application Form FY2020 Page 4

TTP Safety Fund Application Form FY2020 Page 5 https://itims.bia.gov

TTP Safety Fund Application Form FY2020 Page 6

STEP 5. ADDRESS KEY OBJECTIVES OF THE USDOT

STEP 6. PREPARE SUPPORTING DOCUMENTATION

TTP Safety Fund Application Form FY2020 Page 7

STEP 7. AUTHORIZATION

Authorized Representative (Person who authorized the application to be submitted)

Full Name

Title

Telephone Number

Email Address

Authorized Signature Certification: By signing this report, I certify to the best of my knowledge and belief that the information in this application is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and intent set forth in the award documents. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)

X________________________________________________________________________________________

If the authorized representative is unable to sign using an electronic signature, please submit this electronic form without the signature and provide an image of the signed form as supporting documentation.

For requests to develop a Tribe's first transportation safety plan, no additional documentation is required. This application serves as your project narrative.

For requests to update a Tribe's safety plan, please provide a copy of the previous transportation safety plan. This application may serve as your project narrative.

All supporting documentation uploaded with the application should be referenced in the project narrative and should help reviewers understand responses to the selection criteria. An index of all supporting documentation is encouraged.

Required supporting documents are:

Average daily traffic volumes, pedestrian volumes, traffic citation statistics, public surveys, and sign inventories are examples of alternative safety data sources which could be used to supplement relevant incident history.

After considering all other selection criteria, the Federal Highway Administrator will take into account the following key Departmental objectives, as described in the Notice of Funding Opportunity: