FY21-ICAM-Supplemental-Form.pdf
PDF 745 KB Posted
- Attached to
- FY 2021 Competitive Funding Opportunity: Innovative Coordinated Access and Mobility Pilot Program Federal grant opportunity
- Opportunity number
- FTA-2021-009-ICAM
About this file
Supplemental Form
View the file
Other files for this federal grant opportunity
| File | Type | Posted |
|---|---|---|
| FRN 2021-21969.pdf |
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v1.0 Applicant and Proposal Profile Form - FY21 Innovative Coordinated Access and Mobility Page of FY21 Innovative Coordinated Access and Mobility Applicant and Proposal Profile Is this a resubmission due to an invalid/error message from FTA?
Section I. Applicant Information (Name and Direct Phone Number) Applicant Eligibility:
Applicant Eligibility Project Location:
Project Location Section II. Project Information About the Project (Descriptive title of this project) Racial Equity Does the project address racial equity as described in the NOFO (Section E.2)?
Does the project address racial equity as described in the NOFO (Section E.2)?
Barriers To Opportunity Does the project address barriers to opportunity as described in the NOFO (Section E.2)?
Does the project address barriers to opportunity as described in the NOFO (Section E.2)?
Justice40 Does the project support the Justice40 Initiative as described in the NOFO (Section E.2)?
Does the project support the Justice40 Initiative as described in the NOFO (Section E.2)?
Project Budget Description
QTY
Federal Amount Federal Match Amount Total Cost Other Federal Funds Other Total:
Matching Funds Information Project Scalability Is project scope scalable?
Project Timeline (Please be as specific as possible) Timeline Item Description Timeline Item Date Congressional Districts (Place of Performance) Congressional District Section III . Evaluation Criteria ***Address each of the evaluation criteria as described in the Notice of Funding Opportunity.*** Demonstration of Need Demonstration of Benefits Planning and Partnership Local Financial Commitment Project Readiness Technical, Legal, and Financial Capacity 9.0.0.2.20120627.2.874785
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| Yes: |
| No: |
| lbl_hidden_rbl_Resubmission: Is this a resubmission due to an invalid/error message from FTA? |
| cFocus: |
| Grants.gov Tracking Number (13 characters): |
| lbl_hidden_txt_grantsNumber: Grants.gov tracking number |
| Organization Legal Name (200 characters): |
| lbl_hidden_txt_orgLegalName: Organization Legal Name |
| FTA Recipient ID Number (30 characters): |
| lbl_hidden_txt_ftaRecipientIdNumber: FTA Recipient ID |
| Organization CEO (200 characters): |
| lbl_hidden_txt_orgCEO: Organization CEO |
| Project Location - Large Urbanized Area: |
| Project Location - Small Urbanized Area: |
| Applicant Eligibility - Local Government Authority: |
| Applicant Eligibility - Federally Recognized Native American Tribe: |
| Applicant Eligibility - Private Non-Profit Organization: |
| Project Location - Rural: |
| lbl_hidden_rbl_ApplicantEligibility: Applicant Eligbility |
| lbl_hidden_rbl_ProjectLocation: Project Location |
| Description of Service Provided and Areas Served (4000 characters): |
| lbl_hidden_txt_descriptionOfAreaServed: Description of Service Provided and Areas Served |
| Project Title (200 characters): |
| lbl_hidden_txt_projectTitle: Project Title |
| Project Executive Summary (2000 characters): |
| lbl_hidden_txt_summaryOfReq: Project Executive Summary |
| Project Statement of Work (1000 characters): |
| lbl_hidden_txt_projectStatementOfWork: Project Statement of Work |
| lbl_hidden_rbl_IsRacialEquity: Does the project address racial equity as described in the NOFO (Section E.2)? |
| If yes, please describe: (500 characters): |
| lbl_hidden_txt_racialEquity: If yes, please describe |
| lbl_hidden_rbl_IsBarriersOpp: Does the project address barriers to opportunity as described in the NOFO (Section E.2)? |
| If yes, please describe: (500 characters): |
| lbl_hidden_txt_barriers: If yes, please describe |
| lbl_hidden_rbl_IsJustice: Does the project support the Justice40 Initiative as described in the NOFO (Section E.2)? |
| Describe how the project supports the Justice40 initiative, identify the disadvantaged community, and the benefit provided: (1000 characters): |
| lbl_hidden_txt_justice: Describe how the project supports the Justice40 initiative, identify the disadvantaged community, and the benefit provided |
| Item Description (100 characters): |
| lbl_hidden_gridItem_txt_Desc: Description |
| Quantity: |
| lbl_hidden_gridItem_num_Qty: Quantity |
| Federal Amount: |
| lbl_hidden_gridItem_num_FederalAmnt: Federal Amount |
| Federal Match Amount: |
| lbl_hidden_gridItem_num_LocalMatch: Federal Match Amount |
| Other Federal: |
| lbl_hidden_gridItem_num_OtherFederal: Other Federal Funds |
| Other: |
| lbl_hidden_gridItem_num_Other: Other |
| Total Cost: |
| lbl_hidden_gridItem_num_TotalCost: Total Cost |
| Remove Congressional District Item: |
| lbl_hidden_gridTable_budgetRepeatable: Project Budget |
| Insert Project Budget Item: |
| Grand Total - Federal Amount: |
| lbl_hidden_num_TotalFederalAmnt: Grand Total - Federal Amount |
| Grand Total - Federal Match Amount: |
| lbl_hidden_num_TotalLocalMatch: Grand Total - Federal Match Amount |
| Grand Total - Other Federal: |
| lbl_hidden_num_TotalOtherFederal: Grand Total - Other Federal Funds |
| Grand Total - Other: |
| lbl_hidden_num_TotalOther: Grand Total - Other |
| Grand Total - Total Cost: |
| lbl_hidden_num_TotalTotalCost: Grand Total - Total Cost |
| Matching Funds Amount: |
| lbl_hidden_num_matchingFunds: Matching Funds Amount |
| Source of Matching Funds (4000 characters): |
| lbl_hidden_txt_sourceMatchingFunds: Source of Matching Funds |
| Supporting Documentation of Local Match (4000 characters): |
| lbl_hidden_txt_supportingDocuments: Supporting Documentation of Local Match |
| lbl_hidden_rbl_IsScalable: Is Project Scope Scalable |
| If Yes, specify minimum Federal Funds necessary: |
| lbl_hidden_num_minFederalFunds: Specify minimum Federal Funds necessary |
| Provide explanation of scalability with specific references to the budget line items above (4000 characters): |
| lbl_hidden_txt_scalabilityExpl: Provide explanation of scalability with specific references to the budget line items above |
| Timeline Item Description (100 characters): |
| lbl_hidden_gridItem_txt_tlDesc: Timeline Item Description |
| Timeline Item Date (format MM/dd/YYYY): |
| lbl_hidden_gridItem_datetime_tlDate: Timeline Item Date |
| lbl_hidden_gridTable_timelineRepeatable: Project Timeline |
| Insert Project Timeline Item: |
| Congressional District: |
| lbl_hidden_gridItem_ddl_congressDist: Congressional District |
| lbl_hidden_gridTable_congressDistRepeatable: Congressional Districts |
| Insert Congressional District Item: |
| Demonstration of Need (4000 characters): |
| lbl_hidden_txt_demonstrationNeed: Demonstration of Need |
| Demonstration of Benefits (4000 characters): |
| lbl_hidden_txt_demonstrationBenefits: Demonstration of Benefits |
| Planning and Partnership (4000 characters): |
| lbl_hidden_txt_planningPartnership: Planning and Partnership |
| Local Financial Commitment (4000 characters): |
| lbl_hidden_txt_localFinancialCommitment: Local Financial Commitment |
| Project Readiness (4000 characters): |
| lbl_hidden_txt_projectReadiness: Project Readiness |
| Technical, Legal, and Financial Capacity (4000 characters): |
| lbl_hidden_txt_techLegalFinanceCapacity: Technical, Legal, and Financial Capacity |
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