FY23-Extended-Availability-of-Emergency-Relief-Program-Supplemental-Form.pdf
PDF 206 KB Posted
- Opportunity number
- FTA-2023-011-TPM-ER
About this file
This document is an application form for the FY 2023 Emergency Relief Grants for Public Transportation Systems Affected by Major Declared Disasters in Calendar Years 2017, 2020, 2021, and 2022 program. The form requests applicant information including name, address, congressional districts, and details of eligible disasters. It also requests a project description, budget including capital and operating expenses, and responses to evaluation criteria regarding technical capacity, implementation strategy, insurance coverage, and reimbursement from other sources. The related federal grant opportunity provides additional context, with the solicitation number FTA-2023-011-TPM-ER and assigned to the Department of Transportation Federal Transit Administration under the 20.527 - Public Transportation Emergency Relief Program federal grant program. Review and selection will be conducted by the FTA, with funding provided to eligible recipients and subrecipients of the Urbanized Area Formula, Enhanced Mobility of Seniors and Individuals with Disabilities, and Rural Areas Formula grant programs for emergency response and recovery capital and operating costs from eligible disasters between 2017 to 2022.
Supplemental Form
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| File | Type | Posted |
|---|---|---|
| 2023-16416.pdf |
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v1.0.0 Page of FY 2023 Extended Availability of Emergency Relief Grants for Public Transportation Systems Affected by Major Declared Disasters in Calendar Years 2017 and 2020-2022 FY 2023 Extended Availability of Emergency Relief Grants for Public Transportation Systems Affected by Major Declared Disasters in Calendar Years 2017 and 2020-2022 Applicant and Proposal Profile Is this a resubmission due to an invalid/error message from FTA?
Is this a resubmission due to an invalid/error message from FTA?
Section I. Applicant Information (Name and Direct Phone Number) Applicant Type:
Applicant Type:
Eligible Recipient or Subrecipient of 49 U.S.C. 5307, 5310, or 5311?
Project Location (as of 2010 Census):
Project Location (as of 2010 Census):
Eligible Disaster(s) Eligible Disaster(s) Start Date Disaster Number Disaster Name Counties Affected *Please see www.fema.gov/disasters for a list of major disaster declarations, areas designated for Public Assistance, and incident periods.
*Please see www.fema.gov/disasters for a list of major disaster declarations, areas designated for Public Assistance, and incident periods.
Congressional Districts (Project Location) Congressional Districts (Project Location) Congressional District Section II. Project Information About the Project (Descriptive title of this project) Section III. Evaluation Criteria Project Budget (Total) Project Budget for Capital Expenses Grand Total:
Grand Total:
Project Budget for Capital Expenses Project Budget for Capital Expenses Disaster Number Description
QTY
Federal Amount Local Match Total Cost If the expense has already been incurred, please provide date (MM/DD/YY):
If the expense has already been incurred, please provide date (MM/DD/YY) Grand Total:
Grand Total:
Project Budget for Operating Expenses Project Budget for Operating Expenses Disaster Number Description
QTY
Federal Amount Local Match Total Cost If the expense has already been incurred, please provide date (MM/DD/YY):
If the expense has already been incurred, please provide date (MM/DD/YY) Grand Total:
Grand Total:
Is the project scope scalable?
Is the project scope scalable?
*Attach a damage assessment and a detailed breakdown of eligible emergency and permanent repair capital projects (see eligibility criteria).
*Attach a damage assessment and a detailed breakdown of eligible emergency and permanent repair capital projects (see eligibility criteria).
*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 below, 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.
*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 below, 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.
3. Does insurance cover any of the expenses requested above, and if so has a request or insurance payment been received for any of the expenses described above?
3. Does insurance cover any of the expenses requested above, and if so has a request or insurance payment been received for any of the expenses described above?
4. Have you requested or received reimbursement from FEMA or any other Federal entity for any of the expenses described?
4. Have you requested or received reimbursement from FEMA or any other Federal entity for any of the expenses described?
Project Implementation Strategy Project Implementation Strategy Technical, Legal, and Financial Capacity 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 Number |
| Organization CEO (200 characters): |
| lbl_hidden_txt_orgCEO: Organization CEO |
| Direct or Designated Recipient: |
| State: |
| Local Governmental Authority: |
| Federally-Recognized Indian Tribe: |
| lbl_hidden_rbl_ApplicantType: Applicant Type |
| Project Location: Large Urbanized Area (200,000+ people): 0 |
| lbl_hidden_cb_LargeUrban: Large Urbanized Area (200,000+ people) |
| Project Location: Small Urbanized Area (50,000-199,999 people): 0 |
| lbl_hidden_cb_SmallUrban: Small Urbanized Area (50,000-199,999 people) |
| Project Location: Rural (less than 50,000 people): 0 |
| lbl_hidden_cb_Rural: Rural (less than 50,000 people) |
| lbl_hidden_cbl_ProjectLocation: Project Location (as of 2010 Census) |
| Start Date (format MM/DD/YYYY): |
| lbl_hidden_gridItem_datetime_Date: Start Date |
| Disaster Number: |
| lbl_hidden_gridItem_num_DisasterNumber: Disaster Number |
| Disaster Name (100 characters): |
| lbl_hidden_gridItem_txt_Disaster: Disaster Name |
| Counties Affected (100 characters): |
| lbl_hidden_gridItem_txt_CountiesAffected: Counties Affected |
| Remove Project Budget for Operating Expenses Item: |
| lbl_hidden_gridTable_disastersRepeatable: Eligible Disasters |
| Insert Disaster Item: |
| Congressional District: |
| lbl_hidden_gridItem_ddl_congressDist: Congressional District |
| lbl_hidden_gridTable_congressDistRepeatable: Congressional Districts |
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| Project Title (200 characters): |
| lbl_hidden_txt_projectTitle: Project Title |
| Project Executive Summary (4000 characters): |
| lbl_hidden_txt_summaryOfReq: Project Executive Summary |
| List and describe all supporting materials and documents included with proposal (1000 characters): |
| lbl_hidden_txt_projectStatementOfWork: List and describe all supporting materials and documents included with proposal |
| lbl_hidden_gridTable_budgetRepeatable: Overall Project Budget |
| Grand Total - Federal Amount: |
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| Grand Total - Local Match: |
| lbl_hidden_num_TotalLocalMatch: Overall Project Budget - Local Match |
| Grand Total - Total Cost: |
| lbl_hidden_num_TotalTotalCost: Overall Project Budget - Total Cost |
| Disaster Number: |
| lbl_hidden_gridItem_num_DisasterNumberCapital: Disaster Number |
| Item Description (100 characters): |
| lbl_hidden_gridItem_txt_DescCapital: Description |
| Quantity: |
| lbl_hidden_gridItem_num_QtyCapital: Quantity |
| Federal Amount: |
| lbl_hidden_gridItem_num_FederalAmntCapital: Federal Amount |
| Local Match: |
| lbl_hidden_gridItem_num_LocalMatchCapital: Local Match |
| Total Cost: |
| lbl_hidden_gridItem_num_TotalCostCapital: Total Cost |
| If the expense has already been incurred, please provide date (MM/DD/YY): (MM/DD/YY) |
| lbl_hidden_gridItem_txt_DateCapital: Expense Date |
| lbl_hidden_gridTable_budgetRepeatableCapital: Project Budget for Capital Expenses |
| Insert Project Budget for Operating Expenses Item: |
| Grand Total - Federal Amount: |
| lbl_hidden_num_TotalFederalAmntCapital: Grand Total - Federal Amount |
| Grand Total - Local Match: |
| lbl_hidden_num_TotalLocalMatchCapital: Grand Total - Local Match |
| Grand Total - Total Cost: |
| lbl_hidden_num_TotalTotalCostCapital: Grand Total - Total Cost |
| Disaster Number: |
| lbl_hidden_gridItem_num_DisasterNumberOperating: Disaster Number |
| Item Description (100 characters): |
| lbl_hidden_gridItem_txt_DescOperating: Description |
| Quantity: |
| lbl_hidden_gridItem_num_QtyOperating: Quantity |
| Federal Amount: |
| lbl_hidden_gridItem_num_FederalAmntOperating: Federal Amount |
| Local Match: |
| lbl_hidden_gridItem_num_LocalMatchOperating: Local Match |
| Total Cost: |
| lbl_hidden_gridItem_num_TotalCostOperating: Total Cost |
| If the expense has already been incurred, please provide date (MM/DD/YY): (MM/DD/YY) |
| lbl_hidden_gridItem_txt_DateOperating: Expense Date |
| lbl_hidden_gridTable_budgetRepeatableOperating: Project Budget for Operating Expenses |
| Grand Total - Federal Amount: |
| lbl_hidden_num_TotalFederalAmntOperating: Grand Total - Federal Amount |
| Grand Total - Local Match: |
| lbl_hidden_num_TotalLocalMatchOperating: Grand Total - Local Match |
| Grand Total - Total Cost: |
| lbl_hidden_num_TotalTotalCostOperating: Grand Total - Total Cost |
| Matching Funds Amount: |
| lbl_hidden_num_matchingFunds: Matching Funds Amount |
| Provide information on the source, availability, and supporting documentation (4000 characters): |
| lbl_hidden_txt_supportingDocuments: Provide information on the source, availability, and supporting documentation |
| lbl_hidden_rbl_IsScalable: Is the 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 |
| 1. Narrative description of emergency and/or permanent repair capital expenses (4000 characters): |
| lbl_hidden_txt_summaryOfEmergencyRepair: 1. Narrative description of emergency and/or permanent repair capital expenses |
| 2. Narrative description of emergency response operating expenses (4000 characters): |
| lbl_hidden_txt_summaryOfEmergencyResponse: 2. Narrative description of emergency response operating expenses |
| lbl_hidden_rbl_insurancePayments: 3. Does insurance cover any of the expenses requested above, and if so has a request or insurance payment been received for any of the expenses described above? |
| If yes, please describe (include amount and status of reimbursement). (4000 characters): |
| lbl_hidden_txt_insurancePaymentsYes: If yes, please describe (include amount and status of reimbursement) |
| If no, please describe the coverage provided by any insurance carried by the applicant. (4000 characters): |
| lbl_hidden_txt_insurancePaymentsNo: If no, please describe the coverage provided by any insurance carried by the applicant. |
| lbl_hidden_rbl_receivedReimbursement: 4. Have you requested or received reimbursement from FEMA or any other Federal entity for any of the expenses described? |
| If yes, please describe (include amount include amount and status of reimbursement). (4000 characters): |
| Applicants must input the amount of reductions per vehicle from the FY 2023 Bus and Low-No Emissions Reduction Calculator.: If yes, please describe (include amount and status of reimbursement) |
| Project Implementation Strategy (4000 characters): |
| lbl_hidden_txt_implementStratDesc: Project Implementation Strategy |
| lbl_hidden_txt_technicalCapacity: Technical, Legal, and Financial Capacity |
| Technical, Legal, and Financial Capacity (4000 characters): |
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