FY24-ICAM-Supplemental-Form.pdf
PDF 218 KB Posted
- Attached to
- FY 2024 Competitive Funding Opportunity: Innovative Coordinated Access and Mobility Pilot Program Federal grant opportunity
- Opportunity number
- FTA-2024-006-TPM-ICAM
About this file
This document is a supplemental application form for the FY 2024 Innovative Coordinated Access and Mobility Pilot Program federal grant opportunity. The form requests applicant information including organization details, project description, location, and eligibility. It also contains sections for evaluation criteria such as demonstration of need, benefits, planning, partnerships, scalability, implementation strategy, performance measures, capacity, and Justice40 Initiative impact. The budget section includes tables for project costs. Key federal grant programs include the Enhanced Mobility of Seniors and Individuals with Disabilities program. The soliciting agency is the Department of Transportation Federal Transit Administration. The form collects information necessary for grant evaluation and selection according to the criteria in the FY 2024 NOFO.
Supplemental Form
View the file
Other files for this federal grant opportunity
| File | Type | Posted |
|---|---|---|
| 2023-25181.pdf |
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v1.0.0 Page of FY 2024 Innovative Coordinated Access and Mobility FY 2024 Innovative Coordinated Access and Mobility 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 (NOFO Section C.1) Section I. Applicant Information (NOFO Section C.1) (Name and Direct Phone Number) Organization CEO (200 characters) Applicant Eligibility:
Applicant Eligibility:
Applicant Eligibility Current FTA recipient?
Current FTA recipient?
Current FTA recipient?
Project Location:
Project Location:
Eligible Recipient or Subrecipient of 49 U.S.C. 5307, 5310, or 5311?
Is this a Regional or Statewide Project?
Is this a Regional or Statewide Project?
Applicant Eligibility Congressional Districts (Project Location) Congressional Districts (Project Location) Congressional District Section II. Project Information Section II. Project Information About the Project About the Project (Descriptive title of this project) Project Type (select all that apply):
Project Type (select all that apply):
Section III. Evaluation Criteria (NOFO Section E) Section III. Evaluation Criteria (NOFO Section E) Demonstration of Need Demonstration of Need Demonstration of Benefits Demonstration of Benefits Planning and Partnership Planning and Partnership Are the project partners grantees and/or constituents of the Federal agencies that are members of the CCAM?
Are the project partners grantees and/or constituents of the Federal agencies that are members of the CCAM?
Are the project partners grantees and/or constituents of the Federal agencies that are members of the CCAM?
Local Financial Commitment Local Financial Commitment Project Budget Project Budget Description
QTY
Federal Amount Federal Match Amount Other Federal Funds Other Total Cost Total:
Project Scalability Project Scalability Is project scope scalable?
Is project scope scalable?
Is project scope scalable Project Implementation Strategy Project Implementation Strategy Project Timeline (Please be as specific as possible) Project Timeline (Please be as specific as possible) Timeline Item Description Timeline Item Date Performance Measures Performance Measures Please list anticipated performance measures that will be used to quantify project outcomes:
Please list anticipated performance measures that will be used to quantify project outcomes:
Technical, Legal, and Financial Capacity Technical, Legal, and Financial Capacity Section IV. Additional Considerations (NOFO Section E.2) Section IV. Additional Considerations (NOFO Section E.2) Justice40 Justice40 Does the project support the Justice40 Initiative?
Does the project support the Justice40 Initiative?
Does the project support the Justice40 Initiative?
Justice40 Population Impacted Justice40 Population Impacted Justice40 Disadvantaged Community Served as Identified in the NOFO Section E.2 Actual or Estimated Annual Ridership Count Was this estimate generated using the Justice40 online mapping tool?
Was this estimate generated using the Justice40 online mapping tool?
Was this estimate generated using the Justice40 online mapping tool?
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| CurrentPage: |
| PageCount: |
| ResetButton1: |
| btnValidate: |
| programCodeHidden: FTA-2024-006-TPM-ICAM |
| programVersionHidden: 1 |
| 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 |
| State: |
| Direct or Designated Recipient: |
| Local Governmental Entity: |
| Federally Recognized Native American Tribe: |
| Private Non-Private Organization: |
| Operators of Public Transit: |
| lbl_hidden_rbl_ApplicantEligibility: Applicant Eligibility |
| lbl_hidden_rbl_ApplicantType: Current FTA recipient? |
| Large Urbanized Area (200,000+ people): |
| Small Urbanized Area (50,000-199,999 people): |
| Rural (less than 50,000 people): |
| lbl_hidden_rbl_ProjectLocation: Project Location |
| Regional: |
| Statewide: |
| lbl_hidden_rbl_RegionalStatewide: Is this a Regional or Statewide Project? |
| Description of Service Provided and Areas Served: (4000 characters): |
| lbl_hidden_txt_descriptionOfAreaServed: Description of Service Provided and Areas Served |
| Congressional District: |
| lbl_hidden_gridItem_ddl_congressDist: Congressional District |
| Remove Justice40 population Impacted Item: |
| lbl_hidden_gridTable_congressDistRepeatable: Congressional Districts |
| Insert Congressional District Item: |
| Project Title (200 characters): |
| lbl_hidden_txt_projectTitle: Project Title |
| Project Executive Summary (4000 characters): |
| lbl_hidden_txt_summaryOfReq: Project Executive Summary |
| Project Type - Mobility Management: 0 |
| lbl_hidden_cb_mobilityManagement: Mobility Management |
| Project Type - One-Call/One-Click Center: 0 |
| lbl_hidden_cb_oneCallOneClickCenter: One-Call/One-Click Center |
| Project Type - Software Purchase: 0 |
| lbl_hidden_cb_softwarePurchase: Software Purchase |
| Project Type- Vehicle Purchase: 0 |
| lbl_hidden_cb_vehiclePurchase: Vehicle Purchase |
| Project Type - Other: 0 |
| lbl_hidden_cb_other: Other |
| lbl_hidden_cbl_projectType: Project Type |
| Project Type - If Other, specify: (200 characters): |
| lbl_hidden_txt_projTypeOther: If Other Project Type, specify |
| Please describe the need for the project and address how the need is related to the goals listed in the NOFO (Section E.1.a): (4000 characters): |
| lbl_hidden_txt_demonstrationOfNeed: Please describe the need for the project and address how the need is related to the goals listed in the NOFO (Section E.1.a) |
| Please describe how the proposed project addresses the ICAM goals and project elements listed in the NOFO (Section E.1.b): (4000 characters): |
| lbl_hidden_txt_demonstrationOfBenefits: Please describe how the proposed project addresses the ICAM goals and project elements listed in the NOFO (Section E.1.b): |
| Please describe the eligible project and list the project partners and their specific role: (4000 characters): |
| lbl_hidden_txt_planningAndLocal: Please describe the eligible project and list the project partners and their specific role |
| Yes: |
| No: |
| lbl_hidden_rbl_IsGranteesMembers: Are the project partners grantees and/or consituents of the Federal agencies that are members of the CCAM? |
| Provide information on the source, availability, and supporting documentation: (4000 characters): |
| lbl_hidden_txt_sourceMatchingFunds: Provide information on the source, availability, and supporting documentation |
| 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 Funds: |
| lbl_hidden_gridItem_num_OtherFederal: Other Federal Funds |
| Other: |
| lbl_hidden_gridItem_num_Other: Other |
| Total Cost: |
| lbl_hidden_gridItem_num_TotalCost: Total Cost |
| 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 Funds: |
| 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 |
| lbl_hidden_rbl_IsScalable: Is project scope scalable? |
| If Yes, specify minimum Federal Funds necessary: |
| lbl_hidden_num_minFederalFunds: If Yes, 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 |
| Project Implementation Strategy (4000 characters): |
| lbl_hidden_txt_projectImplementationStrategy: Project Implementation Strategy |
| 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: |
| Performance Measure (100 characters): |
| lbl_hidden_gridItem_txt_measuresDesc: Performance Measure |
| lbl_hidden_gridTable_performanceMeasuresRepeatable: Performance Measures |
| Insert Performance Measure: |
| Technical, Legal, and Financial Capacity (4000 characters): |
| lbl_hidden_txt_technicalCapacity: Technical, Legal, and Financial Capacity |
| lbl_hidden_rbl_IsJustice: Does the project support the Justice40 Initiative? |
| Describe how the project supports the Justice40 Initiative and the benefits provided (see NOFO Section E.2): (1000 characters): |
| lbl_hidden_txt_justice: Describe how the project supports the Justice40 Initiative and the benefits provided (see NOFO Section E.2) |
| Describe the methodology used to determine the project meets the Justice40 Initiative (see NOFO Section E.2): (1000 characters): |
| lbl_hidden_txt_justiceMethod: Describe the methodology used to determine the project meets the Justice40 Initiative |
| Justice40 Disadvantaged Community Served as Identified in the NOFO Section E.2 (100 characters): |
| lbl_hidden_gridItem_txt_piDesc: Justice40 Disadvantaged Community Served as Identified in the NOFO Section E.2 |
| Actual or Estimated Annual Ridership Count: |
| lbl_hidden_gridItem_num_AmountImpacted: Actual or Estimated Ridership Count |
| lbl_hidden_gridTable_populationImpactedRepeatable: Justice40 Population Impacted |
| Insert Justice40 Population Impacted Item: |
| What is the percentage of Disadvantaged Communities within the project area?: |
| lbl_hidden_num_percentDisadvComm: What is the percentage of Disadvantaged Communities within the project area? |
| lbl_hidden_rbl_IsOnlineMapping: Was this estimate generated using the Justice40 online mapping tool? |
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