Tribal-Supplemental-Form-2021.pdf
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- Opportunity number
- FTA-2021-003-TR
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Supplemental Form
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| 2021-11197.pdf |
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v2.0 Tribal Transit Program Supplemental Form - Public Transportation On Indian Reservations Program (2021) Page of Public Transportation on Indian Reservations Program (Tribal Transit Program) FY 2021 Applicant and Proposal Profile Section I. Applicant Information Is this a resubmission due to an invalid/error message from FTA?
Is the applicant a federally recognized Indian Tribe or Alaska Native Village, Group, or Community and located in a rural area with a population of 50,000 or less?
Section II. Project Information (Descriptive title of this project) Project Purpose:
Project Type:
(Applicant must check one) Project Budget Description
QTY
Federal Amount Local Match (10%) Total Cost Other Federal Funds Other Total:
Matching Funds Information Are you requesting a Local Match Waiver?
Project Scalability Is project scope scalable?
Project Proposed Milestones (Timeline) Timeline Description Timeline Item Date Congressional District(s) (Place of Performance) Congressional District Section III. Evaluation Criteria Planning and Local/Regional Prioritization Are you applying for a Capital or Operating project?
Project Readiness Are you applying for a Capital or Operating project?
Demonstration of Need Are you applying for a Capital or Operating project?
Demonstration of Benefits Are you applying for a Capital or Operating project?
Financial Commitment and Technical, Legal, Financial and Operating Capacity Are you applying for a Capital or Operating project?
*** Note: Please provide organization Annual Operating Budget as an attachment or within this section.
Planning Proposal Are you applying for a planning project?
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 (if applicable) |
| Organization Chief Executive Officer (200 characters): |
| lbl_hidden_txt_orgCEO: Organization CEO |
| lbl_hidden_rbl_ApplicantEligibility: Is the applicant a federally recognized Indian Tribe or Alaska Native Village, Group, or Community and located in a rural area with a population of 50,000 or less? |
| 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 |
| Project Purpose - Start-up: 0 |
| lbl_hidden_cb_Startup: Start-up |
| Project Purpose - Expansion: 0 |
| lbl_hidden_cb_Expansion: Expansion |
| Project Purpose - Replacement: 0 |
| lbl_hidden_cb_Replacement: Replacement |
| lbl_hidden_cbl_ProjectPurpose: Project Purpose |
| Project Type - Capital: |
| Project Type - Operating (applicant has no existing transit service): |
| Project Type - Planning: |
| lbl_hidden_rbl_ProjectType: Project Type |
| 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 |
| Local Match: |
| lbl_hidden_gridItem_num_LocalMatch: Local Match |
| 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 - Local Match: |
| lbl_hidden_num_TotalLocalMatch: Grand Total - Local Match |
| 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 and/or Supporting Documentation of Local Match (4000 characters): |
| lbl_hidden_txt_sourceMatchingFunds: Source of Matching Funds and/or Supporting Documentation of Local Match |
| lbl_hidden_rbl_IsScalable: Are you requesting a Local Match Waiver? |
| lbl_hidden_rbl_IsScalable: Is Project Scope Scalable |
| Please include supporting documentation to demonstrate financial hardship (4000 characters): |
| lbl_hidden_txt_supportLocalMatch: Please include supporting documentation to demonstrate financial hardship |
| 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 Description (100 characters): |
| lbl_hidden_gridItem_txt_tlDesc: Timeline 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: |
| lbl_hidden_rbl_applyingCapitalOperatingPLP: Planning and Local/Regional Prioritization - Are you applying for a Capital or Operating project? |
| Planning and Local Prioritization (4000 characters): |
| lbl_hidden_txt_planningPrioritization: Planning and Local/Regional Prioritization |
| lbl_hidden_rbl_applyingCapitalOperatingPR: Project Readiness - Are you applying for Capital or Operating project? |
| Project Readiness (4000 characters): |
| lbl_hidden_txt_readinessJustification: Project Readiness |
| lbl_hidden_rbl_applyingCapitalOperatingDN: Demonstration of Need - Are you applying for a Capital or Operating project? |
| Demonstration of Need (4000 characters): |
| lbl_hidden_txt_demonstrationNeed: Demonstration of Need |
| lbl_hidden_rbl_applyingCapitalOperatingDB: Demonstration of Benefits - Are you applying for a Capital or Operating project? |
| Demonstration of Benefits (4000 characters): |
| lbl_hidden_txt_demonstrationBenefits: Demonstration of Benefits |
| lbl_hidden_rbl_applyingCapitalOperatingFCOC: Financial Commitment and Operating Capacity - Are you applying for a Capital or Operating Project? |
| lbl_hidden_txt_financialCommitment: Demonstration of Financial commitment and Technical, Legal Financial and Operating Capacity |
| Financial Commitment and Technical, Legal, Financial and Operating Capacity (4000 characters): |
| lbl_hidden_rbl_applyingPlanningProjectPP: Planning Proposal - Are you applying for a planning project? |
| Planning Proposal (4000 characters): |
| lbl_hidden_txt_planningProposal: Planning Proposal |
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