Regionally Coordinated Transportation Planning
Application for Funding
Regionally Coordinated Transportation Planning
FY 2016 & FY 2017
Template
Issued: February 17, 2015
Response Due: May 7, 2015
1
Texas Department of Transportation
Public Transportation Division
FORM A: Table of Contents and Checklist
Content
Cover Letter Signed by Recipient’s Authorized Representative
Check if Included
in Application

Form A: Table of Contents and Checklist

Form B: Recipient Information

Form C: Contact Information

Form D: Federal and State Compliance Requirements
Form E: Obligation Certificate
Form F: Experience & Capacity
Form G: Stakeholder Engagement
Form H: Inventory of Transportation Resources, Comprehensive Needs Assessment,
Gap Analysis & Identification of Inefficiencies
Form I: 5-Year Public Transit-Human Services Transportation Plan (including the
elements in Table of Contents on pp. 10-12 of General Information & Instructions)
Form J: Quality Assurance
Form K: Leverage Other Resources
Form L: Workplan for FY 2016 (Sept. 1, 2015 through Aug. 31, 2016)
Form M: Workplan for FY 2017 (Sept. 1, 2016 through Dec. 31, 2016)
APPENDIX I: Letters of Commitment
APPENDIX II: Letters of Support
APPENDIX III: Budget Workbook
ADDITIONAL APPENDICES AS NEEDED
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FORM B: Recipient Information
1. Legal Name of Agency:
2. Mailing Address Information (include mailing address, street, city, county, state and zip code):
3. Payee Identification (PIN) Number (14 digits)
4. Type of Agency
5. Primary Contact for this Proposal





Name:
Title:
Phone:
Fax:
Email:
Rural Transit District
Urban Transit District
Metropolitan Transit Authority
Government Entity
Other __________________________________
6. Financial Officer
7. Authorized Representative
Name:
Title:
Phone:
Fax:
E-mail:
Name:
Title:
Phone:
Fax:
Email:
8. Counties served by the proposed activities:
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FORM C: Contact Information
Primary Contact for Regionally Coordinated Transportation Planning
Name:
Title:
Organization:
Mailing Address:
Phone:
Fax:
Email:
Backup Contact for Regionally Coordinated Transportation Planning
Name:
Title:
Organization:
Mailing Address:
Phone:
Fax:
Email:
Billing Contact for Regionally Coordinated Transportation Planning
Name:
Title:
Organization:
Mailing Address:
Phone:
Fax:
Email:
4
FORM D: Federal and State Compliance Requirements
The following elements are required to be on file with the Texas Department of
Transportation (TxDOT) before execution of a project grant agreement. If your agency
has not sent to TxDOT a current copy of any item listed below, then send a current copy
with this funding application.
1. Recipients are required to have a current master grant agreement (MGA) with TxDOT.
Does your agency have a current MGA on file with TxDOT?:
2. In accordance with Title 49 CFR Section 21.9(b) and 43 TAC 31.42, recipients are
required to submit a Title VI Program or Plan to TxDOT.
Has your agency provided a current Title VI Program to TxDOT?
3. In accordance with49 U.S.C. 5323(n), recipients are required to submit signed federal
certifications and assurances to TxDOT.
Has your agency provided a signed FY 2015 certifications and assurances to TxDOT?
4. In accordance with 43 TAC Chapter 31.39, recipients are required to have a current
ethics certification.
Has your agency provided a current ethics policy certification to TxDOT?
5. In accordance with OMB 68 Federal Register 38402 and OMB 68 Federal Register
55671 as amended by 79 Federal Register 75879, recipients are required to have a
DUNS number for an application for Federal funds to be considered complete, must
have an active DUNS number at the time of the funding award and must keep this
DUNS number in active status through the life of the contract.
Provide active DUNS number:
Date DUNS number is due for update:
6. In accordance with 49 CFR 21 and 43 TAC 31.42 a formal Equal Employment
Opportunity (EEO) program is required of any applicant that employed 50 or more
transit-related employees (including temporary, full-time or part-time employees) and
received in excess of $1 million in capital or operating assistance or in excess of
$250,000 in planning assistance in the previous Federal fiscal year.
Has your agency provided a current EEO program to TxDOT?:
5
or
N/A
7. In accordance with the 43 TAC 31.44 agencies are required to have written
procurement policies and procedures.
What was the effective date that your agency’s written procurement policies and
procedures were approved?
8. In accordance with the 49 CFR 18, a current (applicable to the fiscal year) indirect cost
allocation plan is required to support the distribution of indirect costs related to the
grant program, and must be approved by FTA or cognizant agency. Without an
approval letter from the cognizant agency, indirect costs must be excluded from the
reimbursement process.
Approved Indirect Cost Rate:
% or
N/A
Include as a separate attachment: 1) the Indirect Cost approval letter from the
cognizant agency, which documents the approved percentage rate and applicable
fiscal year and 2) Current Indirect Cost Allocation Plan with accompanying
Certificate of Indirect Cost
9. In accordance with the 43 TAC 31.48, agencies should be in compliance prior to
issuance of funding. Provide a status update of any ongoing Improvement Action
Plan(s) (IAP) with TxDOT or indicate if this is not applicable.
Audit - Applicants of federal funding are required to comply with federal (OMB A133) and/or state (State of Texas Single Audit Circular) requirements. Applicants
should respond based on the previous fiscal year.
10.
- If threshold expenditures of $500,000 or more have been met during the Transit
Provider's previous fiscal year, the Transit Provider must submit a copy of the Single
Audit Report and Management Letter (if applicable) to TxDOT's Audit Office, 125 East
Eleventh Street, Austin, TX 78701 or contact TxDOT’s Audit Office at
http://www.txdot.gov/contact_us/audit.htm
- If expenditures are less than $500,000 during the Transit Provider's previous fiscal year,
the Transit Provider must submit a statement to TxDOT's Audit Office as follows: "We did
not meet the $500,000 expenditure threshold or are a For-Profit agency and therefore,
are not required to have a single audit performed for FY ______."
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Has the agency expended $500,000 or more in transit or non-transit federal awards in
the previous fiscal year?
Yes
a.
No
If yes, were annual audits completed in accordance with OMB Circular A133 and submitted to the TxDOT Audit Office?
Yes
b.
No
If no, was a statement (e.g. letter) submitted to the TxDOT Audit Office as
follows: "We did not meet the $500,000 expenditure threshold or are a For-Profit
agency and therefore, are not required to have a single audit performed for FY
_____."
Yes
No
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FORM E: Obligation Certificate
As an authorized official of
(Organization Name)
I certify to the following:
1. The information presented in the application is true and accurate to the best of my
knowledge.
2. I have not intentionally made any misstatements or misrepresented the facts.
3. The organization has the resources and technical capacity to support the proposed
activities and/or project.
4. The organization uses generally accepted accounting standards for its financial
recordkeeping functions.
5. The organization will participate in a continuous, comprehensive dialogue throughout
the life of the project including but not limited to:



On-site monitoring by TxDOT personnel
Timely submission of required reports
Timely written notification of events that will affect the outcome of the project.
6. The organization will comply with all applicable federal, state and local laws and
regulations. This includes but is not limited to:




FTA Certification and Assurances
Master grant agreements
Project grant agreements
Applicable federal program circulars and similar federal and state guidance
7. Applicant Affirmation: Compensation has not been received for participation in the
preparation of the specifications for this call for projects.
Sign:
(Authorized Representative)
Printed/Typed Name:
Title:
Date:
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FORM F: Experience & Capacity
Maximum: 1 page
Do not include the wording of each question, but do include the number of each question
(such as 1.1, 1.2 and so on)
1.1 Describe one specific, convincing example of how your agency effectively engaged
stakeholders in a regional planning project, and why these efforts to engage were
unquestionably successful.
1.2 Describe one specific, convincing example of your agency leveraging funds (other than
regionally coordinated transportation planning funds from TxDOT) to conduct regional
transportation planning activities. List the other, leveraged funding source(s) and how
your agency overcame any challenges to access these funds.
1.3 Convincingly explain your agency’s capacity to begin proposed activities on Sept. 1, 2015
and manage proposed activities, provide necessary staff support and complete all
activities and deliverables by Dec. 31, 2016. Specify whether work will be performed inhouse (by your agency’s staff), through a partnership arrangement or using contracted
services.
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FORM G: Stakeholder Engagement
Maximum: 2 pages
Do not include the wording of each question, but do include the number of each question
(such as 1.1, 1.2 and so on)
2.1 List the stakeholders and partners (including individuals with disabilities, individuals 65
and older and agencies that serve these priority populations) who participated in
developing this funding application and clearly illustrate how these stakeholders and
partners substantially contributed to the development of this funding application.
2.2 Provide letters of commitment from representatives of each of the following groups
indicating their firm commitment to actively participate in developing and approving
this five-year public transit-human services transportation plan:
 Representatives of public, private and non-profit transportation providers, including
recipients of Section 5307 funds (small urban transportation providers), Section 5311
funds (rural transportation providers) and Sections 5310 (Enhanced Mobility of
Seniors and Individuals with Disabilities);
 Representatives of human services providers;
 Representatives of metropolitan planning organizations (unless in a planning region
with no MPO);
 Individuals with disabilities;
 Individuals 65 and older;
 People with low incomes;
 Veterans;
 Workforce agencies
 Advocates for children;
 Other members of the public.
Note: Include letters of commitment in an appendix. These letters do not count as part of
the two-page maximum for Form G.
2.3 Convincingly explain the process your agency will use to ensure active, effective and
regular participation of individuals with disabilities, individuals 65 and older and
agencies that represent or serve these priority population in the development and
approval of this five-year public transit-human services transportation plan and explain
how your agency will document this ongoing participation.
2.4 Convincingly explain the process your agency will use to ensure active, effective and
regular participation of representatives of each of the other groups listed above in the
development and approval of this five-year public transit-human services transportation
plan and how your agency will document this ongoing participation.
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FORM H: Inventory of Transportation Resources, Comprehensive Needs Assessment,
Gap Analysis & Identification of Inefficiencies
Maximum: 2 pages
Do not include the wording of each question, but do include the number of each
question (such as 1.1, 1.2 and so on)
Clearly and convincingly describe:
3.1 Appropriate and effective steps that your agency will take to identify, document and
assess:
a. Transportation providers including public, private and non-profit transportation
providers;
b. Available transportation services;
c. Inefficiencies, including overlaps and gaps in services, including services for priority
populations listed above; and
d. Underused equipment owned by public and private transportation providers; and
3.2 Appropriate and effective methodologies that your agency will use to conduct a reliable
comprehensive needs assessment and gap analysis to identify, document and assess
unmet transportation needs including gaps and overlaps in transportation services for:
a.
b.
c.
d.
e.
f.
g.
h.
Individuals with disabilities
Individuals 65 and older
People with low incomes
Individuals with limited English proficiency
Children
Veterans
Workforce agencies
Other members of the public
3.3 How this inventory of transportation resources, comprehensive needs assessment and
gap analysis will:
a. Be consistent with and not duplicate resource inventories, needs assessments and gap
analyses conducted by other metropolitan, regional and statewide planning processes;
and
b. Promote integration of services of programs funded by Federal Transit Administration,
Federal Highway Administration, health and human services agencies, work force
agencies, veterans’ agencies and others.
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FORM I: 5-Year Public Transit-Human Services Transportation Plan (including the
elements in Table of Contents on pp. 10-12 of General Information & Instructions)
Maximum: 2 pages
Do not include the wording of each question, but do include the number of each
question (such as 1.1, 1.2 and so on)
Clearly describe specific approaches and steps your agency will take to appropriately and
effectively:
4.1 Develop:
a. Vision and mission statements;
b. Goal(s) and objectives that are focused and strategic; and
c. Strategies, activities and/or projects to address identified overlaps and gaps between
current transportation services, as well as opportunities to improve efficiencies in
transportation service delivery.
4.2 Identify multiple financial and labor resources to be leveraged to help sustain this
planning process and to “work this plan” following its completion in Dec. 2016.
4.3 Prioritize objectives, strategies and/or projects to pursue (and upon which to base future
funding requests), considering (a) anticipated availability of resources from multiple
sources, (b) time, and (c) feasibility.
4.4 Ensure that this plan will:
a. Be consistent with other metropolitan, regional and statewide plans, and;
b. Promote integration of services of programs funded by Federal transit Administration,
Federal Highway Administration, the Department of Health and Human Services, other
health and human services agencies, work force agencies, veterans’ agencies and
others.
4.5 Develop:
a. Local performance measures to objectively evaluate progress and effectiveness in
achieving the goal(s), objectives and priorities in your plan;
b. A process for collecting, maintain and assessing data to evaluate these local
performance measures, and;
c. A process for collecting, maintain and assessing data to evaluate statewide
performance measures.
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FORM J:
QUALITY ASSURANCE
Maximum: 1/2 page
Do not include the wording of each question, but do include the number of each
question (such as 1.1, 1.2 and so on)
5.1 Identify the individual who will manage the development of this plan and describe:
a. How s/he will:
a. ensure quality assurance measures;
b. make certain all activities are completed on time and as part of an
inclusive process that meaningfully engages other stakeholders; and
b. His/her relevant experience.
5.2 Describe how your agency will track activities identified in the updated coordinated plan
and keep stakeholders informed of progress
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FORM K: LEVERAGE OTHER RESOURCES
Maximum: 1 page
Do not include the wording of each question, but do include the number of each
question (such as 1.1, 1.2 and so on)
6.1 Identify funds other than regionally coordinated transportation planning funds from
TxDOT that your agency will leverage to develop this 5-year public transit-human services
transportation plan.
6.2 Specify activities for which these other leveraged funds will be used.
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FORM L: Workplan for FY 2016 (September 2015 – August 2016)
No page limit
Expand and repeat rows and pages as needed
7.1 Complete a thorough and appropriate workplan using the template below to spell out: a) a goal, b) objectives for achieving this goal, c) activities to
accomplish each objective, d) a lead and team responsible for each set of activities, e) a completion date for each activity, f) deliverables to complete, and g) a
projected cost for developing each deliverable. This workplan shall correspond with the proposed activities described in Forms G -K.
Goal: (Sample: To prepare an updated, 5-year public transit-human services transportation plan for the period January 2017 through December 2021 to
ensure a network of transportation services to effectively and efficiently get people to where they need to go)
Objective
Activity
Lead &
Completion Deliverable
Projected Cost to develop
Team
Date
deliverable(s) under each
objective
Objective 1:
Activity 1.1:
Activity 1.2:
Activity 1.3:
Activity 1.4:
Continue as
needed
Identify lead
& team per
activity
Indicate
completion
date per
activity
Deliverable 1: A report on the inventory of transportation
resources. This report shall include (a) a description of the
methodology used to conduct this inventory, (b)
observations/findings/conclusions, (c) recommendations
concerning the public transit – human services transportation
plan, (d) appendices including data collection forms,
assessment documents as applicable, minutes, sign-in sheets
and documentation that stakeholders including individuals with
disabilities, individuals 65 and older and persons with low
incomes participated in the development and approval of this
inventory and report.
Deliverable 1
Projected Cost: $_______
Deliverable 2: A report on the comprehensive needs
assessment and gap analysis. This report shall include (a) a
description of the methodology used to conduct this needs
assessment and gap analysis concerning the public’s
transportation needs, (b) observations/findings/conclusions
concerning unmet needs and inefficiencies such as overlaps
and gaps in services, (c) a discussion of recommendations and
Deliverable 2
Projected Cost: $_______
15
Indicate a projected cost for
developing Deliverable 1.
Provide calculations for how
each cost figure was derived
(either in this space or in an
attached document that
clearly identifies these
calculations as corresponding
to Deliverable 1).
Indicate a projected cost for
developing Deliverable 2.
Provide calculations for how
each cost figure was derived
implications concerning the public transit – human services
transportation plan, (d) appendices including data collection
forms, assessment documents, minutes, sign-in sheets and
documentation that stakeholders including individuals with
disabilities, individuals 65 and older and persons with low
incomes participated in the development and approval of this
comprehensive needs assessment, gap analysis and report.
(either in this space or in an
attached document that
clearly identifies these
calculations as corresponding
to Deliverable 2)
Deliverable 3: A final updated, five-year public transit humanservices transportation plan that includes all required
elements. This deliverable also will include support
documentation including minutes, sign-in sheets and other
documentation that stakeholders including individuals with
disabilities, individuals 65 and older and persons with low
incomes participated in the development and approval of this
five-year plan and include the elements in the table of contents
included in the Information and Instructions section of this
funding application packet.
Deliverable 3
Projected Cost: $_______
16
Indicate a projected cost for
developing Deliverable 3.
Provide calculations for how
each cost figure was derived
(either in this space or in an
attached document that
clearly identifies these
calculations as corresponding
to Deliverable 3)
FORM M: Workplan for FY 2017 (September 2016 – December 2016)
No page limit
Expand and repeat rows and pages as needed
8.1 Complete a thorough and appropriate workplan using the template below to spell out: a) a goal, b) objectives for achieving this goal, c) activities to
accomplish each objective, d) a lead and team responsible for each set of activities, e) a completion date for each activity, f) deliverables to complete, and
g) a projected cost for developing each deliverable. This workplan shall correspond with the proposed activities described in Forms G -K.
Goal:
Objective
Activity
Lead &
Team
Completion
Date
Objective 1:
Activity 1.1:
Identify lead
& team per
activity
Indicate
completion
date per
activity
Activity 1.2:
Activity 1.3:
Activity 1.4:
Continue as
needed
Deliverable
Projected Cost to develop
deliverable(s) under each
objective
Deliverable $_______
Deliverable 1: A report on the inventory of transportation
resources. This report shall include (a) a description of the
methodology used to conduct this inventory, (b)
observations/findings/conclusions, (c) recommendations
concerning the public transit – human services transportation
plan, (d) appendices including data collection forms,
assessment documents as applicable, minutes, sign-in sheets
and documentation that stakeholders including individuals with
disabilities, individuals 65 and older and persons with low
incomes participated in the development and approval of this
inventory and report.
Deliverable 2: A report on the comprehensive needs
assessment and gap analysis. This report shall include (a) a
description of the methodology used to conduct this needs
assessment and gap analysis concerning the public’s
transportation needs, (b) observations/findings/conclusions
concerning unmet needs and inefficiencies such as overlaps
and gaps in services, (c) a discussion of recommendations and
implications concerning the public transit – human services
17
Indicate a projected cost for
developing each deliverable.
Provide calculations for how
each cost figure was derived
(either in this space or in an
attached document that
clearly identifies which
calculations correspond to
which deliverables).
transportation plan, (d) appendices including data collection
forms, assessment documents, minutes, sign-in sheets and
documentation that stakeholders including individuals with
disabilities, individuals 65 and older and persons with low
incomes participated in the development and approval of this
comprehensive needs assessment, gap analysis and report.
Deliverable 3: A final updated, five-year public transit humanservices transportation plan that includes all required
elements. This deliverable also will include support
documentation including minutes, sign-in sheets and other
documentation that stakeholders including individuals with
disabilities, individuals 65 and older and persons with low
incomes participated in the development and approval of this
five-year plan and include the elements in the table of contents
included in the Information and Instructions section of this
funding application packet.
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APPENDIX I: Letters of Commitment
No page limit
A letter of commitment is a letter documenting an entity’s or individual’s pledge of resources
for a proposed project or activity. This may be a commitment of financial support, staff
support, services, or other resources. A letter of commitment must state exactly what the
entity or individual commits to provide and describe the nature of the commitment. This
letter must be signed by a person fully authorized to bind the entity or individual.
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APPENDIX II: Letters of Support
No page limit
A letter of endorsement/support is a letter documenting an entity’s or individual’s support for
a proposed project or activity. Unlike a letter of commitment, a letter of
endorsement/support is not a commitment of resources or active participation in the
proposed project.
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APPENDIX III: Budget Workbook for FY 2016 (Sept. 2015 – Aug. 2016), FY 2017 (Sept.
2016 – Dec. 2016), Cumulative Budget for Fiscal Years 2016 and 2017, and Contractual,
if Applicable
Complete a budget worksheet for each of fiscal years 2016 and 2017, a cumulative budget
worksheet for both fiscal years, and for contractual, if applicable.
No page limit
Provide a detailed project budget on how your agency proposes to spend requested grant
funds. Three separate budget worksheets are included in an Excel - Project Budget
Workbook is available at
http://www.txdot.gov/inside-txdot/division/public-transportation/local-assistance.html
When using the PTN Excel Project Budget(s):
1. Use separate Budget Worksheets for FY 2016 and FY 2017. Complete a third
cumulative budget worksheet (for both fiscal years 2016 and 2017. Finally, complete a
fourth budget worksheet for “contractual,” If your agency requests funds for
“contractual.” These Budget Worksheets are identified by tabs at the bottom of the
Budget Workbook labeled “FY 2016,” “FY 2017,” “Cumulative,” and “Contractual.”
2. Input information in white cells only. Do not change the spreadsheet format or
internal codes in any way.
3. Input number of units, unit of measure (such as hours or items) and rate (cost per unit)
to show the total project cost for each line item. (For example:
 50 (# of units) hours (unit of measure) X $21.50 per hour (rate) = $1,075 (total);
 15 (# of units) notebooks (unit of measure) X $4.25 each (rate) = $63.75; or
 78 miles X 4 trips (# of units; unit of measure) X $.505 per mile (rate) = $816.00
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ADDITIONAL APPENDICES AS NEEDED
No page limit
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