Eligibility Screening Form for Applicants to PSRC for FTA Section
5310 (Enhanced Mobility of Seniors and Individuals with Disabilities)
Funds
Instructions: If you plan to apply to PSRC for Section 5310 program funds as part of the 2014
PSRC Coordinated Grant process, you must complete this eligibility screening form. Please
submit completed forms to Gil Cerise at gcerise@psrc.org no later than 5:00 pm on Friday,
August 22, 2014. PSRC encourages applicants to submit eligibility screening forms as early as
possible. Forms submitted will be vetted with FTA and WSDOT, and confirmations will be
provided to grant applicants, as early as possible. Projects that submit eligibility forms after the
above deadline will not be considered eligible for PSRC’s FTA Section 5310 funds in the 2014
Coordinated Grant.
(Note: Applicants for “WSDOT Consolidated Grant Funding Only” do not need to complete this
worksheet.)
Contact Gil Cerise at PSRC at gcerise@psrc.org or 206-971-3053 if you have questions about
this form.
Project Title:
Project Sponsor:
1. Project Description
Please provide a brief project description in the space below. Please include information
on the scope of your project, and what it is intended to accomplish (i.e., what will be built,
purchased, or provided with this grant request?).
Please insert project description in the space above.
2. Section 5310 Program Eligibility
a. Based on your review of Sections III-14 and III-15 of FTA Circular C9070.1G, please
check one box below to indicate how your proposed project is classified.
Eligible Capital Expenses that Meet the 55% Requirement (pages III-10 to III12 of FTA Circular 9070.1G)
Other Eligible Capital and Operating Expenses (pages III-12 to III-15 of FTA
Circular 9070.1G)
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b. If applying or considering applying for funding under the PSRC-managed Section
5310 grant funds, please describe how your project is consistent with that funding
source’s eligibility requirements. See Section 5310 FTA Circular 9070.1G. Eligible
activities can be found under Sections III-14 and III-15 (pages III-10 to III-15) of FTA
Circular C9070.1G.
Please describe how your project qualifies as a Section 5310 program eligible activity in the
space above.
3. Eligible Applicant Information:
Please check all that apply below. Space is also provided below to indicate, in your own words,
how you qualify as an applicant for Section 5310 program funds.
a. Eligible Subrecipient of Traditional Section 5310 Projects:
Private nonprofit organization
A state or local governmental authority that is approved by a state to coordinate services
for seniors and individuals with disabilities.
A state or local government authority that certifies that there are no nonprofit
organizations readily available in the area to provide service (please attach certification
to application submitted to PSRC).
b. Eligible Subrecipient for Other Section 5310 Projects:
A state or local governmental authority
Private nonprofit organization
An operator of public transportation that receives a Section 5310 grant indirectly through
a recipient.
Use the space below to describe how your organization qualifies as an eligible applicant for
Section 5310 funds. If your organization does not fit into the choices identified in tables 3.a. or
3.b. above, you must describe how your organization qualifies in the box below.
Please describe how your organization qualifies to receive a Section 5310 funding grant in the
space above.
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4. Project Funding Request Information:
Note: This question is designed to educate and assist project sponsors in submitting complete
and accurate grant applications, demonstrating that requirements for the use of federal funds
will be fully met. Applications will not be evaluated at this time on the project funding request
information provided below, and this information may be updated at the time of grant application
submittal.
Key Information to Consider in Answering Question 4:
 Project sponsors are required to provide a minimum of 20% in local matching funds for
capital projects, including mobility management and acquisition of transportation
services under the “Traditional Section 5310” fund category, and a minimum of 50% in
local matching funds for operating projects.
 Local matching funds must be documented to be available, or reasonably expected, at
the time the grant application is submitted to PSRC (September 30, 2014), with the
exception of matching funds sought through the WSDOT Consolidated Grant Program.
PSRC's definitions and guidance for determining secure and reasonably expected funds
may be found here.
 The phase for which PSRC’s federal funds are being requested must be fully funded
with this request.
o The Section 5310 funding request plus the local matching funds must fully complete
the phase of the project as described. If less funding is awarded at time of
recommendation, the project scope must be correspondingly adjusted or additional
local funds provided to complete the phase.
o Example 1: if a project sponsor is requesting funding for a purchase of six vehicles,
all six vehicles must be fully funded with the requested Section 5310 funding and
local match. If less funds are awarded, the sponsor must identify how many fewer
vehicles are now able to be purchased or provide additional local funds to fully fund
the entire purchase.
o Example 2: if a project sponsor is requesting operating assistance, the hours of
service provided must be identified and fully funded with the requested Section 5310
funding and local match. If less funds are awarded, the sponsor must identify the
reduced level of service able to be provided or provide additional local funds to fully
fund the project as described.
 Deadlines: the expected date of usage for these funds, if awarded, is July 1, 2015
through June 30, 2017.
Please identify the following information for the grant application you are considering preparing
for the September 30, 2014 deadline to PSRC. (Note: PSRC recognizes that information
provided below is an estimate only, and that the amounts provided by the September 30
Coordinated Grant deadline may vary from those provided below):
Section 5310 Draft Grant Request
Local Matching Funds (Cash)
Local In-Kind Match (1) (please describe)
Matching Funds Being Sought from WSDOT
Consolidated Grant (if any)
Total Project Cost
$
$
$
$
$
(1) See page III-16 of FTA Circular 9070.1G for information on matching funds, including non-cash or inkind match that would be eligible as match for Section 5310 funds.
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(Optional) Please use space below to include any additional information or explanation related
to the project cost from the table above.
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