Federal Fiscal Year 2020

Highway Safety Behavioral Grant Application

Department of Transportation Highway Safety Office

Behavioral Grants Program

5300 Bishop Blvd - Cheyenne, WY 82009

GOAL

The Wyoming Department of Transportation's Highway Safety Behavioral Grants Program goal is to reduce traffic crashes, deaths, injuries and the associated economic losses in Wyoming through the coordinated efforts of traffic safety partners, state and local law enforcement agencies.

PART 1

Applicant Contact Information

*Agency/Organization:

*DUNS Number (http://www.dnb.com/us):

*Wyoming Secretary of State Filing ID:

*Project Title:

*Mailing Address:

*City, State, Zip + 4:

* Required Fields

Information on completing this application and project resources are available on the Wyoming Department of Transportation website at: http://www.dot.state.wy.us/home/dot_safety/safety_grant_info.html.

Submit grant application to DOT-HSOGRANTS@WYO.GOV on or before March 18, 2019.

PART 2

Description of Project

1) Problem Identification - Describe the problem; use available local data relevant to the area you will be providing service. Include the source of the data. (If you will be using more than one program area you must complete 1 application for each program area i.e. one for Occupant Protection and one for Impaired Driving) (No more than 1000 characters)

2) Project Description- Describe how your project will implement data driven strategies based on the problem identification with the overall goal of helping Wyoming meet the state Core Performance Measures listed in the cover letter. (No more than 1000 characters)

3) Objectives - In order for any project to be successful, it must contain measurable end results. The objectives tell who is going to be doing what, when, how much, and how it will be measured. Identify objective(s) to address the problem, do not describe strategies. For example: (1) Complete four Wyoming AARP Smart Driver Program trainings for law enforcement to assist in training targeted demographic statewide. (2) Conduct a minimum of 10 Older Driver trainings focusing on counties identified by data reaching a minimum of 100 individuals. (No more than 4000 characters)

4) Activities – In a logical sequence, describe planned activities that will accomplish the project objectives. For Example: (1) Develop presentations and materials for law enforcement officers utilizing developed curriculum by Department of Health and AARP; (2) Partner with the Wyoming Highway Patrol to complete trainings statewide; (3) Conduct a minimum of ten public AARP Older Driver Program trainings in Albany, Carbon, Fremont, and Natrona Counties with trained law enforcement officers as indicated by data driven analysis; (Please clearly describe the activities using bullet points) (No more than 3000 characters)

5) Activity Evaluation – Comprehensive evaluation involves an analysis of whether a project has achieved its stated objectives: Describe how you will evaluate each activity as it relates to your objectives. Evaluation should answer the who, what, when, where, why, and how of your objectives. Use actual numbers to demonstrate safety improvement. (NOTE: you must include an evaluation on each activity) (No more than 3000 characters)

PART 3

Budget Detail

Personnel:

Salaries (describe each position title, duties, number of hours to be spent on the project to include base pay, benefits; benefits are to be broken down and approximated by each line item ex. Health, life, unemployment ect.). (No more than 1500 characters)

Overtime (if applicable describe the purpose, when, where, overtime rate or policy, number of hours, and any benefits that would be included in overtime.) (No more than 1500 characters)

Local Match (if applicable list amount and/or what will be used) (No more than 1500 characters)

If receiving funding for personnel services from another funding source, please list the funding source, dollar amount, and hourly break down for each position. (No more than 1500 characters)

In-State Travel Expenses:

This should include a detailed description of the requested and who, where, and all anticipated expenses. (No more than 1500 characters)

Out-of-State Travel Expenses:

This should include a detailed description of the requested and who, where, and all anticipated expenses. (No more than 1500 characters)

Contractual Expenses: (List and identify costs directly related to project activities such as sub-contracts and describe proposed contractual agreements, purpose, and cost. (No more than 1500 characters)

Media: (List and identify costs directly related to project activities, media buys and describe proposed contractual agreements, purpose and cost. For non-media only applications please include the events the media budget will be focused around (No more than 1500 characters)

Equipment: (What equipment, if any, will be purchased to meet the needs of this project? A brief explanation of what the purpose of the equipment must be included.

Note: Any equipment purchased must be related to a traffic safety project. If equipment will be used for non grant related traffic safety activities, an assessment of proportionate funding must be completed based on traffic safety use. Maintenance beyond the first year is the responsibility of the sub-recipient.) (No more than 1500 characters)

Other Direct Costs: (List and identify costs directly related to project activities that do not fit in the other categories such as resource materials). (No more than 1500 characters)

Indirect Costs: (Indirect or administrative costs must provide documentation of the rate with the submittal of this grant application.) (No more than 1500 characters)

Budget Summary Table

(Summarize previous Budget Detail)

**Hit the Tab Key after entering each number.**

Budget Category	Federal Share Requested	Local Match	Total Project Cost
Personnel Services	$	$	$ 0.00
In-State Travel	$	$	$ 0.00
Out-of-State Travel	$	$	$ 0.00
Media	$	$	$ 0.00
Contractual	$	$	$ 0.00
Equipment	$	$	$ 0.00
Other Direct Costs	$	$	$ 0.00
Indirect	$	$	$ 0.00
Total**	$ 0.00	$ 0.00	$ 0.00

** PLEASE VERIFY YOUR TOTALS AND DOUBLE CHECK YOUR NUMBERS.

PART 4

FEDERAL GRANT MONIES

These questions relate to any Federal grant monies received for transit or safety activities.

(CFDA #20.600, 20.601, 20.607, etc.)

Yes No

Has the key (essential) personnel in the direct implementation and administration of the grant during the previous year remained the same? (Key personnel include the Grant Administrator, Accounting, Budget or Controller personnel) (2 CFR 200.331 (a) (6) (3)).
Has the organization as a whole remained unchanged during the previous year?
Has the accounting/financial system remained the same as last year? (There weren’t any upgrades or modifications to the system.) (2 CFR 200.331(a)(6)(3))
3a. If there were changes, please explain.
Does your entity receive Federal grant money directly from any Federal awarding agencies? FTA, NHTSA, etc. (These monies do not have any WYDOT involvement for applications, payments, etc.) (2 CFR 200.331(a)(6)(4)).
Has a Federal agency monitored or inquired or been directly involved in the grant (2 CFR 200.331(a)(6)(4))
5a. Has the Federal agency every performed a review or audit of the grant?
5b. If yes, did the Federal agency determine that there were no financial or compliance issues? If no, please provide a description of the financial and/or compliance issues written up by the Federal agency.
Does your entity have written procedures for procurement transactions? (2 CFR 200.318-323)

PART 5

Authorizing Official Information

The agency personnel contact information below must be completed

Project Administrator
Printed Name:
Title:
Telephone:
e-mail:
Authorizing Official for Agency/Organization
Printed Name:
Title:
Telephone:
e-mail:

By the submittal of this application for funding, I certify under penalty of law, based on information and belief formed after reasonable inquiry the statements and information contained in this application are true, accurate, and complete.

Please email the application along with all supporting documents to

DOT-HSOGRANTS@WYO.GOV.

If you have trouble emailing the application or have questions, please contact Stephanie Lucero @ 307-777-4198, Karson James @ 307-777-4200.