FRA F 6180.135 HSIPR Program Application Form Track 3 -- Planning

Track 3–Planning OMB No. 2130-0583

Project Name:       Date of Submission:       Version Number:    

H igh Speed Intercity Passenger Rail (HSIPR) Program

Application Form

Track 3–Planning

Welcome to the Track 3–Planning Application for the Federal Railroad Administration’s High Speed Intercity Passenger Rail (HSIPR) Program. Applicants for Track 3 are required to submit this Application Form and Supporting Materials (forms and documents) as outlined in Section G of this application and as detailed in the HSIPR Guidance.

We appreciate your interest in the program and look forward to reviewing your application. If you have questions about the HSIPR program or this application, please contact us at HSIPR@dot.gov.

Instructions:

• Please complete this document and provide any supporting documentation electronically.

• In the space provided at the top of each section, please indicate the project name, date of submission (mm/dd/yy) and the application version number. The distinct Track 3 Planning Project name should be less than 40 characters and follow the following format: State abbreviation-route or corridor name-project title (e.g., HI-Fast Corridor-Track Work IV).

• For each question, enter the appropriate information in the designated gray box. If a question is not applicable to your Planning Project, please indicate “N/A.”

• Narrative questions should be answered concisely in the space provided.

• Applicants must upload this completed application form and any supporting documentation to www.GrantSolutions.gov by August 24, 2009 at 11:59pm EDT.

• Fiscal Year (FY) refers to the Federal Government’s fiscal year (Oct. 1- Sept. 30).

• Please direct questions to: HSIPR@dot.gov

1. Point of Contact and Application Information

Application Point of Contact (POC) Name:      			POC Title:      
Street Address / City:      	City:      		State:      	Zip Code:      		Telephone Number:      
Fax:      			Email:      
Name of lead State applying:       States are the only eligible applicants under Track 3
Name(s) of additional States applying in this group (if applicable):            
Is this Planning Project related to additional applications for HSIPR funding? Yes No Maybe If “Yes” or “Maybe” provide the following information:
Application Program/Project Name		Lead Applicant	Track		Total HSIPR Funding Requested (if known)		Status of Application
     		     			$      
     		     			$      
     		     			$      
     		     			$      

Project Name:       Date of Submission:       Version Number:    

B. Project Overview

Planning Project Name:      
Which corridor service(s) is (are) the subject of the Planning Project (Corridor name, between which cities/stations, etc)? Please limit your response to 1,000 characters.      
Which of the following planning activities are proposed to be funded under the HSIPR Program?
	Alternative Analysis Studies
	Service Development Planning
	“Service” or “Tier 1” NEPA
	Other (Please Describe):      
Describe the service attributes of the Program/Project for which you are planning (check all that apply):
Additional Service Frequencies New Service Service Quality Improvements		Improved On-Time performance on Existing Route Increased Average Speeds/Shorter Trip Times Other (Please Describe):      
What are the anticipated start and end dates for this Planning Project? (mm/yyyy) Start Date:       End Date:      

6. Total Cost of Planning Activity(s) (Year of Expenditure (YOE) Dollars*): $      

Of this amount, how much would come from the FRA HSIPR Program: (YOE Dollars**) $      

* Year-of-Expenditure (YOE) dollars are inflated from the base year. Applicants should include their proposed inflation assumptions (and methodology, if applicable) in the supporting documentation

** This is the amount for which the applicant is applying.

7. Planning Project Overview. Please limit response to 4,000 characters.

Please provide a description of work for the planning activities to be funded under the HSIPR Program, including:

• Component of a Service Development Plan

• Planning Tasks / Milestones

• Preparation of Documents, Including Expected Deliverables

Detail the nature of any studies to be conducted and the expected outcomes from these, including design, technical and field studies. Also include anticipated outreach and coordination efforts with the public, agencies, affected railroads, and property owners, as applicable.

     

8. Future Project Overview Narrative: Provide an overview of the main features and characteristics and milestones of the Program/Project that is the subject of the planning study, including a brief description of the items listed below. Please limit response to 4,000 characters.

• The location of the Program/Project (upload map if applicable)

• The intercity passenger rail service proposed (if applicable)

• The types of improvements under consideration/evaluation

• Connectivity and integration with other modes

• How the Program/Project supports the States’ strategic transportation goals

     

Project Name:       Date of Submission:       Version Number:    

3. Eligibility Information

Provide the percentage and amount of matching funds: Applications submitted under Track 3 require at least a 50% non-Federal match. Percentage:       % Total Amount (YOE*): $       * Year-of-Expenditure (YOE) dollars are inflated from the base year. Applicants should include their proposed inflation assumptions (and methodology, if applicable) in the supporting documentation
Indicate the source, amount and percentage of matching funds:
Non FRA Funding Sources	New or Existing Funding Source?	Status of Funding1	Type of Funds	Dollar Amount (YOE Dollars)	% of Total Project Cost	Describe any uploaded supporting documentation to help FRA verify funding source
     			     	     	     	     
     			     	     	     	     
     			     	     	     	     
     			     	     	     	     
Is the planning activity included in the State’s Statewide Transportation Improvement Program (STIP) at the time of application? Yes No If not, describe / explain:      

Project Name:       Date of Submission:       Version Number:    

3. Public Return on Investment

1. Project Benefits. Please limit response to 4,000 characters.

Describe the benefits that are anticipated to result from the planned investment which is subject to this planning activity, including the extent to which the activity may be expected to:

• Lead to benefits for intercity passenger rail including travel time reductions, increased frequencies, and enhanced service quality

• Address safety issues

• Address intercity passenger rail reliability issues

• Be integrated and complementary to the relevant comprehensive planning process (23 U.S.C. 135)

• Support livable communities

• Promote environmental quality and/or energy efficiency

• Provide other public benefits in a cost-effective manner

     

Project Name:       Date of Submission:       Version Number:    

3. Project Success Factors

1. Planning Project Management Approach and Applicant Qualifications Narrative. Please limit response to 4,000 characters.

Describe qualifications of the applicant and its key partners to successfully complete the planning activities, including the following information:

• Management Experience – provide relevant information on experience in managing rail programs and planning activities of a similar size and scope to the one proposed in this application. Provide an organizational chart (or equivalent) that outlines the roles played by key Planning Project team members in completing activities as well as information on the role of contract support, engineering support and program management.

• Financial Management Capacity and Capability– provide relevant information on capability to absorb potential Planning Project cost overruns.

• Risk Assessment – provide a preliminary assessment of uncertainties within the planning process and possible mitigation strategies (consider grantee risk, funding risk, schedule risk and stakeholder risk).

Describe any areas in which you could use technical assistance, best practices, advice or support from others, including FRA.

     

2. Timeliness of Planning Project Completion: Provide a brief timeline for completion of key milestones within the period of performance for the planning activity. Please upload a schedule if available. Please limit response to 2,000 characters.

Describe the extent to which the planning activities will:

• Directly lead to project and/or Service Development Program applications

• Lead to NEPA for route selection

• Lead to completion of a Service Development Program

• Lead to construction and service delivery

     

Project Name:       Date of Submission:       Version Number:    

3. Additional Information

1. Please provide any additional information, comments, or clarifications and indicate the section and question number that you are addressing (e.g., Section D, Question 3). This section is optional.

     

Project Name:       Date of Submission:       Version Number:    

G. Summary of Application Materials

Application Forms	Required	Optional	Reference	Description	Format
Application Form			HSIPR Guidance Section 4.3.3.3	This document to be submitted through GrantSolutions.	Form
Supporting Documents	Required	Optional	Reference	Description	Format
Planned Investment map			Application Question B.6	Map of the Planned Investment location. Please upload into GrantSolutions.	None
Standard Forms	Required	Optional	Reference	Description	Format
SF 424: Application for Federal Assistance			HSIPR Guidance Section 4.3.3.3eference	Please submit through GrantSolutions	Form
SF 424A: Budget Information-Non Construction	For		HSIPR Guidance Section 4.3.3.3	Please submit through GrantSolutions	Form
SF 424B: Assurances-Non Construction			HSIPR Guidance Section 4.3.3.3	Please submit through GrantSolutions	Form
FRA Assurances Document			HSIPR Guidance Section 4.3.3.3	May be obtained from FRA’s website at http://www.fra.dot.gov/downloads/admin/assurancesandcertifications.pdf. The document should be signed by an authorized certifying official for the applicant. Submit through GrantSolutions.	Form

PRA Public Protection Statement: Public reporting burden for this information collection is estimated to average 32 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  According to the Paperwork Reduction Act of 1995, a federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection of information unless it displays a currently valid OMB control number.  The valid OMB control number for this information collection is 2130-0583.

1 Reference Notes: The following categories and definitions are applied to funding sources:

Committed: Committed sources are programmed capital funds that have all the necessary approvals (e.g. legislative referendum) to be used to fund the proposed project without any additional action. These capital funds have been formally programmed in the State Rail Plan and/or any related local, regional, or state Capital Investment Program (CIP) or appropriation. Examples include dedicated or approved tax revenues, state capital grants that have been approved by all required legislative bodies, cash reserves that have been dedicated to the proposed project, and additional debt capacity that requires no further approvals and has been dedicated by the sponsoring agency to the proposed project.

Budgeted: This category is for funds that have been budgeted and/or programmed for use on the proposed project but remain uncommitted, i.e., the funds have not yet received statutory approval. Examples include debt financing in an agency-adopted CIP that has yet to be committed in their near future. Funds will be classified as budgeted where available funding cannot be committed until the grant is executed, or due to the local practices outside of the project sponsor's control (e.g., the project development schedule extends beyond the State Rail Program period).

Planned: This category is for funds that are identified and have a reasonable chance of being committed, but are neither committed nor budgeted. Examples include proposed sources that require a scheduled referendum, requests for state/local capital grants, and proposed debt financing that has not yet been adopted in the agency's CIP.

Form FRA F 6180.135 (07-09)

P age 9