5310 Application

1Applicant Information

2Project Information

3Agency History with 5310 Funding

4Project Advancement of the Coordinated Plan

Applicant Information

Have all your attachments ready to upload before you start filling out this application. You will not be able to save and come back later to finish your application. Please label the files you are uploading according to instructions. All attachments that need to be downloaded and instructions are available on the Funding.oki.org website.

Contact Name

First Last

Contact Phone:(Required)

Contact Email:(Required)

Legal Name of Agency:(Required)

Agency Email:

Type of Organization (select one):(Required)

Private non-profit agency

State or local government authority

Operator of public transportation services (including private operators or public transit services)

Federal Tax ID:(Required)

DUNS:

Ohio Charter #:

Agency Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code Country

Is there a public transit system(s) serving the project area?(Required)

Yes

Upload Attachment A: Verification of Unavailable, Insufficient or Inappropriate Transit(Required)

You must include a letter from the transit system serving your project service area either explaining how your two agencies will work together or verifying the transit system’s inability to meet your clients’ needs. Please name your file "Your Agency-Attachment A."

Max. file size: 5 MB.

Upload Attachment B: Applicant Financial Information(Required)

Single Full Audit or Annual Financial Statement — Provide a copy of your most recent full audit, labeling it “Attachment B”. For applicants and subrecipient agencies receiving less than $750,000 and not required to conduct full audits, OKI accepts annual financial statements prepared by a professional accountant or tax preparer in lieu of a single full audit. OKI reviews this information to determine an assessment of financial risk and may recommend denial of 5310 funding if an applicant’s funding request represents amounts proportionately higher than the agency’s overall financial state; an agency has no record of stable financial controls; or have significant findings reported by an audit. Note that OKI will continue to monitor subrecipient agencies by requiring copies of annual audits or financial records be provided through the duration of a project or through the useful life benefit of vehicles acquired. Please name your file "Your Agency-Attachment B."

Max. file size: 20 MB.

Project Information

Project Name

Types of Project Requested

Vehicle Request?(Required)

Yes

If yes, quantity?

Please enter a number from 1 to 999.

Preventative Maintenance?(Required)

Yes

Equipment?(Required)

Yes

If yes, what kind?

Mobility Management Program?(Required)

Yes

Project Description Narrative:(Required)

Provide a brief description of your project. Explain what you are requesting funding to provide; why the project is needed; and what population type this project will serve. Please be concise, we are only looking for a short summary.

Project Goals Narrative:(Required)

Goals should be SMART. Specific, Measurable, Attainable, Relevant, and Time-Bound.

Project Management Narrative:(Required)

Provide a brief description of your organizational and governing structure of your agency including an explanation of how this project will be managed.

Upload Attachment C: Organizational Chart

If your agency has a table of organization/organizational chart, please provide it. Please name your file "Your Agency-Attachment C."

Max. file size: 5 MB.

Agency History with 5310 Funding

Please describe the status of any 5310 funding you have received in the past.

Number of grants received(Required)

Amounts of grant(s) received

Drawdown History

Provide amount of any remaining balances

Did your project remain on budget? Please explain:

Consistency with Coordinated Public Transit-Human Services Transportation Plan

Is your agency identified in the Coordinated Public Transit-Human Services Transportation Plan for the OKI region (Coordinated Plan)?(Required)

Yes

Does this project address one or more of the Coordinated Plan’s identified gaps between current services and needs described in Chapter 3?(Required)

Yes

Does this project fulfill one or more of the Coordinated Plan’s Strategies to Improve Transportation identified in Chapter 4?(Required)

Yes

Upload Attachment D: Certification of Project Derived from a Locally Developed, Coordinated Public Transit-Human Services Transportation Plan(Required)

Please name your file "Your Agency-Attachment D."

Max. file size: 2 MB.

Project Advancement of the Coordinated Plan

View the OKI Coordinated Plan to see the chapters referenced in the following questions.

1. What gaps in service will this project help to fill? The gaps below are identified in the current Coordinated Plan. Check all that apply(Required)

Inadequate transportation options during evenings, late nights, and weekends for elderly, disabled and low-income populations.

Inadequate transportation options for low-income specialized transportation users, particularly for trips to work and job training opportunities.

Limited collaboration of services provided, particularly across county or state lines.

Unaffordable fares, particularly for suburban and rural areas of the region.

Inadequate number and variety of destination types available to users.

No single point of information for users on current transportation options available.

Describe how your project will fill gaps checked above (0-15 points)(Required)

2. What strategies from the Coordinated Plan Chapter 4 does this project undertake to address the identified gaps in service? Include the Identified Need number from the Plan and the Strategy addressed. (0-15 points)(Required)

3. How does this project provide service to the targeted populations (seniors and/or individuals with disabilities)? (0-15 points)(Required)

4. What coordination efforts has the applicant undertaken to help eliminate or reduce duplication in services? (0-25 points)(Required)

5. How will this project be sustained beyond the use of funding awarded? (0-15 points)(Required)

6. Quantify the project’s anticipated benefits (i.e. number of people to be served, number of trips to be provided or enhanced). (0-15 points)(Required)

7. Does this project include technologies that improve mobility service accessibility and efficiency and/or reduce operating costs? (Bonus 5 points)(Required)

Coordinating Agencies

Coordinated Agency list

Provide a list of all agencies you currently coordinate with. For each agency, please tell us how you coordinate with them, specifically noting how this coordination results in transportation efficiencies.

Upload Attachment E: Upload Letter from Coordinating Agencies

A letter must be provided from each agency listed confirming any current and ongoing coordination efforts. Letters must be submitted together, as one attachment. Please name your file "Your Agency-Attachment E.”

Max. file size: 20 MB.

Signed Certification of Local Match

Upload Attachment F: Certification of Local Match(Required)

Please name your file "Your Agency-Attachment F."

Max. file size: 5 MB.

Vehicle Requests

Vehicle Request Details

Complete one row for each requested vehicle. Add rows as needed. *Passenger trips: A trip is counted every time a passenger boards a vehicle. For example, 10 people in one vehicle going to and from a location equals 20 passenger trips.

Type of Vehicle requested

Number of days per week vehicle will be operated

Estimated passenger trips to be provided per year*

Estimated mileage per year

Estimated hours per year

Replacement or new?

Current Vehicle Inventory

Review the OKI TAM Inventory on the Funding.oki.org website. If the OKI TAM inventory is not accurate, please use the inventory table to prepare your agency’s Current Vehicle Inventory. Update any of the information on the table as necessary to accurately describe your current inventory.

The OKI Transit Asset Management Plan inventory is accurate for my agency

Yes

Upload your completed Attachment G: Modified OKI TAM Inventory Attachment G

Please name your file "Your Agency-Attachment G."

Max. file size: 5 MB.

Preventive Maintenance Request

Upload your completed Attachment H: Preventative Maintenance Spreadsheet

Please name your file "Your Agency-Attachment H."

Max. file size: 5 MB.

Title VI

Upload your completed Attachment I: Title VI Data Collection Form(Required)

Please name your file as "Your Agency-Attachment I".

Max. file size: 5 MB.

Upload Attachment J: Title VI Plan

Please name your file as "Your Agency-Attachment J".

Max. file size: 5 MB.

Application Certification

Upload Attachment K: Signed Application Certification(Required)

Please name your file as "Your Agency-Attachment K".

Max. file size: 5 MB.

Name

This field is for validation purposes and should be left unchanged.