Laserfiche WebLink
Appendix C. SS4A worksheet <br />Applicants should follow the instructions in the NOFO to correctly apply for a grant. See the SS4A website <br />for more information. <br />Instructions: The purpose of this worksheet is to determine whether an applicant's existing plan(s) is substantially <br />similar to an Action Plan for purposes of applying for an Implementation Grant or to conduct Supplemental <br />Planning/Demonstration Activities only. Use of this worksheet is required. Applicants should not adjust the formatting <br />or headings of the worksheet. <br />For each question below, answer "yes" or "no." If "yes," cite the specific page in your existing Action Plan or other <br />plan(s) that corroborate your response, or cite and provide other supporting documentation separately. <br />An applicant is eligible to apply for an Action Plan Grant that funds supplemental action plan activities, or an <br />Implementation Grant, only if the following two conditions are met: <br />• Answer "yes" to Questions © 0 0 <br />Answer "yes" to at least four of the six remaining Questions 0 0 0 0 0 0 <br />If both conditions are not met, an applicant is still eligible to apply for an Action Plan Grant that funds creation of a <br />new Action Plan. <br />Lead Applicant: <br />UEI: <br />0 Are both of the following true? <br />• Did a high-ranking official and/or governing body in the jurisdiction <br />publicly commit to an eventual goal of zero roadway fatalities and <br />serious injuries? <br />• Did the commitment include either setting a target date to reach zero, <br />OR setting one or more targets to achieve significant declines in <br />roadway fatalities and serious injuries by a specific date? <br />VJ To develop the Action Plan, was a committee, task force, implementation <br />group, or similar body established and charged with the plan(s <br />development, implementation, and monitoring? <br />() Does the Action Plan include all of the following? <br />Analysis of existing conditions and historical trends to baseline the level <br />of crashes involving fatalities and serious injuries across a jurisdiction, <br />locality, Tribe, or region; <br />Analysis of the location where there are crashes, the severity, as well as <br />contributing factors and crash types; <br />• Analysis of systemic and specific safety needs is also performed, as <br />needed (e.g., high risk road features, specific safety needs of relevant <br />road users; and, <br />• A geospatial identification (geographic or locational data using maps) <br />of higher risk locations. <br />C43 <br />U.S. Department of Transportation <br />YES ONO <br />If yes, provide documentation: <br />YES ONO <br />If yes, provide documentation: <br />YES ❑ NO <br />If yes, provide documentation: <br />Still have questions? Visitthe SS4Awebsite <br />SS4A Self -Certification Eliaibility Worksheet I Paae 1 of 2 <br />0 Did the Action Plan development include all of the following activities? YES ❑ NO <br />• Engagement with the public and relevant stakeholders, including the If yes, provide documentation: <br />private sector and community groups; <br />• Incorporation of information received from the engagement and <br />collaboration into the plan; and <br />• Coordination that included inter- and intra-governmental cooperation <br />and collaboration, as appropriate. <br />© <br />Did the Action Plan development include all of the following? <br />YES ❑ NO <br />• Considerations of equity using inclusive and representative processes; <br />If yes, provide documentation: <br />• The identification of underserved communities through data; and <br />• Equity analysis, in collaboration with appropriate partners, focused on <br />initial equity impact assessments ofthe proposed projects and strategies, <br />and population characteristics. <br />0 <br />Are both of the following true? <br />YES NO <br />• The plan development included an assessment of current policies, plans, <br />I, provide documentation <br />guidelines, and/or standards to identify opportunities to improve how <br />processes prioritize safety; and <br />• The plan discusses implementation through the adoption of revised or <br />new policies, guidelines, and/or standards. <br />0 <br />Does the plan identify a comprehensive set of projects and strategies to <br />YES NO <br />address the safety problems in the Action Plan, time ranges when <br />projects and strategies will be deployed, and explain project <br />If yes, provide documentation: <br />prioritization criteria? <br />0 <br />Does the plan include all of the following? <br />YES NO <br />• A description of how progress will be measured over time that includes, at <br />If yes, provide documentation <br />a minimum, outcome data. <br />• The plan is posted publicly online. <br />Was the plan finalized and/or last updated between 2018 and June <br />YES NO <br />2023? <br />If yes, provide documentation: <br />CaStill have questions? Visit the SS4A website <br />U.S. Department of Transportation SS4A Self -Certification Eligibility Worksheet I Page 2 of 2 <br />Appendix C <br />