Federal Fiscal Year 2022

Highway Safety Behavioral Grant Application

Wyoming Department of Transportation

Highway Safety Behavioral Grants Program

5300 Bishop Blvd - Cheyenne, WY 82009

OUR 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’s Filing ID:

Note: A copy of the ‘Certificate of Good Standing’ from the Secretary of State’s office must be attached. The link to the site: https://wyobiz.wy.gov/Business/FilingSearch.aspx.

*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/behavioral-grants.html

Submit grant application to highway.safetygrants@wyo.gov on or before March 31, 2021.

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) Goals - In order for any project to be successful, it must contain measurable end results. The goals explain the overall impact of the deliverables. For example: (1) Reduce the misuse rate for child restraints by 2% from 37.30% to 35.3% by September 30, 2021.(2) Decrease impaired driving crashes by 5% in Laramie County. (3) Increase citizen knowledge of impaired driving risks, statistics, and laws. (No more than 4000 characters)

4) Deliverables – In a logical sequence, describe planned deliverables that will accomplish the project goals. For Example: (1) Organize and instruct 4 renewal classes and 4 update classes around the state. (2) Partner with the Wyoming Highway Patrol to complete trainings statewide. (3) Conduct a minimum of ten Safety Education trainings in Albany, Carbon, Fremont, and Natrona Counties with trained law enforcement officers as indicated by data driven analysis. Please clearly describe the deliverables using bullet points. (No more than 3000 characters)

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

PART 3

Budget Detail

Personnel Expenses:

Salaries (describe each position title, duties, % of time in position). (No more than 1500 characters)

Overtime (if applicable describe the purpose, when, and where.) (No more than 1500 characters)

If receiving funding for personnel services from another funding source, please list the funding source. (No more than 1500 characters)

In-State Travel Expenses: Outline the details for the requested travel to include who, where, and why travel is necessary. (No more than 1500 characters)

Out-of-State Travel Expenses: Outline the details for the requested travel to include who, where, and why travel is necessary. (No more than 1500 characters)

Contractual Expenses: Record costs directly related to the project deliverables and describe proposed contractual agreements and purpose. List the name of each subcontractor and a statement of the work to be performed by each. (No more than 1500 characters)

Media: Describe proposed contractual agreements and purpose. 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 an ongoing traffic safety project. If equipment will be used for non-grant related traffic safety deliverables, 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: Record costs directly related to project deliverables that do not fit in the other categories such as resource materials. (No more than 1500 characters)

Indirect Costs: Documentation of the rate is required for the indirect or administrative costs. Include with the submittal of this grant application. (No more than 1500 characters)

Budget Summary Table

(Complete with data from the Excel-Budget Detail Template)

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

Budget Category	Project Amount Requested	Supplemental Funding	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 deliverables.

(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 highway.safetygrants@wyo.gov.

If you have trouble emailing the application or have questions, please contact Stephanie Lucero (307-777-4198), Alex Toalson (307-777-4199), Ariel Villa (307-777-4272) or Karson James (307-777-4200).