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Safety Research Proposal

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					                                    INSTRUCTIONS FOR COMPLETING GRANT APPLICATION
               This is an EXCEL spreadsheet with embedded WORD documents for inputting narratives. You will need to move within thie document by clicking on the tabs indicated.


Step 1              Enter all highlighted fields on the "DATA" tab; save file to self populate the rest of the document.

Step 2              Complete the "Problem Identification" page to include appropriate data and statistical analysis.

Step 3              Complete "Project Goals" page, to include the specific goals the proposal seeks to accomplish.

                            EXAMPLES                Conduct 1200 hours of overtime enforcement for DWI.

                                                    Provide DWI court monitoring training for 6 court systems.

                                                    Implement 2 Traffic Safety Summits reaching 1,500 participants.

                                                    Decrease impaired driving fatal and injury crashes in my project area by 2%.

                                                    Increase occupant protection usage in my project area to the state avaerage.

Step 4              Complete the "Project Description" page with an explanation of your agency, current programs, geographic location of service area,
                    and staffing.

                    Explain the program your agency is proposing; including the services to be provided, additional staff required, equipment necessary
                    for program implementation, and travel associated with program activities.
                    Provide current partnerships your agency has and potential new partnerships with the implementation of your proposed activities.

Step 5              Complete the "Evaluation" page. Including an explanation of how the proposed activities will be evaluated for outcome and efficiency.

Step 6              Complete the "Budget Summary" page. Please include all sources of funding.

Step 7              Complete "Annex C" to represent a timeline of when activities will be performed and costs associated with each outcome.

                    "Annex C" is divided into alcohol, occupant protection, and additional program areas and denotes specific campaign dates in each
                    program area. Please list program activities under the respective categories and show increase in activities for each campaign
                    period.
                    Each goal on the "Project Description" page should be noted on the Annex C Column A. Goals that pertain to alcohol, occupant
                    protection, or additional program areas should be under their respective sections.
                    The bottom section representing cost should only represent the amount requested from the LHSC.


                                                                          Definitions of the cost categories

Personal            Salaries, fringe benefits directly related to the project. This includes salaries and fringe benefits for each person working the project. The cost of travel and
Services:           training is listed separately. Employees working on the project but not paid by this grant may be listed as match unless paid by another federal grant.

Travel:             Travel and training directly related to the project. Out of state travel must be approved in advance by LHSC and must include course and/or conference by
                    name. Employees working on the project but not paid by this grant may be listed as match unless paid by another federal grant.
Contractual         Expenses incurred in paying for a service perfomed by any person or organization not connected directly with your Agency or Unit, i.e. consultants, studies, etc.
services:           All subcontracts must be approved by LHSC prior to implementation. The cost of each service is itemized. Procurement of contractual services must be in
                    accordance with state rules and regulations.
Commodities:        Materials and/or supplies acquired for the purpose of this particular highway safety project. Items that may be included are promotional items that encourage the
                    general public to adopt highway safety practices during the course of the normal operation of this project. All purchases must be in accordance with state rules
                    and regulations.
                    Note: regular operating supplies should be included in other direct costs.

Other Direct        Items that represent expenditures for office operation, i.e. postage, telephone service, equipment maintenance etc. Also included are equipment purchased and
Costs:              data processing equipment. Purchase of equipment only is not allowable. Equipment must be a part of the project.
                    Indirect Costs included this section must have a negotiated approved rate from the agency's cognizant agency.




Additional Comments related to the overall review and expectations of the LHSC.

                    Justification must be provided if the proposal includes travel that exceeds more than 5% of personal services.

                    Justification must be provided if the commodities exceed 5% of the total proposed amount.

                    Justification must be provided if equipment requested exceed 20% of the total proposed amount.

                    Equipment requested shall be directly related to the implementation of the project.

                    Individual equipment items that exceed $5,000.00 must have NHTSA approval and requests submitted to the LHSC PTS Coordinator.

                    LHSC will not fund paid media or advertising in individual contracts.
                                   Project Description Section
 Project Title

 Project Number                                                CFMS Number
 Priority Program Area

 Project Description (short)

 Agency Type
 Project Begin Date:                                    Project End Date:
 Federal Tax ID#
                                     Contracting Agency Section
 Contracting Agency Name:
 Agency Address/PO Box
 Agency City, State, Zip
 Agency Phone Number
 Agency Fax Number
 Agency E-mail address

           Implementing Agency Section (if different that Contracting Agency)
 Implementing Agency Name
 Implementing Agency Street
 Agency City, State Zip
 Agency Phone #
 Agency Fax #
 Agency E-mail

                                          Funding Section
 Amount Requested from the LHSC
 Match / InKind
 Other grant funds to be utilized
 Agency Program Income
 Total Project Cost                $                                               -
 IS EQUIPMENT INCLUDED IN THIS CONTRACT                        Item over $5,000?


Authorizing Official Information
 Name
 Title
 Address
 City, State, Zip
 Phone
 Fax
 E-mail address

Project Director Information
  Name
  Title
  Address
  City, State, Zip
  Phone
  Fax
  E-mail address

Fiscal Officer Information
  Name
  Title
  Address
  City, State, Zip
  Phone
  Fax
                                   Problem Identification
PROBLEM IDENTIFICATION (500 words or less) All LHSC contracts are awarded based upon research driven
programs that are concentrated on topics shown to be an area of concern. Impaired Driving and Occupant
Protection are the most prevalent areas of need in Louisiana; however, all program proposals should have
supportive documentation defining the need. Local data such as numbers of crashes, crash locations, and
offender citation should support your proposed activities. In addition to local data, LSU Traffic Research Group
and/or FARS should be provided to support your agencies explanation of problems. If multiple program areas are
chosen attachments are permissible.
            * Double Click shaded area below.
                                                              Project Goals
PROJECT GOALS/OBJECTIVES (250 words or less) If multiple program areas are chosen attachments are permissible

I. LHSC OBJECTIVE STATEMENT
  This subgrant is part of the Louisiana Highway Safety Commission (LHSC) statewide FY 2011 Fatal and Injury (F&I) Crash
  Reduction Effort. The primary objective of this statewide effort is to reduce fatal and injury crashes on Louisiana Roadways.

Reduce statewide traffic fatalities from a 5 year average of 956 (2004-2008) to 890 by 2011, a 4.5% reduction.

Reduce fatal and serious injury crashes from a five year average of 12,782 to 11,912 in 2011, a 4.5% reduction.

Reduce alcohol related fatalities from a five year average of 449 to 418 by 2011, a 4.5% reduction.

Increase child passenger safety use from a 5 year average of 88% (2004-2008) to 97% by 2011. An increase of 2 percentage points.

Increase safety belt use from a 5 year average of 76% (2004-2008) to 78% by 2011. An increase of 1 percentage point.

Reduce pedestrian fatalities from a five year average of 105 (2004-2008) to 98 by 2011, a 4.7% reduction.

Reduce motorcycle fatalities from a 5 year average of 85 (2004-2008) to 79 by 2011, a 4.7% reduction.

II. WORK STATEMENT - Project Goals
   If awarded, this subgrant will provide the following outcomes. (Courses taught, persons reached, overtime hours worked,
               * Double Click implemented, etc.)
   tickets written, programs shaded area below.
                                                    Project Description / Narrative
PROJECT GOALS/OBJECTIVES (750 words or less) Multiple pages allowable if addressing multiple program areas.

  Please include agency mission, what services do you provide, who do you serve, how the additional traffic safety program will be incorporated into current
  programming, and who are you partners. (Please include partnership support letters where applicable.) Please describe fully how your proposed activities will be
  implemented.
                  * Double Click shaded area below.
                                                      Project Description / Narrative
Additional page provided if necessary

                  * Double Click shaded area below.
                                                    Evaluation
PROJECT EVALUATION If multiple program areas are chosen attachments are permissible. Please include explanation of how the
proposed activities will be evaluated for outcome and efficiency.
                * Double Click shaded area below.
                                                                          Budget Summary
PROJECT TITLE:                 0
CONTRACTING AGENCY:            0

                                                                                     CASH EXPENSES                                                      TOTAL
1. PERSONAL SERVICES                                                                                                                                   PROJECT
                                                                              LHSC requested       MATCH / IN       Other grant       Agency
  Salaries:                                # hrs                rate             amount              KIND             funds       Program Income       COSTS
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                        Subtotal Salaries     $          -                      $            -    $         -      $             -
  Fringe Benefits                                           Rate                                                                                   $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
                                               Subtotal Fringe Benefits       $          -     $           -    $            -    $         -      $             -
TOTAL PERSONAL SERVICES                                                       $          -     $           -    $            -    $         -      $             -
2. TRAVEL                                  Est. miles   mileage rate
   In State Travel (routine only)                       $              0.48   $          -                                                         $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
  Out of State Conferences (LHSC prior approval required)                                                                                          $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
                                                                                                                                                   $             -
TOTAL TRAVEL                                                                  $          -     $           -    $            -    $         -      $             -
3. CONTRACTUAL SERVICES                 Quantity            Cost/program
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
TOTAL CONTRACTUAL SERVICES                                                    $          -     $           -    $            -    $         -      $             -
4. COMMODITIES
                                        Quantity              Cost/item
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
TOTAL COMMODITIES                                                             $          -     $           -    $            -    $         -      $             -
5. OTHER DIRECT COSTS                   Quantity             Cost/item
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
Equipment:                              Quantity             Cost/item
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
                                                                              $          -                                                         $             -
TOTAL EQUIPMENT                                                               $          -     $           -    $            -    $         -      $             -
TOTAL OTHER DIRECT COSTS                                                      $          -     $           -    $            -    $         -      $             -
GRAND TOTAL                                                                   $         -      $           -    $            -    $         -      $             -

                                                                                                                                                       PROJECT
                                                                              LHSC requested       MATCH / IN       Other grant       Agency
                                                                                 amount              KIND             funds       Program Income       COSTS
PROJECT TITLE                        $                                                                 -            CONTRACTING AGENCY             $                                                                               -
                                                              1st QUARTER                                              2nd QUARTER                                                 3rd Quarter                                         4th Quarter
         PROGRAM ACTIVITIES
                                                Oct                Nov                  Dec                Jan              Feb                Mar                Apr                  May            Jun               Jul               Aug              Sep           Total
                                                                                                                                                           April 1-30 Underage
         Campaign Periods                                                        Dec 19 - Jan 4 DWI                  Feb 27 - Mar 8 DWI                                        Motorcycle Awareness                 July 1-4 DWI                     OTLUA early Sept
                                                                                                                                                                  Drinking
                                                            Nov 14-30 Seatbelt                                                                                                   CIOT end of May                                                           CPS

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PLANNED BUDGET for funds requested from the LHSC only (These figures should not include, MATCH/InKind, additional grant funds, or program income

1. PERSONAL SERVICES
                                     P                                                                                                                                                                                                                                     $0.00
2. TRAVEL
                                     P                                                                                                                                                                                                                                     $0.00
3. CONTRACTUAL SERVICES
                                     P                                                                                                                                                                                                                                     $0.00
4. COMMODITIES
                                     P                                                                                                                                                                                                                                     $0.00
5. OTHER DIRECT COSTS
                                     P                                                                                                                                                                                                                                     $0.00
TOTAL BUDGET
                                     P           $0.00               $0.00                $0.00             $0.00             $0.00                $0.00            $0.00                $0.00         $0.00              $0.00             $0.00            $0.00         $0.00

P = Planned     C = Completed                                                             SUBMIT TO LHSC BY THE 20th DAY OF EACH MONTH                                                                      $0.00                                                $0.00
                                                     Staff Review Sheet
Agency Name                                                           0
Agency Type                                                           0
Program Area(s)
Geographical area served
Target population served
Does application provide statistical analysis to
support problem identification
Total $$ Requested from the LHSC                         $        -
Total cost of project all funding sources included
                                                         $        -
PROGRAM INCOME                                           $        -
Travel Requested                                         $        -
% Travel                                                   #DIV/0!    Over 5% of personal services requires justification
Salary Requested                                         $        -
                                                                      Over 25% requires justification for non-enforcement.
%Salary of LHSC requested funds
                                                           #DIV/0!    Enforcement proposals less than 75% require justification
Fringe Requested                                         $        -
%Fringe of LHSC requested funds                            #DIV/0!    Over 25% requires justification
Commodities                                              $        -
%Commodities of LHSC requested funds                       #DIV/0!    Over 5% requires justification
Equipment Requested                                      $        -
%Equipment of LHSC Requested funds                         #DIV/0!    Over 20% requires justification
Does proposal include any equipment that
exceeds $5,000.00 per item?
Do activities support either of the National
Mobilizations?
Do activities physically end prior to the state fiscal
year end?
Are support letters provided from partnering
agencies or potential partners?
Do any requested funds cover paid media?
Additional reviewer comments:

				
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Description: Safety Research Proposal document sample