424.1 HFL Project Application

OMB Control Number: 2125-0607

Highways for LIFE Project Application
Burden Statement - This collection of information is voluntary and will be used to select projects for funding with Highways for LIFE program funds. Public reporting burden is estimated to average 8 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. The purpose of HFL is to accelerate the rate of adoption of innovations and technologies, thereby, improving safety and highway quality while reducing congestion caused by construction. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 2125-0607. This collection will expire on May 31, 20XX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Highway Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.
Application For:	FY 20XX:				Contact Name:
(May be both)	FY 20XX:				Contact Title:
					Contact Phone:
Application Date:					FAX:
					E-Mail:
Project Number:
County:					State Hwy Dept:
State I/D:					Address:
Congressional Dist:					City/State/Zip:
1. Project Information
a. Purpose of project: (I.e. new facility, expanding capacity, reconstruction, rehabilitation, operational improvement, bridge replacement, etc.)
b. Type of work:
c. Project scope: (I.e. length of project, number of bridges/spans, etc)
d. Anticipated FHWA concurrence in project construction authorization date:				e. Allotted construction time:
f. Estimated calendar days that motorists will be impacted by the construction:				g. Time of day motorists will be impacted by the construction::
h. Type and extent of public information or involvement is proposed to be made prior to and during construction. (200 words or less)
2. Highways for LIFE Incentives
____________________		Amount of grant requested.
____________________		Request for a waiver of State			_________	percent match.
____________________		All the above.
3. Innovative Features
a. Describe the innovative technologies, manufacturing processes, financing, contracting methods, etc. that will be included in the project. (300 words or less)
b. Safety: Describe any roadway safety issues in the project area, including crash history, crash potential, etc. Identify how project and innovative features will improve safety during and/or after construction. (300 words or less)
c. Congestion: Identify the improvements, innovations, incentives that will be included as part of the project to reduce construction congestion. (300 words or less)
d. Quality: Identify how implementation of the proposed innovative feature will improve the quality as experienced by the driver, both during and after construction. (300 words or less)
e. Will technical support be requested.			_________	Yes	_________	No
(If Yes, identify the type and when requested. FHWA will coordinate the technical support required.)
4. Performance Goals
a. Safety:
Work Zone Safety During Construction
_____	Does the project include the performance goal of the work zone crash rate equal to or less than the pre-construction rate at the project location?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
Worker Safety During Construction
_____	Does the project include the performance goal of an incident rate for worker injuries to be less than 4.0 based on the OSHA 300 rate?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
Facility Safety After Construction
_____	Does the project include the performance goal of a 20% reduction in fatalities and injuries as reflected in 3-year average crash rates, using preconstruction rates as the baseline?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
b. Construction Congestion
Faster Construction
_____	Does the project have a 50% reduction, compared to traditional methods, in the duration that highway users are impacted?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
Trip Time During Construction
_____	Does the project include the performance goal of less than 10% increase in trip time during construction as compared to the average pre-construction speed using 100% sampling?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
OR
Queue Length During Construction
_____	Does the project include the performance goal of a moving queue length less than 1/2 mile (travel speed 20% less than posted speed) in a rural area OR a moving queue length less than 1 1/2 mile (travel speed 20% less than posted speed) in an urban area?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
c. Quality
Smoothness
_____	Does the project include the performance goal of International Roughness Index (IRI) of less than 48 in/mi?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
Noise
_____	Does the project include the performance goal of a Close Proximity (CPX) noise measurement of less than 96.0 decibels?
_____	If not, what does the STA propose the goal to be? Justify. (200 words or less)
5. List any standard procedures or specifications that must and will be superseded or waived in order to implement the innovation(s) or provide contractors with the flexibility needed to achieve the performance goals at reasonable cost. (200 words or less)
6. Will the successful implementation of the innovative features described above lead to change in the administration of the State's transportation program. Explain. (i.e. changes decision-making, standard procedures, specification, etc) (200 words or less)
7. Provide other information about the project that should be considered in the selection process. (200 words or less)
Signature of Authorized SHA Representative:				____________________________________
		Date:		______________________