Travel & Training Form

OMB Control No. 1076-0190
Expiration Date ##/##/####

United States Department of the Interior
BUREAU OF INDIAN AFFAIRS

Indian Highway Grant Application Instructions
The Highway Safety Act of 1966, U.S.C. Title 23, Section 402, provides U.S. Department of
Transportation funding to assist Indian tribes in implementing traffic safety projects. These projects are
designed to reduce the high number of traffic crashes and their resulting fatalities, injuries, and property
damage within Indian Country.
Tribes can use this application to apply for the Bureau of Indian Affairs (BIA), Office of Justice
Services (OJS), Indian Highway Safety Program (IHSP) Grant Writing Training, Lifesavers Conference
attendance, or other traffic conferences. This grant application will cover registration fees and travel
expenses for tribal employees who work for federally recognized tribes in the realm of traffic
enforcement/safety. Complete the application in its entirety; do not leave any blank spaces/fields.
The BIA IHSP offers data driven performance-based grant opportunities. A traffic safety problem must
be identified; and be justified by data. These 402 funds are intended to supplement an existing traffic
safety program on the reservation.
IHSP grants are funded in the form of reimbursements. Tribes must first expend their funds and submit
documentation for reimbursement and consideration each month. Trip Report and other financial
reports (requests for reimbursement) are required. A Tribal Resolution and the Tribe’s most current
approved Indirect Cost Rate Agreement letter must be submitted with the application. Please contact the
IHSP at (505)563-3139 to inquire about BIA IHSP Grant Writing Training.
Lifesavers Conference grant application is due on March 1of the current year. BIA IHSP Grant Writing
and other traffic conference grant application deadline dates will be announced by the IHSP on a
training announcement provided to all federally recognized tribes.
Grant applications can be e-mailed to:
[email protected]
or mailed to:

Bureau of Indian Affairs
Office of Justice Services - Indian Highway Safety Program
1001 Indian School Road NW, Suite 251
Albuquerque, New Mexico 87104

Grant application and attachments can also be e-mailed to the following address:
[email protected]

OMB Control No. 1076-0190
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Indian Highway Safety Grant Application Instructions
Complete all fields and do not leave any blank.
TRIBES INFORMATION:
Provide the Name of the Tribe, Tribal Leaders Name, Title, Mailing and Fedex Address, City State,
and Zip Code. Tribes DUNS/Unique Entity Identifier (UEI) and SAM’s Cage Code for the
federally recognized tribe applying for grant funding.
APPLICANT INFORMATION:
Provide the First and Last Name, Job Title, Department, Phone and Fax Number, and E-Mail and
Office Address of the applicant. Place a check next to the applicant’s title and the training session
they would like to attend.
TRAFFIC DATA INFORMATION:
Place a check in the appropriate box regarding reporting crashes or other traffic data to the state.
TRIBAL STATUTES AND ENFORCMENT STATISTICS
Placing a check in the “no” box to questions in this category does not disqualify the Tribe from
receiving a grant. Check yes or no if the Tribe:
• has an impaired driving law
• has a seat belt law
• has a child seat belt law
PROBLEM STATEMENT:
Providing a problem statement is essential in determining if a Tribe will receive an Indian Highway
Safety Grant. Provide data to support the statement. Identify the specific traffic related problems the
Tribe is experiencing on the reservation. Applicant should provide a narrative of what they would
like to grain from the training.
TRAVEL EXPENSES & REGISTRATION FEE ASSISTANCE:
Indicate the city and state training will take place along with the dates. Applicant must sign and date
the application along with obtaining supervisory approval. Indirect Cost Rate Letter and approved
Travel & Training Form is required with submission of this form.
TERMS CONDITIONS AND RESPONSIBILIITES:
Each condition MUST be initialed. Applications received without initials, signature, and date will
not be considered for funding. Do not leave any field blank in the application. Authorizing official
must sign and date the form prior to submission.
Questions and grant applications along with attachments can be e-mailed to:
[email protected]

Bureau of Indian Affairs - Office of Justice Services
Indian Highway Safety Program

OMB Control No. 1076-0190
Expiration Date ##/##/####

Indian Highway Safety Grant Application
TRIBES INFORMATION:
Tribe Name:
Title:

Tribal Leader Name:
Mailing Address:
City:

State:

Zip Code:

State:

Zip Code:

FedEx Address:
City:
DUNS/UEI:

SAM Cage Code:

APPLICANT INFORMATION:
First Name:

Last Name:

Job Title:

Department:

Phone Number:

Fax Number:

E-mail Address:
Office Address:
City:

State:

Zip Code:

Tribal Program Representing (check one below):
Traffic Safety Planning
Training Opportunities:

Law Enforcement
Lifesavers Conference

Courts

Other:

IHSP Grant Writing Training

Other Traffic Conference:
BIA IHSP will provide Training Announcements for session allowable under the IHSP Grants

TRAFFIC DATA INFORMATION:
In order to apply for a grant a data breakdown utilizing the most recent fiscal year data available for the
reservation is required.
Does the Tribe report crashes or other data to the state?

Yes

No

TRIBAL STATUTES AND ENFORCEMENT STATISTICS:
Does the Tribe have a:
impaired driving law?
Yes

No

seat belt law?

Yes

No

child safety seat law?

Yes

No

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PROBLEM STATEMENT:
Provide a narrative on the traffic issues the federally recognized tribe you work for is currently experiencing.

Provide a narrative of the goal which you wish to achieve by attending training listed in this application.

TRAVEL EXPENSES & REGISTRATION FEE ASSISTANCE:
Complete the attached Travel/Training form to reflect the requested budget for registration fees and travel
expenses and submit it with this form by the deadline date in the BIA IHSP Training Announcement.
Registration and travel expense reimbursements are based on actual travel costs, not to exceed the federal travel
regulations rate for:
(City, State of Training)

Dates of Training

I understand Travel will be reimbursed at the normal tribal rate not to exceed the federal travel regulations.

Applicant Signature

Date

I certify the applicant has received approval, and is available to attend the
if the grant is awarded.

Supervisor Signature

Date

Does the Tribe have an approved Indirect Cost Rate letter?

(Course Name)

Supervisor's Name (Print)
Yes

If yes, attach a copy of the Tribes approved Indirect Cost Rate letter.

No

OMB Control No. 1076-0190
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TERMS CONDITIONS AND RESPONSIBILITIES:
Read and check to acknowledge each of the items listed. Applications received without checked boxes to
acknowledge this section will be considered incomplete and will not be eligible for funding.
Requests for reimbursements with required supporting travel documents, receipts, and trip report must be
submitted to the BIA IHSP.
Tribe understands the BIA IHSP is a REIMBURSABLE grant program.
The Tribe must expend their funds and seek reimbursement based upon an approved budget and
application.
All travel must be approved in advance by the BIA IHSP.
In order to comply with the provisions of FAST ACT, and the required State Certifications and
Assurances, the BIA IHSP will allocate funds on behalf of the Tribes to meet certain conditions and
comply with all applicable rules and regulations for administering a traffic safety program.
Approved Indirect Cost Rate Letter is attached. If not attached the application is incomplete.
Tribes participating in the federal grant processes must comply with the Single Audit Act of 1984.
I,
, do hereby state and affirm: I have authority to submit this
application on behalf of the Tribal government named herein. I further understand and affirm: I have obtained
all necessary approvals, and have discussed this application with the necessary and appropriate people.
Signature:

Date:

Name:

Title:
E-mail completed and signed registration form and attachments to:
[email protected]

The BIA IHSP staff is available, Monday - Friday from 8:00 AM -5:00 PM MST, to answer questions at
(505)563-3764.

Bureau of Indian Affairs - Office of Justice Services
Indian Highway Safety Program

OMB Control No. 1076-0190
Expiration Date ##/##/####

TRAVEL & TRAINING AUTHORIZATION FORM
REVISED 09/2019

Traveler:

Title:

Tribe:

Project Number:

Phone Number:

E-Mail Address:

TRAINING REQUEST

TRAVEL REQUEST

Course Title:
Start Date:
End Date:
Training Location:

Purpose:
Start Date:
End Date:
I certify travel:
☐ Yes ☐No is outside a 50 mile radius of my duty station
☐ Yes ☐No exceeds 12 hours

(City, State)

Registration Fee:
Travel required ☐ Yes ☐ No
Which grant target(s) does this training relate to?
#1
#2
#3
#4
#5
Which grant strategies does this training apply to?

Travel will be reimbursed at the tribal rate not to exceed the
federal travel regulations
Daily
Daily
Total Request:
Federal Rate:
Tribal Rate:

Lodging: $
Per Diem: $

$
$

$
$

Travel Expenses (Enter Estimated Costs Below)
Airfare:
Luggage Fees:
Airport Parking:
Lodging Taxes:
Taxi Fare/Shuttle:
POV Mileage:
miles @
$
cents per mile =

$ 0.00

Mileage rates can be found at: http://www.gsa.gov/portal/category/26429

Total Estimated Travel Costs:
Quote & comparison must be attached for Rental Car/ POV

Rental Car/ POV:
I understand that this information is being submitted to support a claim against a federally funded grant program. False statements
on this form may be prosecutable under 18 USC 1001. The information on this form is true, correct, and complete to the best of my
knowledge and ability.

Traveler/ Trainee’s Signature

Date

Chief of Police (PTS)/ Supervisor Signature (CPS) Date
Chief of Police/ Supervisor Name (Print)

BIA Indian Highway Safety Program
Reason for Denial:

Date

☐Approved

☐Disapproved

OMB Control No. 1076-0190
Expiration Date ##/##/####

Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) for the BIA Indian
Highway Safety Program (IHSP) to fulfill the data obligations of 23 CFR 1300.11. Your response is voluntary and we will not share the results publicly. We
may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB Control Number.
OMB has reviewed and approved this survey and assigned OMB Control Number 1076-0190, which expires ##/##/####.
Estimated Burden Statement: We estimate the application will take you 120 minutes to complete, including time to read instructions, gather information,
and complete and submit the application. You may submit comments on any aspect of this information collection to the Information Collection Clearance
Officer, Office of Regulatory Affairs & Collaborative Action—Indian Affairs (RACA), U.S. Department of the Interior, 1849 C Street NW, Mail Stop 4660,
Washington, DC 20240.