Monthly & Annual Reports Spreadsheet

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Overview

PRA Statement
October
November
December
January
February
March
April
May
June
July
August
September
DSTD
COIT
DSOGPO
Annual Report

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Sheet 1: PRA Statement

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 report will take you around 50 to 570 minutes to complete, including time to read instructions, gather information, and complete and submit the report. 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.

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Sheet 2: October

Bureau of Indian Affairs

Indian Highway Safety Program

Monthly Report

TRIBE:

PT #:

MONTH:

October

Full Time Grant

Overtime Grant

Number of HSO(s):

1

To

Select One

the number of

motor vehicle related fatalities

by

from the FY2016 number of

to

by the end of FY2018.

2

To

Select One

the number of

motor vehicle related crashes

by

from the FY2016 number of

to

by the end of FY2018.

3

To

Select One

the number of

Select One

by

from the FY2016 number of

to

by the end of FY2018.

4

To

Select One

the number of

Select One

by

from the FY2016 number of

to

by the end of FY2018.

5

To

Select One

the number of

Select One

by

from the FY2016 number of

to

by the end of FY2018.

Monthly

Year to Date

FY18

MOTOR VEHICLE FATALITIES:

Total

Total

Target

Total number of:

1

Motor Vehicle Crash (MVC) Fatalities:

0

0

2

Alcohol Related MVC Fatalities:

0

3

Speed Related MVC Fatalities:

0

4

MVC Fatalities with 0.08+ BAC:

0

5

MVC Fatalities with driver <age 20:

0

6

Unrestrained Fatalities, all seat positions:

0

7

Motor Cycle Fatalities:

0

8

Un-Helmeted Motor Cycle Fatalities:

0

9

Pedestrian Fatalities:

0

10

Bicyclist Fatalities:

0

MOTOR VEHICLE CRASHES:

Total number of:

1

Motor Vehicle Crashes per Month

0

0

2

Injury Crashes:

0

3

Alcohol Related Crashes:

0

4

Speed Related Crashes:

0

5

Property Damage Crashes:

0

DUI ARREST

Total number of:

1

DUI arrests by PD (overall):

0

2

DUI arrests by HSO(s):

0

3

DUI arrests by OT Officers (Grant Funded):

0

Monthly

Year to Date

FY18

SPEED /SEAT BELT CITATIONS

Total

Total

Target

Total number of:

1

Speed Citations by PD (overall):

0

2

Speed Citations issued by HSO(s):

0

3

Speed Citations issued by OT (Grant Funded):

0

SEAT BELT CITATIONS (CPS = Child Passenger Safety)

Total number of:

4

Seat Belt Citations by PD (overall):

0

5

Seat Belt Citations issued by HSO(s):

0

6

Seat Belt Citations issued by OT (Grant Funded):

0

4

CPS Seat Citations issued by PD (overall):

0

5

CPS Seat Citations issued by HSO(s):

0

6

CPS Seat Citations issued by OT (Grant Funded):

0

WRITTEN TRAFFIC CITATIONS

Total number of:

1

Traffic Citations issued by PD (overall):

(Excluding DUI/Speeding/Seatbelt):

0

2

Traffic Citations issued by HSO(s):

(Excluding DUI/Speeding/Seatbelt):

0

3

Traffic Citations issued by OT Officers (Grant Funded):

(Excluding DUI/ Speeding/ Seatbelt):

0

WRITTEN & VERBAL WARRNINGS

Total number of:

1

Written Warnings by PD (overall):

0

2

Written Warnings by HSO(s):

0

3

Verbal Warnings by PD (overall):

0

4

Verbal Warnings by HSO(s):

0

CHECK POINTS/ SATURATION PATROLS (Required Data)

Total number of:

1

Check Points:

0

2

Saturation Patrols:

0

TRAFFIC SAFETY PRESENTATIONS (Required Data)

Total number of:

1

Traffic Safety Presentations:

0

Presentation

Presentation

Date

Description

Location

Audience

SIGNATURE (Project Coordinator/ Chief of Police)

DATE

TITLE

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Sheet 3: November

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	November
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
									0
	2	DUI arrests by HSO(s):							0
									0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 4: December

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	December
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 5: January

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	January
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 6: February

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	February
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 7: March

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	March
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 8: April

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	April
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 9: May

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	May
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 10: June

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	June
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 11: July

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	July
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
									Year to Date		FY18
SPEED /SEAT BELT CITATIONS									Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 12: August

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	August
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 13: September

Bureau of Indian Affairs
Indian Highway Safety Program
Monthly Report
	TRIBE:	0				PT #:	0		MONTH:	September
			Full Time Grant			Overtime Grant		Number of HSO(s):
1	To	Select One	the number of		motor vehicle related fatalities
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
2	To	Select One	the number of		motor vehicle related crashes
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
3	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
4	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
5	To	Select One	the number of		Select One
		by	0%	from the FY2016 number of			0	to	0	by the end of FY2018.
							Monthly		Year to Date		FY18
MOTOR VEHICLE FATALITIES:							Total		Total		Target
Total number of:
	1	Motor Vehicle Crash (MVC) Fatalities:							0		0
	2	Alcohol Related MVC Fatalities:							0
	3	Speed Related MVC Fatalities:							0		0
											0
	4	MVC Fatalities with 0.08+ BAC:							0		0
	5	MVC Fatalities with driver <age 20:							0		0
	6	Unrestrained Fatalities, all seat positions:							0		0
	7	Motor Cycle Fatalities:							0		0
	8	Un-Helmeted Motor Cycle Fatalities:							0		0
	9	Pedestrian Fatalities:							0		0
	10	Bicyclist Fatalities:							0		0
MOTOR VEHICLE CRASHES:
Total number of:
	1	Motor Vehicle Crashes per Month							0		0
	2	Injury Crashes:							0
	3	Alcohol Related Crashes:							0
	4	Speed Related Crashes:							0
	5	Property Damage Crashes:							0
DUI ARREST
Total number of:
	1	DUI arrests by PD (overall):							0		0
	2	DUI arrests by HSO(s):							0
	3	DUI arrests by OT Officers (Grant Funded):							0
							Monthly		Year to Date		FY18
SPEED /SEAT BELT CITATIONS							Total		Total		Target
Total number of:
	1	Speed Citations by PD (overall):							0		0
	2	Speed Citations issued by HSO(s):							0
	3	Speed Citations issued by OT (Grant Funded):							0
SEAT BELT CITATIONS (CPS = Child Passenger Safety)
Total number of:
	4	Seat Belt Citations by PD (overall):							0
	5	Seat Belt Citations issued by HSO(s):							0
	6	Seat Belt Citations issued by OT (Grant Funded):							0
	4	CPS Seat Citations issued by PD (overall):							0
	5	CPS Seat Citations issued by HSO(s):							0
	6	CPS Seat Citations issued by OT (Grant Funded):							0
WRITTEN TRAFFIC CITATIONS
Total number of:
	1	Traffic Citations issued by PD (overall):
		(Excluding DUI/Speeding/Seatbelt):							0		0
	2	Traffic Citations issued by HSO(s):
		(Excluding DUI/Speeding/Seatbelt):							0
	3	Traffic Citations issued by OT Officers (Grant Funded):
		(Excluding DUI/ Speeding/ Seatbelt):							0
WRITTEN & VERBAL WARRNINGS
Total number of:
	1	Written Warnings by PD (overall):							0
	2	Written Warnings by HSO(s):							0
	3	Verbal Warnings by PD (overall):							0
	4	Verbal Warnings by HSO(s):							0
CHECK POINTS/ SATURATION PATROLS (Required Data)
Total number of:
	1	Check Points:							0		0
	2	Saturation Patrols:							0		0
TRAFFIC SAFETY PRESENTATIONS (Required Data)
Total number of:
	1	Traffic Safety Presentations:							0		0
	Presentation		Presentation
	Date		Description			Location				Audience
		SIGNATURE (Project Coordinator/ Chief of Police)							DATE
		TITLE

---

Sheet 14: DSTD

Bureau of Indian Affairs
Indian Highway Safety Program
Mobilization and Sustained Enforcement Form
	Tribe:	0					PT #:	0
	Mobilization:		Don't Shatter the Dream					Reporting Period:		to
			Enforcement Type:		DUI		Safety Belt			Both
					Police		Police		Law Enforcement
	Total number of Officers:				BIA		Tribal		Other
	On reservation
	Participating in mobilization
	Preparing report(s) for mobilization
	Total Officer hours worked by all participating Law Enforcement Agencies during the mobilization
		* Include overtime
				Enforcement:	*DUI/DWI		*Seat Belt		DUI/DWI & Seat Belt
				Total Hours:
	Total number of:					Total number of:
			Check Points:					Saturation Patrols:
			Hours Worked:					Hours worked:
	Tribal Safety Belt Law (check one):					Primary		Secondary		No Law
	Total Number of:
		MOTOR VEHICLE (MV):				CITATIONS:
		Fatalities:				Safety Belt:
		Crashes:				Child Passenger Safety:
		Injury Crashes:				Suspended Revoked Licenses:
		ARRESTS:				Uninsured Motorists:
		DUI/DWI:				Speeding:
		Drug:				Reckless Driving:
		Felony:				Other Traffic Citations:
						Fugitives Apprehended:
						Stolen Vehicles Recovered:
	Total number of Public Service Announcement broadcasts during mobilization:
				TV:	QTY:		Cost:
				Tribal/ Local News Paper:	QTY:		Cost:
				Radio:	QTY:		Cost:
		Attach an additional page if other public information activities took place during mobilization
	Signature						Name & Title
	Phone:					E-Mail:
FORM IS DUE 15 DAYS UPON COMPLETION OF MOBILIZATION

---

Sheet 15: COIT

Bureau of Indian Affairs
Indian Highway Safety Program
Mobilization and Sustained Enforcement Form
	Tribe:	0					PT #:	0
	Mobilization:		Click It Or Ticket					Reporting Period:		to
			Enforcement Type:		DUI		Safety Belt			Both
					Police		Police		Law Enforcement
	Total number of Officers:				BIA		Tribal		Other
	On reservation
	Participating in mobilization
	Preparing report(s) for mobilization
	Total Officer hours worked by all participating Law Enforcement Agencies during the mobilization
		* Include overtime
				Enforcement:	*DUI/DWI		*Seat Belt		DUI/DWI & Seat Belt
				Total Hours:
	Total number of:					Total number of:
			Check Points:					Saturation Patrols:
			Hours Worked:					Hours worked:
	Tribal Safety Belt Law (check one):					Primary		Secondary		No Law
	Total Number of:
		MOTOR VEHICLE (MV):				CITATIONS:
		Fatalities:				Safety Belt:
		Crashes:				Child Passenger Safety:
		Injury Crashes:				Suspended Revoked Licenses:
		ARRESTS:				Uninsured Motorists:
		DUI/DWI:				Speeding:
		Drug:				Reckless Driving:
		Felony:				Other Traffic Citations:
						Fugitives Apprehended:
						Stolen Vehicles Recovered:
	Total number of Public Service Announcement broadcasts during mobilization:
				TV:	QTY:		Cost:
				Tribal/ Local News Paper:	QTY:		Cost:
				Radio:	QTY:		Cost:
		Attach an additional page if other public information activities took place during mobilization
	Signature						Name & Title
	Phone:					E-Mail:
FORM IS DUE 15 DAYS UPON COMPLETION OF THE MOBILIZATION

---

Sheet 16: DSOGPO

Bureau of Indian Affairs
Indian Highway Safety Program
Mobilization and Sustained Enforcement Form
	Tribe:	0					PT #:	0
	Mobilization:		Drive Sober of Get Pulled Over					Reporting Period:		to
			Enforcement Type:		DUI		Safety Belt			Both
					Police		Police		Law Enforcement
	Total number of Officers:				BIA		Tribal		Other
	On reservation
	Participating in mobilization
	Preparing report(s) for mobilization
	Total Officer hours worked by all participating Law Enforcement Agencies during the mobilization
		* Include overtime
				Enforcement:	*DUI/DWI		*Seat Belt		DUI/DWI & Seat Belt
				Total Hours:
	Total number of:					Total number of:
			Check Points:					Saturation Patrols:
			Hours Worked:					Hours worked:
	Tribal Safety Belt Law (check one):					Primary		Secondary		No Law
	Total Number of:
		MOTOR VEHICLE (MV):				CITATIONS:
		Fatalities:				Safety Belt:
		Crashes:				Child Passenger Safety:
		Injury Crashes:				Suspended Revoked Licenses:
		ARRESTS:				Uninsured Motorists:
		DUI/DWI:				Speeding:
		Drug:				Reckless Driving:
		Felony:				Other Traffic Citations:
						Fugitives Apprehended:
						Stolen Vehicles Recovered:
	Total number of Public Service Announcement broadcasts during mobilization:
				TV:	QTY:		Cost:
				Tribal/ Local News Paper:	QTY:		Cost:
				Radio:	QTY:		Cost:
		Attach an additional page if other public information activities took place during mobilization
	Signature						Name & Title
	Phone:					E-Mail:
FORM IS DUE 15 DAYS UPON COMPLETION OF THE MOBILIZATION

---

Sheet 17: Annual Report

Bureau of Indian Affairs

Indian Highway Safety Program

FY18 Annual Report

Due: October 31, 2018

Project Number:

0

Tribe:

0

Grant Award:

Amount Expended:

If grant funds were not fully expended explain why: (REQUIRED) § 1300.35

attach an additional page if needed

TARGETS

To

Select One

the number of

motor vehicle related fatalities

by

0%

from the FY2016 number of

0

to

0

by the end of FY2018.

Was performance target achieved?

Select One

To

Select One

the number of

motor vehicle related crashes

by

0%

from the FY2016 number of

0

to

0

by the end of FY2018.

Was performance target achieved?

Select One

To

Select One

the number of

Select One

by

0%

from the FY2016 number of

0

to

0

by the end of FY2018.

Was performance target achieved?

Select One

To

Select One

the number of

Select One

by

0%

from the FY2016 number of

0

to

0

by the end of FY2018.

Was performance target achieved?

Select One

To

Select One

the number of

Select One

by

0%

from the FY2016 number of

0

to

0

by the end of FY2018.

Was performance target achieved?

Select One

If targets were not achieved explain why: (REQUIRED) § 1300.35

attach an additional page if needed

Project Number:

0

Tribe:

0

Total number of:

sworn police personnel (include upper management)

sworn police officers who work traffic enforcement

FATALITY AND CRASH DATA

Total number of:

0

motor vehicle crash (MVC) fatalities in FY18

0

alcohol-related MVC fatalities in FY18

0

speed-related MVC fatalities in FY18

0

MVC fatalities involving driver with BAC of .08+ in FY18

0

drivers age 20 or younger involved in MVC fatalities in FY18

0

unrestrained occupant MVC fatalities, all seat positions in FY18

0

motorcyclist fatalities in FY18

0

un-helmeted motorcyclist fatalities in FY18

0

pedestrian fatalities in FY18

0

bicyclist fatalities in FY18

0

motor vehicle crashes in FY18

0

motor vehicle injury crashes in FY18

0

alcohol-related motor vehicle crashes in FY18

0

speed-related motor vehicle crashes in FY18

TRAFFIC CITATION DATA

Total number of:

0

traffic citations (excluding DUI and speed) issued in FY18

0

Issued by Police Department (P.D)

0

Issued by Highway Safety Officer(s) (HSO)

0

written and/or verbal traffic warning citations issued in FY18

0

Issued by P.D.

0

Issued by HSO(s)

0

DUI/DWI/OWI arrests in FY18

0

Issued by P.D.

0

Issued by HSO(s)

DUI/DWI/OW convictions in FY18

0

speed citations issued in FY18

0

Issued by P.D.

0

Issued by HSO(s)

B.A.C. LAW

Is the Tribal BAC Law .08?

Select One

If no, what is it?

SOFTWARE SYSTEM

What software system is used to collect traffic statistics?

Does the Tribe report the following to the state:

Traffic Data:

Select One

Serious Motor Vehicle Crashes:

Select One

Motor Vehicle Fatalities:

Select One

Project Number:

0

Tribe:

0

OCCUPANT PROTECTION & CHILD PASSENGER SAFETY (CPS)

Does the Tribe have a Safety Belt Law?

Select One

If yes, is the law:

Select One

Effective date of safety belt law:

Does the Tribe have a CPS law?

Select One

Effective date of CPS law:

Total number of:

0

Safety Belt citations issued in FY18 by PD (overall)

0

Safety Belt citations Issued by HSO(s)

0

Child Passenger Safety seat (CPS) citations issued in FY18 by PD (overall)

0

Child Passenger Safety seat (CPS) citations issued by HSO(s)

Are HSO(s) certified CPS Technicians?

Select One

If yes, list HSO names:

1

2

3

4

List CPS event dates and locations held within the community in FY18

Date

Location

CPS Tech. Name

CHECK POINTS & SATURATION PATROLS

Does the jurisdiction allow for check points?

Select One

Total number of:

0

checkpoints in FY18

0

saturation patrols in FY18

MOBILIZATIONS

If the Police Department did not participate in the mobilization explain why on a separate sheet of paper.

Don't Shatter the Dream Statistics:

Total number of:

0

Crashes

0

Speeding Citations

0

MVC Fatalities

0

DWI Arrests

0

Safety Belt Citations

0

Felony Arrests

0

Child Safety Citations

0

Drug Arrests

0

Suspended License Citations

0

Fugitives Apprehended

0

Uninsured Motorists Citations

0

Recovered Stolen Vehicles

Number of Officers who participated in DSTD:

0

Click It or Ticket Statistics:

Total number of:

0

Crashes

0

Speeding Citations

0

MVC Fatalities

0

DWI Arrests

0

Safety Belt Citations

0

Felony Arrests

0

Child Safety Citations

0

Drug Arrests

0

Suspended License Citations

0

Fugitives Apprehended

0

Uninsured Motorists Citations

0

Recovered Stolen Vehicles

Number of Officers who participated in COIT:

0

Project Number:

0

Tribe:

0

MOBILIZATIONS (CONTINUED)

Drive Sober or Get Pulled Over Statistics:

Total number of:

0

Crashes

0

Speeding Citations

0

MVC Fatalities

0

DWI Arrests

0

Safety Belt Citations

0

Felony Arrests

0

Child Safety Citations

0

Drug Arrests

0

Suspended License Citations

0

Fugitives Apprehended

0

Uninsured Motorists Citations

0

Recovered Stolen Vehicles

Number of Officers who participated in DSOGPO:

0

MEDIA ADVERTISEMENTS

Don’t Shatter the Dream

Total number of articles announcing mobilization in FY18:

Billboard Rentals:

QTY:

Total Costs:

News Paper Articles:

QTY:

0

Total Costs:

$-

Radio Announcements:

QTY:

0

Total Costs:

$-

Click It or Ticket Statistics:

Total number of articles announcing mobilization in FY18:

Billboard Rental

QTY:

Total Costs:

News Paper:

QTY:

0

Total Costs:

$-

Radio:

QTY:

0

Total Costs:

$-

Drive Sober or Get Pulled Over Statistics:

Total number of articles announcing mobilization in FY18:

Billboard Rental

QTY:

Total Costs:

News Paper:

QTY:

0

Total Costs:

$-

Radio:

QTY:

0

Total Costs:

$-

EDUCATIONAL PRESENTATIONS

Did each HSO funded under the Indian Highway Safety grant or Over-time grant provide 2 educational presentations?

Select One

If no, explain:

If yes, please provide dates, locations, and Officers name.

Date

Event/ Location

Officers Name

Please include photographs of activities throughout the FY18 grant year.

Project Number:

0

Tribe:

0

TRAINING

Provide a list of training Officers and other staff attended paid for by the IHSP Grant

Date

Course Title

# of Attendees

Total Training Cost

Total Travel Cost

FY2018 Project Management Training

FY2019 BIA IHSP Grant Writing Training

Lifesavers Conference

BAT MOBILE

Is the tribe in a district where a BATmobile is available?

Select One

Did the tribal police department utilize the BAT mobile?

Select One

If yes, how many times?

If no, please explain why the tribal police department is not utilizing the BAT mobile:

Is the tribal police department interested in utilizing the BATmobile in the future?

Select One

HIGHLIGHTS & ACHIEVEMENTS

1. What are the grant programs (Police Department's) highlights for the FY18 grant year?

Please note: Officer's attending training and conferences are not considered highlights. Unless they impact traffic safety/enfocement activities and/or assist in reaching program targets outlined in the grant agreement.

(BIA IHSP highly encourages grant programs to submit photos if available)

Project Number:

0

Tribe:

0

HIGHLIGHTS & ACHIEVEMENTS (continued)

2. What are the grant programs (Police Department's) achievements within the FY18 grant year?

Please note: Officer's attending training and conferences are not considered highlights. Unless they impact traffic safety/enfocement activities and/or assist in reaching program targets outlined in the grant agreement.

(BIA IHSP highly encourages grant programs to submit photos if available)

Signature

Date

Name, Title (Print)