Application Stage

5

ATTACHMENT A

WILDLIFE CROSSINGS PROGRAM APPLICATION CHECKLIST

The Federal Highway Administration (FHWA)provides this Application Checklist for the Fiscal Year (FY) 2022 and 2023 Wildlife Crossings Pilot Program (Wildlife Crossings Program) to assist project sponsors who intend to apply for a Wildlife Crossings Program grant. Interested project sponsors who qualify as eligible applicants should read the FY 2022 and FY 2023 Wildlife Crossings Program Notice of Funding Opportunity (NOFO) in its entirety and especially where noted in this application checklist to submit eligible and competitive applications.

Basic Project Information

Basic Project Information - Provide a narrative for the below items on basic details pertinent to the project, including project name, description, location, involved parties, etc. Items in this section will be used to determine grant program eligibility as detailed in Section C of the NOFO.
1	Project Name
2	Project Description	Provide a concise description of the project including a discussion of the proposed project’s history and a description of any previously incurred costs. The project description should place the project into a broader safety context, including the history and trends of WVCs within the project area, any previous studies or interventions regarding WVCs in the project area, and their performance results. The description should also place the project into a broader conservation context, including identification of the species that will benefit from the project; existing conservation designations or plans for the wildlife corridor, habitat, or project area; and benefits to ecosystem processes and functions. The applicant may further use this section to place the project into a broader investment context, including other infrastructure investments being pursued by the project sponsor or other entities in the transportation corridor, or wildlife corridor or habitat including other conservation grant programs administered by other Federal, State, or local agencies.
3	Wildlife Crossings Program Request amount	Exact amount in year-of-expenditure dollars: $ _______________________
4	Total Project Cost	Estimate in year-of-expenditure dollars: $
Eligibility Criteria
5	Who is the Eligible Applicant?	(Name and identify which eligible applicant category applies. Select from the below statutory eligible applicants. If there are multiple eligible applicants applying together, please select each of the eligible applicants.) A State DOT A metropolitan planning organization Unit of local government A regional transportation authority A special purpose district or public authority with a transportation function Indian Tribe An FLMA
6	Is there an Eligible Partner? If so, who is the Eligible Partner?	Yes No If yes, name and identify which eligible partner category applies. Select from the below statutory eligible partners. If there are multiple eligible partners applying together, please select each of the eligible partners. A metropolitan planning organization Unit of local government A regional transportation authority A special purpose district or public authority with a transportation function Indian Tribe An FLMA A foundation, nongovernmental organization, or institution of higher education A Federal, Tribal, regional, or State government agency
7	Indicate the amount, type, and source(s) of the required 20% non-federal match. If applicant believes a different matching share applies, cite the percentage, and justification. (See Section C.2 of the NOFO). Then, indicate the amount, type, and source(s) of the different non-federal match.
8	Eligible Project Type	(Identify which eligible project type the proposed project addresses. Select from the below statutory eligible types) Construction project, including all activities that lead to a built project Non-construction project, including all other projects, such as research and planning studies
Additional Project Information
9	State(s) and/or Tribal land in which the project is located
10	Identify the Lead Applicant (who will be the applicant responsible for administration of Wildlife Crossings Program funds if application is selected and point of contact for the application.)
11	If a joint application, please provide organizational names of co-applicants, eligible partners, and sub-recipients that will receive funds.
Location Information
12	Location of project area	(Provide State and County, name of the city, town, or jurisdiction)
13	Provide Census FIPS codes or other geographic code identifiers for the project area	(Provide appropriate code(s))
14	Provide geographic coordinates for the project	(Provide Latitude/Longitude)
15	Is the project located in an urban area or rural area? (See Section C.3.d of the NOFO)	(Please select one) Urban Area per FHWA Adjusted Urban Area map: (https://hepgis.fhwa.dot.gov/fhwagis/ViewMap.aspx?map=MPO+Boundaries|FHWA%20Adjusted%20Urban%20Area) Rural (rural Area is an area not located in an Urban area, as defined above)
16	Is the project located (entirely or partially) in federally designated community development zone?	(Please select one) Yes No If Yes, please describe which of the four federally designated community development zones in which your project is located. Opportunity Zones: (https://opportunityzones.hud.gov ) Empowerment Zones: (https://www.hud.gov/hudprograms/empowerment_zones) Promise Zones: (https://www.hud.gov/program_offices/field_policy_mgt/fieldpolicymgtpz ) Choice Neighborhoods: (https://www.hud.gov/program_offices/public_indian_housing/programs/ph/cn )
17	Is the project area located on a federally recognized Indian Tribe land?	(Please select one) Yes No If yes, please provide the name of the Tribal land.
18	Provide the congressional district(s) the project is located within

Project Costs

Project Costs – Provide information detailing the costs associated with the project. These costs will be used to determine eligible award amount, how the project supports financial goals of the program, how the application meets Financial Completeness technical criteria (along with other information; see Section E.1.c), and other factors. More information on this section can be found in Section D.2.c.ii of the NOFO.
1	Wildlife Crossings Program Request Amount	Exact amount in year-of-expenditure dollars: $
2	Estimated Total of Other Federal funding (excluding Wildlife Crossings Program Request)	Estimate amount in year-of-expenditure dollars: $
3	Estimated Other Federal funding (excluding Wildlife Crossings Program) further detail	(List each Federal Program that will provide other Federal funding and identify whether that program is Formula or Discretionary and the amount provided from each Federal Program, e.g. Program: Amount: , and repeat for each source)
4	Estimated non- Federal funding	(Identify each source of non-Federal funding and estimated amount, e.g. Source: Amount: , and repeat for each source)
5	Future Eligible Project Cost (Sum of Wildlife Crossings Program request, Other Federal funds, and non-Federal funds, above.)	Estimate in year-of-expenditure dollars: $
6	Previously incurred project costs (including any expenses expected to be incurred between the applicant being selected for award and obligation of Wildlife Crossings Program funds)	Estimate in year-of-expenditure dollars: $
7	Total Project Cost (Sum of ‘previous incurred’ and ‘future eligible’)	Estimate in year-of-expenditure dollars: $

Project Merit Criteria

Project Merit Criteria – Provide narrative response on how the project responds to the primary and secondary selection criteria in Section E.1 of the NOFO. In responding to Project Merit Criteria, refer to Section E.1.a and E.1.b of the NOFO.
1.1	Criterion #1.1: Wildlife Vehicle Collisions
	The project contributes to the Wildlife Vehicle Collisions criterion by…
1.2	Criterion #1.2: Terrestrial and Aquatic Habitat Connectivity
	The project contributes to the Terrestrial and Aquatic Habitat Connectivity criterion by…
2.1	Criterion #2.1: Leveraging Investments
	The project contributes to the Leveraging Investments criterion by…
2.2	Criterion #2.2: Economic Development and Visitation Opportunities
	The project contributes to the Economic Development and Visitation Opportunities by…
2.3	Criterion #2.3: Innovation
	The project contributes to the Innovation criterion by…
2.4	Criterion #2.4: Education and Outreach
	The project contributes to the Education and Outreach criterion by…
2.5	Criterion #2.5: Monitoring and Research
	The project contributes to the Monitoring and Research criterion by…
2.6	Criterion #2.6: Survival of Species
	The project contributes to the Survival of Species criterion by…
2.7	Criterion #2.7: Climate Change, Sustainability, and Resilience
	The project contributes to the Climate Change, Sustainability, and Resilience criterion by…
2.8	Criterion #2.8: Equity and Barriers to Opportunity
	The project contributes to the Equity and Barriers to Opportunity criterion by…

Technical Criteria

Technical Criteria– Submit the requested information in Section E.1.c. for DOT to conduct a review of the technical criteria for the project.
3.1	Project Administration
	The project addresses the Project Administration criterion by…
A	Will the State DOT be administering the grant? If so, has the State DOT agreed to administer the grant and is there information on this agreement? (See Section E.1.c of the NOFO, and 23 U.S.C. 171(f)(2)(A)(ii))	Yes No If yes, please provide supporting information on the agreement between the State DOT and applicant.
3.2	Technical Soundness
	The project addresses the Technical Soundness criterion by…
A	What are the proposed evaluation and design criteria, standards, and methodologies, including guidance and best practices from local, Tribal, State, or national entities?
B	Is there a long term plan for project monitoring?	Yes No If yes, please provide supporting information, including the methodology proposed to be used
C	Is there a long term plan for maintenance, if applicable?	Yes No If yes, please provide supporting information, including any agreements.
3.3	Project Readiness
	The project addresses the Project Readiness criterion by…
A	NEPA Status – Indicate if the NEPA determination will likely be the result of a Categorical Exclusion (CE), Environmental Assessment (EA), or Environmental Impact Statement (EIS), if applicable	Planned or Actual Start of NEPA Date: Planned or Actual Completion of NEPA Date: Final NEPA Determination or current status of NEPA process:
B	Will all necessary environmental approvals and permits meet the project delivery timeline specified in the project schedule, if applicable?	Yes (Please provide documentation) No
C	If applicable, is the project currently programmed in the: TIP STIP MPO Long Range Transportation Plan State Long Range Transportation Plan	(Please select one) Yes No (If Yes, please specify in which plans the project is currently programmed, the year in which the project is currently programmed, and provide the identifying number if applicable)
D	Has there been public engagement opportunities?	Yes (Provide details including the degree to which public comments and commitments have been integrated into project development and design) No
E	Will there be public engagement opportunities?	Yes (Please provide details) No
F	Indicate detailed project schedule including all major project milestones
G	Is right-of-way acquisition necessary?	Yes No If Yes, Planned or Actual Start of Right-of-Way Acquisition Date: ____________ If Yes, Planned or Actual Completion of Right-of-Way Acquisition Date: ____________
H	Right-of-way acquisition considerations (If applicable)	If right-of-way must be acquired for the project: Would right-of-way acquisition require relocation of any people or businesses? Yes No If Yes, are people or businesses being relocated members of traditionally underserved and underrepresented populations (Environmental Justice communities)? If Yes, please describe the required relocation of any people or businesses.
I	Design Status (If applicable)	Planned or Actual Start of Preliminary Design Date: ____________________ Planned or Actual Completion of Preliminary Design Date: ____________________ Planned or Actual Start of Final Design Date: _____________________ Planned or Actual Completion of Final Design Date: ___________________
J	Anticipated Construction Start Date (If applicable):	Date: _____________________
K	Anticipated Project Completion Date:	Date: _____________________
L	Indicate potential project risks and strategies undertaken or that might be taken to mitigate those risks.
3.4	Financial Completeness
	The project addresses the Financial Completeness criterion by…