TTPSF Application Form

2025-2026 TRIBAL

TRANSPORTATION PROGRAM SAFETY FUND

APPLICATION FORM
OMB CONTROL NUMBER: 21XX-XXXX
EXPIRATION DATE: mm/dd/yyyy
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid
OMB Control Number. The OMB Control Number for this information collection is 21XX-XXXX. Public reporting for this collection of information is
estimated to be approximately 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and
maintaining the data needed, completing, and reviewing the collection of information.
All responses to this collection of information are required to obtain or retain a benefit (per 23 USC 202(e)). 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,
Department of Transportation, Federal Highway Administration, 1200 New Jersey Ave SE, Washington, D.C. 20590.

INSTRUCTIONS
Submit this application form along with a project narrative and supporting documentation
by following further instructions online at: https://highways.dot.gov/federal-lands/
programs-tribal/safety/funds
This is an interactive form in the Adobe Acrobat (.pdf) format. To ensure full functionality,
download a free copy of Acrobat Reader if you do not already have it installed on your computer.
Viewing WKHIRUPLQ a web browser or other PDF viewers may result in an inability to use
interactive features and may not allow the user to save content entered into the form.
If you have questions about the TTPSF please send an email to [email protected]
or call Adam Larsen at 360-619-2601.

Application Checklist
FHWA may be unable to process incomplete applications. A complete application package consists of:
Completed Application Form
Project Narrative (see Application Guide for template. Not required for applications to develop or
update Safety Plans)
Supporting Documentation (plans, studies, maps, photos, data, etc.)
National Tribal Transportation Facility Inventory Route and Section Numbers
(Required for Infrastructure Improvement)
Letter from Route Owner Acknowledging the Project
(Required for Safety Studies & Infrastructure Improvement unless route is owned by BIA or a Tribe)
TTP Safety Fund Application Form

Page 1

PART 1. SELECT CATEGORY
3OHDVHUHYLHZWKH Notice of Funding Opportunity and theApplication GuideWRLGHQWLI\WKHPRVWDSSURSULDWH
category IRU\RXUDSSOLFDWLRQ3OHDVHselect aIXQGLQJFDWHJRU\IRUWKLVDSSOLFDWLRQ:
Safety Plan

Systemic Roadway Departure Countermeasures

Data Assessment, Improvement, and Analysis

Infrastructure Improvement

PART 2. ENTER APPLICANT INFORMATION
Applicant Identifier
Find your six-character code here.
Unique Entity Identifier (UEI)
Must be registered at www.sam.gov
Official Name of Tribe
Street Address
City
State
Zip Code
Contact Person for this Project
Full Name
Title
Organizational Affiliation
(Department)
Telephone Number
Email Address
Additional Email Address
This optional field can be used to list an additional email address that may be contacted about this project.

TTP Safety Fund Application Form

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Status of Prior TTPSF Awards
Describe the status of projects funded by TTPSF awards in prior years. For completed projects please provide
an evaluation of the project’s success in improving transportation safety. Include an additional page if needed.

PART 3. ENTER PROJECT INFORMATION
Project Title

Project Abstract
In a maximum of five sentences, summarize project work that would be completed under the project, the
hazardous road location or feature or the highway safety problem that the project would address, and whether
the project is a complete project or part of a larger project with prior investment. The project abstract must
succinctly describe how this specific request for TTPSF would be used to complete the project.

TTP Safety Fund Application Form

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PART 4. Project Funding
TTPSF Grant Request

$ 0.00

Tribal Match (includes TTP Shares)

$ 0.00

Other Federal Funds

$ 0.00

State/Local Public Agency

$ 0.00

Other Funding Source

$ 0.00

Project Total

$ 0.00

Describe Matching Contributions
Describe other funding sources or leveraged resources anticipated to be part of this project, if any.

Is the applicant delinquent on any Federal debt?
If yes, include an explanation as supporting documentation when uploading
this application.

No

Will the applicant accept partial funding?
If yes, describe independent components of the proposed project that could be
accomplished with various funding packages in the project narrative.

Yes

TTP Safety Fund Application Form

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PART 5. Facility Inventory and Ownership - Only required for applications to the

"Infrastructure Improvement" and "Data Assessment, Improvement, and Analysis" Categories.
Include the route’s common name, ownership, and route/section numbers from the National Tribal
Transportation Facilities Inventory (NTTFI). If inventory information is not provided in this form, the
application may be considered not qualified. For roadways not owned by the BIA or a Tribe, a letter from the
owner acknowledging the project is required. If the project will impact more than nine routes, attach a
separate document listing all project routes. More information about the NTTFI is available at https://itims.bia.gov
Data Assessment and Improvement projects that are not specific to a route do not require route information.
Common Name of Route

Route Owner

NTTFI Route Number

NTTFI Section Number

Will more than nine routes be improved by this project?

If yes, please provide a separate document listing all routes that the project will improve as
supporting documentation when uploading this application.

TTP Safety Fund Application Form

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PART 6. AUTHORIZATION
Full Name
Authorized
Representative
(Person who
authorized the
application to be
submitted)

Title
Telephone Number
Email Address

Authorized Signature
Certification: By signing this report, I certify to the best of my knowledge and belief that the information in this
application is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the
purposes and intent set forth in the award documents. I am aware that any false, fictitious, or fraudulent
information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)

X________________________________________________________________________________________
If the authorized representative is unable to sign using an electronic signature, please submit this electronic
form without the signature and also provide an image of the signed form as supporting documentation.

OMB CONTROL NUMBER: 21XX-XXXX
EXPIRATION DATE: mm/dd/yyyy
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for
failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 21XXXXXX. Public reporting for this collection of information is estimated to be approximately 15 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, completing, and
reviewing the collection of information.
All responses to this collection of information are required to obtain or retain a benefit (per 23 USC 202(e)). 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, Department of Transportation, Federal Highway Administration, 1200 New Jersey Ave SE,
Washington, D.C. 20590.

TTP Safety Fund Application Form

Page 6