Tcsp

OMB Control Number: 2125-XXXX

Expiration Date: To Be Determined

TRANSPORTATION, COMMUNITY, AND SYSTEM PRESERVATION PROGRAM GRANT APPLICATION

Burden Statement - This collection of information is voluntary and will be used to select projects for funding with Transportation, Community, and System Preservation (TCSP) Program funds. Public reporting burden is estimated to average 1.5 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 the TCSP Program is to address the relationships among transportation, community, and system preservation plans and practices and identify private sector-based initiatives to improve such relationships. 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-XXXX with an expiration date of XXXX.

PART A. PROJECT INFORMATION

Fiscal Year:	2007
Project Title:
Project Location (City/County, State):
GRANTEE CONTACT INFORMATION
Grantee Contact Name:
Agency:
Mailing Address (Street/P.O. Box):
City, State, Zip code:
Phone:
Fax:
E-Mail:
STATE DOT CONTACT INFORMATION
State Contact Person:
Phone:
Fax:
E-Mail:
FHWA DIVISION OFFICE CONTACT INFORMATION
Division Contact Person:
Phone:
Fax:
E-Mail:

CONGRESSIONAL INFORMATION
Congress Member:
Congressional District No.:
TCSP Program Funds:	$0.00
Matching Funds/In-kind Services Value:	$0.00
Matching Funds/In-kind Services Source:
Total TCSP-Related Project Costs:	$0.00

TO BE COMPLETED BY THE DIVISION OFFICE
State Administered?		Yes		No
Division Administered?		Yes		No
Date grant application approved by FHWA Division Office

Part B. Project Abstract

(Maximum 4 sentences) Briefly describe the how the TCSP Program funds will be used for the project.

Part C. Project Narrative

(Maximum 2 pages) Describe the project and the expected results, including project goals and timeframe.