OFFICE OF CONGRESSMAN BRIAN HIGGINS
SURFACE TRANSPORTATION AUTHORIZATION
PROJECT FORM

Please provide responses to each information request immediately below the question in bold.  This completed form is due by 5pm on March 6, 2009, via Microsoft Word email attachment to andy.tantillo@mail.house.gov.  Please call 202-225-3306 if you have any questions or need additional information.  Thank you.

General Information:  
1. Name of Organization: 

2. Name of Project: Brief description of the project and location (city, county, state, etc.).  Please clarify the specific segment for which project funding is being sought, including terminus points.

3. Amount of Federal Funding Requested:  


Project Details
4. Please categorize the project:  Check one
_____  Highway or bridge		_____ 	Intermodal facility (passenger)
_____  Transit rail new start		_____	Intermodal facility (freight)
_____  Bus or bus facility		_____  Bicycle/Pedestrian facility
_____  Other (please identify)

5. Project Description: 1 to 2 sentences on specifically how the money will be spent.  

6. What is the purpose of this project?  Why would it be a good use of federal taxpayer dollars?  

7. What is the status of the project?  How much work, if any, has been completed to date?  What is the schedule for completion of the project?  Will the requested funding for the project be obligated within the next 6 years?


Funding Details
8.  What is the total cost of the project?

9. What is the State/Local Share of the project cost?  Has the state or local government indicated they would commit to providing the local match?  E.g., most road projects require a State and/or local match of at least 20% of the project's total cost. Example: A $1,000,000 project with a 20% match would be $800,000 Federal and $200,000 State/Local funding, so you should request only $800,000 herein.

10. Please provide a list of any previous State or Federal funding (such as in an appropriations act or SAFETEA-LU) for this project, if any.


Environmental Approval
11. Has the proposed project encountered, or is it likely to encounter, any significant opposition or other obstacles based on environmental or other types of concerns? If yes please describe.

12. Describe the type of federal environmental assessment that you anticipate will be required for this project, (e.g., do you anticipate a simple EA or a full EIS?  Do you anticipate a FONSI, a Negative Declaration, or a finding of impacts) and how far along you are in that process (specifically, if an EA or EIS is required, when do you anticipate its completion, and if a Record of Decision is required, when is it anticipated, and from which agency)?


State and Local Approval
13. Please check eligibility with NYSDOT.  Did NYSDOT indicate the project is eligible, and if so, under which account or program?  If it is a highway or bridge project, did NYSDOT confirm that the facility to be constructed or reconstructed is on a Federal Aid highway?

14. Please identify the State or other qualified recipient responsible for carrying out the project.  Note: Must be qualified recipient of federal highway or transit funding, as appropriate.

15. Is the project on the State's Transportation Improvement Plan, or the Greater Buffalo-Niagara Regional Transportation Council�s Transportation Improvement Plan?  

16.  Please attach a letter of support from State and/or regional transportation officials as indicating the project is critical to their needs.  


Miscellaneous
17. Do any other House Members represent your organization or this project?  Have you contacted any other Representatives or Senators to make this request this year?  If yes, who? 

18. If making more than 1 request: This request is our    1st    2nd    3rd    priority.   


Abstract:
Below, please provide an abstract of no more than one page to describe your proposed project.  Please include whether it is part of a larger system of projects, its benefit to Western New York, and how the project meets a specific federal responsibility or the criteria of the federal program under which you are seeking funding.
Congressman Higgins Surface Transportation Authorization Form	Page 1 of 3