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SS4A Self-Certiﬁcation Eligibility Worksheet | Page 1 of 2 Safe Streets and Roads for All Self-Certification Eligibility Worksheet Lead Applicant:UEI: Instructions: The purpose of this worksheet is to determine whether an applicant’s existing plan(s) is substantially similar to an Action Plan for purposes of applying for an Implementation Grant or to conduct Supplemental Planning/Demonstration Activities only. Use of this worksheet is required. Applicants should not adjust the formatting or headings of the worksheet. For each question below, answer “yes” or “no.” If “yes,” cite the speciﬁc page in your existing Action Plan or other plan(s) that corroborate your response, or cite and provide other supporting documentation separately. An applicant is eligible to apply for an Action Plan Grant that funds supplemental action plan activities, or an Implementation Grant, only if the following two conditions are met: •Answer “yes” to Questions • Answer “yes” to at least four of the six remaining Questions If both conditions are not met, an applicant is still eligible to apply for an Action Plan Grant that funds creation of a new Action Plan. Are both of the following true? • Did a high-ranking ofﬁcial and/or governing body in the jurisdiction publicly commit to an eventual goal of zero roadway fatalities and serious injuries? • Did the commitment include either setting a target date to reach zero, OR setting one or more targets to achieve signiﬁcant declines in roadway fatalities and serious injuries by a speciﬁc date? To develop the Action Plan, was a committee, task force, implementation group, or similar body established and charged with the plan’s development, implementation, and monitoring? Does the Action Plan include all of the following? • Analysis of existing conditions and historical trends to baseline the level of crashes involving fatalities and serious injuries across a jurisdiction, locality, Tribe, or region; • Analysis of the location where there are crashes, the severity, as well as contributing factors and crash types; • Analysis of systemic and speciﬁc safety needs is also performed, as needed (e.g., high risk road features, speciﬁc safety needs of relevant road users; and, • A geospatial identiﬁcation (geographic or locational data using maps) of higher risk locations. YES YES YES NO NO NO If yes, provide documentation: If yes, provide documentation: If yes, provide documentation: 3 3 7 9 1 1 2 2 4 5 6 8 Still have questions? Visit the SS4A website Applicants should follow the instructions in the NOFO to correctly apply for a grant. See the SS4A website for more information. Safe Streets and Roads for All Self-Certification Eligibility Worksheet SS4A Self-Certiﬁcation Eligibility Worksheet | Page 2 of 2 Did the Action Plan development include all of the following? • Considerations of equity using inclusive and representative processes; • The identiﬁcation of underserved communities through data; and • Equity analysis, in collaboration with appropriate partners, focused on initial equity impact assessments of the proposed projects and strategies, and population characteristics. Are both of the following true? • The plan development included an assessment of current policies, plans, guidelines, and/or standards to identify opportunities to improve how processes prioritize safety; and • The plan discusses implementation through the adoption of revised or new policies, guidelines, and/or standards. Does the plan include all of the following? • A description of how progress will be measured over time that includes, at a minimum, outcome data. • The plan is posted publicly online. Does the plan identify a comprehensive set of projects and strategies to address the safety problems in the Action Plan, time ranges when projects and strategies will be deployed, and explain project prioritization criteria? Was the plan ﬁnalized and/or last updated between 2018 and June 2023? YES NO If yes, provide documentation: If yes, provide documentation: If yes, provide documentation: If yes, provide documentation: If yes, provide documentation: If yes, provide documentation: Did the Action Plan development include all of the following activities? • Engagement with the public and relevant stakeholders, including the private sector and community groups; • Incorporation of information received from the engagement and collaboration into the plan; and • Coordination that included inter- and intra-governmental cooperation and collaboration, as appropriate. YES NO YES NO YES NO YES NO YES NO 7 9 4 5 6 8 Still have questions? Visit the SS4A website Appendix C. SS4A worksheet Appendix C City Council 32 – 171 6/4/2024