NYSDOT 5310

Quarterly Narrative Report Form

Part 1 Grantee Information

Reporting Qtr./Calendar Year
Circle and Report Year / Q1 (Jan-Mar)
Year: / Q2 (Apr-Jun)
Year: / Q3 (Jul-Sep)
Year: / Q4 (Oct-Dec)
Year:
Contract Number
List Project Identification Number (PIN)
Grantee Name
Project Title
Report Prepared by:
Date Prepared:
Contact Information
(Email & Phone)
Type of Project (Please check all that apply): / Operating □
Capital □
Mobility Management □

Notes:

Part 2 Accomplishments / Successes – Challenges / Opportunities

2.1  Please provide a brief narrative for each of the following:

a.  Describe each of the outreach efforts for this reporting cycle.

b.  The methodology for determining and meeting the 5310 target population goals

of the project.

c.  Describe the ongoing coordinated planning efforts, and list outreach efforts to various agencies and organizations.

2.2  Identify milestones accomplished or planned for this report cycle:

Identify Milestone / Original Estimated Completion Date / Revised Estimated Completion date / Actual / Projected Completion Date

2.3  Please provide the agency performance measures in place.

Part 3 Operating Assistance Operating Information (Trip based)

Transit/specialized operator:

Third Party Contractor:

Route name and number (if applicable):

A. Please provide for EACH route the information in the table below: (copy and paste as needed)

Number of New Service Stops along the route
Number of Jobs Accessed
Number of new service stops connecting employment/employer sites within ¼ mile of route
Type of service / Extended Time □
Extended Route □
Childcare center (s) reached
Training facilities reached
Number of entry level jobs accessed
Affordable housing reached
Other support services

B. Operating Partners – Describe efforts to coordinate and integrate new service within the existing transportation system (some examples may include; Integrated fare mechanisms,

Brokerages, Consolidated consumer information systems, Coordinated Transportation)

C. Please fill out the information below for all service type information that applies to this project:

SERVICE TYPE / REPORT / Month 1 / Month 2 / Month 3 / Total
1.  Fixed Route
2.  Shuttle Service
3.  Demand Response
4.  Vanpool / Unlinked passenger trips (number of one-way trips)
Revenue (hours)
Route Length – One way (miles)
Vehicles in service (number)
List service type below: / Seats per vehicle (average)
Jobs Targeted (number)
Geographic Coverage (County, Town)
Service area (sq. mile)

Revised (06/2016)

NYSDOT 5310

Quarterly Narrative Report Form

Part 4 Capital Assistance (Capital Investment)

4.1  Provide a description of the procurement process used, along with supporting documentation for all purchases of capital items greater than $3,000.

4.2  List an inventory of the capital items procured to date, vendors, and cost of equipment. Supporting documents with invoices, canceled checks, etc. and contracts for any equipment funded with 5310 Federal funds, should be secured in separate files, and available upon request.

Part 5 Mobility Management Assistance (Information based)

SERVICE TYPE / REPORT / Month 1 / Month 2 / Month 3 / Total
·  Mobility Manager (MM)
·  One stop center/customer referrals
·  Trip/Itinerary Planning
·  One-on-One Travel training
·  Group training
·  Internet based information
·  Information materials/marketing
·  Other (describe) / Community Outreach Sessions (number)
Individual Customer Contacts (number)
Persons Trained (number)
Coordination w/other Providers (number)
Marketing Activities (number)
Jobs targeted -If applicable (number)
Web hits (number)
Vehicles added (number)
Project Description, target audience (s) / Number of units supplied (if applicable)
Human service agency (s) contacted
List service type below for all that apply to this project report:
Other (describe)
Other (describe)

Part 6 Financial Information

6.1 Financial Partnerships – Identify funding partners, the amount of and the sources of matching funds:

6.2 Provide any sustainability efforts for the project, to secure other resources of funding for the future of the project.

Revised (06/2016)