TxDOT Public Transportation Division - Sample FTA Service Form

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General Information

Grantee Name

FY 2004: Service Form

JARC HELP/FAQ SITE

Please complete at least one form for each subrecipient

General Service Information - Required

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Enter Service Name:
Select the subrecipient that provided this service or add a new subrecipent.

Add a subrecipient

Grant Funding Information

Enter the total FY 2004 funding for the implemented service by the designated recipient/subrecipient, including funds provided by JARC, funds provided by the grantee, and funds from other sources:

1. Indicate total amount of federal JARC funds:

Value Known: $

Not Applicable:

Not Reported:

2. Indicate total amount of other project funds:

Value Known: $

Not Applicable:

Not Reported:

Enter the total funding to date (from project inception through September 30, 2004) for the implemented service by the designated recipient/subrecipient, including funds project by JARC, funds provided by the grantee, and funds from other sources.

1. Indicate total amount of federal JARC funds to date:

Value Known: $

Not Applicable:

Not Reported:

2. Indicate total amount of other project funds to date:

Value Known: $

Not Applicable:

Not Reported:

When did service begin? Type in the actual service date (mm/dd/yyyy) the implemented service began:

mm/dd/yyyy (no spaces)

Select the type of service implemented by service category: See Service Examples
(Select Only One)	If Other, please describe:(250 characters) :

Geographic Information - Required

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Please provide the following geographic information about implemented service.
1. Enter the legal name of the geographic area where the service is provided:

Select the geographical area category where the service is provided:

(Select Only One)

Select the size of the area being served:

(Select Only One)

Ridership Information - Partially Required

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Please enter the following ridership information for FY 2004 (October 1, 2003-September 30, 2004).

Required

Enter total number of one-way trips provided by this service:

Value Known:
Not Applicable:
Not Reported:

Enter the total cost per one-way trip (include all expenses; do not deduct fares or subsidies):

Value Known:		$
Not Applicable:
Not Reported:

Describe the method used to calculate the cost per trip: (250 characters)

If available, please provide the following:

Enter the total number of one-way trips provided on WEEKDAYS from 5 am to 8 pm:

Value Known:
Not Applicable:
Not Reported:

Enter the total number of one-way trips provided on WEEDKAY NIGHTS from 8 pm to 5 am:

Value Known:
Not Applicable:
Not Reported:

Enter the total number of one-way trips provided on WEEKENDS from 8 pm Friday until 5 am Monday:

Value Known:
Not Applicable:
Not Reported:

Employment Information - Partially Required

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Required

Employment Information for FY 2004 (October 1, 2003-September 30, 2004)

Required Please answer only one of the following options for the type of service selected in Question #5.

Fixed Route Service Option:: Enter TOTAL number of employment sites reached by JARC-supported service during FY 2004. An employment site is defined as a fixed route service stop that reaches employers within 1/4 mile of that stop and was not served by the public transportation system prior to implementation of the JARC-assisted service. The employment site stops may be either geographically based (a new service area) or time-based (e.g., late night and/or weekend).

Value Known:
Not Applicable:
Not Reported:

Demand-Responsive Service Option:: Enter TOTAL number of employment sites reached by JARC-supported service during FY 2004. An employment site is an address having one or more employers that was not reached by public transportation prior to the implementation of the JARC-assisted service. The employment site reached by the service may be either geographically based (a new service area) or time-based (e.g., late night and/or weekend).

Value Known:
Not Applicable:
Not Reported:

Ridesharing Option:: Enter TOTAL number of employment sites reached by JARC-supported service during FY 2004. An employment site is an address having one or more employers that was not reached by public transportation prior to the implementation of the JARC-assisted service. The employment site reached by the service may be either geographically based (a new service area) or time-based (e.g., late night and/or weekend).

Value Known:
Not Applicable:
Not Reported:

One-Stop/Information Referral Option:: Enter TOTAL number of customer contacts (not unique individuals) during FY 2004. (Example: If Ms. Smith requests information four times, that would be four customer contacts, not one.)

Value Known:
Not Applicable:
Not Reported:

Mobility Manager/Brokerage Option:: Enter TOTAL number of customer contacts (not unique individuals) during FY 2004. (Example: If Ms. Smith books four trips, that would be four customer contacts, not one.)

Value Known:
Not Applicable:
Not Reported:

Auto-Based Program Option:: Enter TOTAL number of customers served during FY 2004.

Value Known:
Not Applicable:
Not Reported:

Other Option:: Enter TOTAL number of customers served during FY 2004.

Value Known:
Not Applicable:
Not Reported:

Describe Other Option:(250 characters)

If Available, please provide the following:

Enter the number of jobs made accessible within a quarter mile of the new fixed route stop or directly reached by demand response or ridesharing. If the service is demand response, use the Jobs Reached Notes field below to indicate what the data represents. The valid values are: (1) the number of jobs actually reached or (2) the total possible jobs within the service area.

Value Known:
Not Applicable:
Not Reported:

Jobs Reached Notes (250 characters)

Enter the number of jobs defined as entry level made accessible within a quarter mile of the new fixed route stop or directly reached by demand response or ridesharing. Entry level is defined as low skilled jobs that require a high school education or less. If the service is demand response, use the Entry Level Job Notes field below to indicate what the data represents. The valid values are: (1) the number of jobs actually reached or (2) the total possible jobs within the service area.

Value Known:
Not Applicable:
Not Reported:

Entry Level Job Notes (250 characters)

New Employment Support Services Information

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If available, please enter the following New Employment Support Services Information for FY 2004 (October 1, 2003-September 30, 2004)

Number of child care sites reached by JARC-supported service during FY 2004 and not previously reached by public transportation before JARC-assisted service was implemented:

Value Known:
Not Applicable:
Not Reported:

Number of training sites reached by JARC-supported service during FY 2004 and not previously reached by public transportation before JARC-assisted service was implemented:

Value Known:
Not Applicable:
Not Reported:

Number of OTHER employment support services sites reached by JARC-supported service during FY 2004 and not previously reached by public transportation before JARC-assisted service was implemented:

Value Known:
Not Applicable:
Not Reported:

Addtional Information

Other Notes (250 characters)


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