Appendix D to Part 1200 - Certifications and Assurances for National Priority Safety Program Grants (23 U.S.C. 405)
23:1.0.2.13.1.9.1.1.36 : Appendix D
Appendix D to Part 1200 - Certifications and Assurances for
National Priority Safety Program Grants (23 U.S.C. 405) State:
Fiscal Year: ___
Each fiscal year the State must sign these Certifications and
Assurances that it complies with all requirements, including
applicable Federal statutes and regulations that are in effect
during the grant period.
In my capacity as the Governor's Representative for Highway
Safety, I:
• certify that, to the best of my personal knowledge, the
information submitted to the National Highway Traffic Safety
Administration in support of the State's application for Section
405 grants below is accurate and complete.
• understand that incorrect, incomplete, or untimely information
submitted in support of the State's application may result in the
denial of an award under Section 405.
• agree that, as condition of the grant, the State will use
these grant funds in accordance with the specific requirements of
Section 405(b), (c), (d), (e), (f) and (g), as applicable.
• agree that, as a condition of the grant, the State will comply
with all applicable laws and regulations and financial and
programmatic requirements for Federal grants.
Signature Governor's Representative for Highway Safety Date Printed
name of Governor's Representative for Highway Safety
Instructions: Check the box for each part for which the State is
applying for a grant, fill in relevant blanks, and identify the
attachment number or page numbers where the requested information
appears in the HSP. Attachments may be submitted
electronically.
□ Part 1: Occupant Protection (23 CFR 1200.21)
All States: [Fill in all blanks below.]
• The State will maintain its aggregate expenditures from all
State and local sources for occupant protection programs at or
above the average level of such expenditures in fiscal years 2010
and 2011. (23 U.S.C. 405(a)(1)(H))
• The State will participate in the Click it or Ticket national
mobilization in the fiscal year of the grant. The description of
the State's planned participation is provided as HSP attachment or
page # __.
• The State's occupant protection plan for the upcoming fiscal
year is provided as HSP attachment or page # __.
• Documentation of the State's active network of child restraint
inspection stations is provided as HSP attachment or page # __.
• The State's plan for child passenger safety technicians is
provided as HSP attachment or page # __.
Lower Seat belt Use States: [Check at least 3 boxes below and
fill in all blanks under those checked boxes.]
□ The State's primary seat belt use law, requiring all occupants
riding in a passenger motor vehicle to be restrained in a seat belt
or a child restraint, was enacted on __/__/__ and last amended on
__/__/__, is in effect, and will be enforced during the fiscal year
of the grant.
Legal citation(s):
□ The State's occupant protection law, requiring occupants to be
secured in a seat belt or age-appropriate child restraint while in
a passenger motor vehicle and a minimum fine of $25, was enacted on
__/__/__ and last amended on __/__/__, is in effect, and will be
enforced during the fiscal year of the grant.
Legal citations:
• __________ Requirement for all occupants to be secured in seat
belt or age appropriate child restraint
• __________ Coverage of all passenger motor vehicles
• __________ Minimum fine of at least $25
• __________ Exemptions from restraint requirements
□ The State's seat belt enforcement plan is provided as HSP
attachment or page # __.
□ The State's comprehensive occupant protection program is
provided as HSP attachment # __.
[Check one box below and fill in any blanks under that
checked box.]
□ The State's NHTSA-facilitated occupant protection program
assessment was conducted on __/__/__;
OR
□ The State agrees to conduct a NHTSA-facilitated occupant
protection program assessment by September 1 of the fiscal year of
the grant. (This option is available only for fiscal year 2013
grants.)
□ Part 2: State Traffic Safety Information System Improvements (23
CFR 1200.22)
• The State will maintain its aggregate expenditures from all
State and local sources for traffic safety information system
programs at or above the average level of such expenditures in
fiscal years 2010 and 2011.
[Fill in at least one blank for each bullet
below.]
• A copy of [check one box only] the □ TRCC charter or
the □ statute legally mandating a State TRCC is provided as HSP
attachment # __ or submitted electronically through the TRIPRS
database on __/__/__.
• A copy of meeting schedule and all reports and other documents
promulgated by the TRCC during the 12 months preceding the
application due date is provided as HSP attachment # __ or
submitted electronically through the TRIPRS database on
__/__/__.
• A list of the TRCC membership and the organization and
function they represent is provided as HSP attachment # __ or
submitted electronically through the TRIPRS database on
__/__/__.
• The name and title of the State's Traffic Records Coordinator
is
• A copy of the State Strategic Plan, including any updates, is
provided as HSP attachment # __ or submitted electronically through
the TRIPRS database on __/__/__.
• [Check one box below and fill in any blanks under that
checked box.]
□ The following pages in the State's Strategic Plan provides a
written description of the performance measures, and all supporting
data, that the State is relying on to demonstrate achievement of
the quantitative improvement in the preceding 12 months of the
application due date in relation to one or more of the significant
data program attributes: pages _____.
OR
□ If not detailed in the State's Strategic Plan, the written
description is provided as HSP attachment # __.
• The State's most recent assessment or update of its highway
safety data and traffic records system was completed on
__/__/__.
□ Part 3: Impaired Driving Countermeasures (23 CFR 1200.23)
All States:
• The State will maintain its aggregate expenditures from all
State and local sources for impaired driving programs at or above
the average level of such expenditures in fiscal years 2010 and
2011.
• The State will use the funds awarded under 23 U.S.C. 405(d)
only for the implementation of programs as provided in 23 CFR
1200.23(i) in the fiscal year of the grant.
Mid-Range State:
• [Check one box below and fill in any blanks
under that checked box.]
□ The statewide impaired driving plan approved by a statewide
impaired driving task force was issued on __/__/__ and is provided
as HSP attachment # __.
OR
□ For this first year of the grant as a mid-range State, the
State agrees to convene a statewide impaired driving task force to
develop a statewide impaired driving plan and submit a copy of the
plan to NHTSA by September 1 of the fiscal year of the grant.
• A copy of information describing the statewide impaired
driving task force is provided as HSP attachment # __.
High-Range State:
[Check one box below and fill in any blanks under that
checked box.]
□ A NHTSA-facilitated assessment of the State's impaired driving
program was conducted on __/__/__;
OR
□ For the first year of the grant as a high-range State, the
State agrees to conduct a NHTSA-facilitated assessment by September
1 of the fiscal year of the grant;
• [Check one box below and fill in any blanks under that
checked box.]
□ For the first year of the grant as a high-range State, the
State agrees to convene a statewide impaired driving task force to
develop a statewide impaired driving plan addressing
recommendations from the assessment and submit the plan to NHTSA
for review and approval by September 1 of the fiscal year of the
grant;
OR
□ For subsequent years of the grant as a high-range State, the
statewide impaired driving plan developed or updated on __/__/__ is
provided as HSP attachment # __.
• A copy of the information describing the statewide impaired
driving task force is provided as HSP attachment # __.
Ignition Interlock Law: [Fill in all blanks
below.]
• The State's ignition interlock law was enacted on __/__/__ and
last amended on __/__/__, is in effect, and will be enforced during
the fiscal year of the grant.
Legal citation(s):
. □ Part 4: Distracted Driving (23 CFR 1200.24)
[Fill in all blanks below.]
Prohibition on Texting While Driving
The State's texting ban statute, prohibiting texting while
driving, a minimum fine of at least $25, and increased fines for
repeat offenses, was enacted on __/__/__ and last amended on
__/__/__, is in effect, and will be enforced during the fiscal year
of the grant.
Legal citations:
• __________ Prohibition on texting while driving
• __________ Definition of covered wireless communication
devices
• __________ Minimum fine of at least $25 for first offense
• __________ Increased fines for repeat offenses
• __________ Exemptions from texting ban
Prohibition on Youth Cell Phone Use While Driving
The State's youth cell phone use ban statute, prohibiting youth
cell phone use while driving, driver license testing of distracted
driving issues, a minimum fine of at least $25, increased fines for
repeat offenses, was enacted on __/__/__ and last amended on
__/__/__, is in effect, and will be enforced during the fiscal year
of the grant.
Legal citations:
• __________ Prohibition on youth cell phone use while
driving
• __________ Driver license testing of distracted driving
issues
• __________ Minimum fine of at least $25 for first offense
• __________ Increased fines for repeat offenses
• __________ Exemptions from youth cell phone use ban
□ Part 5: Motorcyclist Safety (23 CFR 1200.25)
[Check at least 2 boxes below and fill in any blanks
under those checked boxes.]
□ Motorcycle riding training course:
• Copy of official State document (e.g., law, regulation,
binding policy directive, letter from the Governor) identifying the
designated State authority over motorcyclist safety issues is
provided as HSP attachment # __.
• Document(s) showing the designated State authority approving
the training curriculum that includes instruction in crash
avoidance and other safety-oriented operational skills for both
in-class and on-the-motorcycle is provided as HSP attachment #
__.
• Document(s) regarding locations of the motorcycle rider
__.
• Document showing that certified motorcycle rider training
instructors teach the motorcycle riding training course is provided
as HSP attachment # __.
• Description of the quality control procedures to assess
motorcycle rider training courses and instructor training courses
and actions taken to improve courses is provided as HSP attachment
# __.
☐ Motorcyclist awareness program:
• Copy of official State document (e.g., law, regulation,
binding policy directive, letter from the Governor) identifying the
designated State authority over motorcyclist safety issues is
provided as HSP attachment # __.
• Letter from the Governor's Representative for Highway Safety
regarding the development of the motorcyclist awareness program is
provided as HSP attachment # __.
• Data used to identify and prioritize the State's motorcyclist
safety program areas is provided as HSP attachment or page #
__.
• Description of how the State achieved collaboration among
agencies and organizations regarding motorcycle safety issues is
provided as HSP attachment # or page #__.
• Copy of the State strategic communications plan is provided as
HSP attachment # __.
☐ Reduction of fatalities and crashes involving motorcycles:
• Data showing the total number of motor vehicle crashes
involving motorcycles is provided as HSP attachment or page #
__.
• Description of the State's methods for collecting and
analyzing data is provided as HSP attachment or page # __.
☐ Impaired driving program:
• Data used to identify and prioritize the State's impaired
driving and impaired motorcycle operation problem areas is provided
as HSP attachment or page # __.
• Detailed description of the State's impaired driving program
is provided as HSP attachment or page # __.
• The State law or regulation defines impairment. Legal
citation(s):
☐ Reduction of fatalities and accidents involving impaired
motorcyclists:
• Data showing the total number of reported crashes involving
alcohol-impaired and drug-impaired motorcycle operators is provided
as HSP attachment or page # __.
• Description of the State's methods for collecting and
analyzing data is provided as HSP attachment or page # __.
• The State law or regulation defines impairment. Legal
citation(s):
☐ Use of fees collected from motorcyclists for motorcycle
programs: [Check one box below and fill in any blanks under the
checked box.]
☐ Applying as a Law State -
• The State law or regulation requires all fees collected by the
State from motorcyclists for the purpose of funding motorcycle
training and safety programs are to be used for motorcycle training
and safety programs. Legal citation(s):
AND
• The State's law appropriating funds for FY __ requires all
fees collected by the State from motorcyclists for the purpose of
funding motorcycle training and safety programs be spent on
motorcycle training and safety programs. Legal citation(s):
☐ Applying as a Data State -
• Data and/or documentation from official State records from the
previous fiscal year showing that all fees collected by the
State from motorcyclists for the purpose of funding motorcycle
training and safety programs were used for motorcycle training and
safety programs is provided as HSP attachment # __.
☐ Part 6: State Graduated Driver Licensing Laws (23 CFR 1200.26)
[Fill in all applicable blanks below.]
The State's graduated driver licensing statute, requiring both a
learner's permit stage and intermediate stage prior to receiving a
full driver's license, was enacted on __/__/__ and last amended on
__/__/__, is in effect, and will be enforced during the fiscal year
of the grant.
Learner's Permit Stage - requires testing and education, driving
restrictions, minimum duration, and applicability to novice drivers
younger than 21 years of age.
Legal citations:
• __________ Testing and education requirements
• __________ Driving restrictions
• __________ Minimum duration
• __________ Applicability to notice drivers younger than 21
years of age
• __________ Exemptions from graduated driver licensing law
Intermediate Stage - requires driving restrictions, minimum
duration, and applicability to any driver who has completed the
learner's permit stage and who is younger than 18 years of age.
Legal citations:
• __________ Driving restrictions
• __________ Minimum duration
• __________ Applicability to any driver who has completed the
learner's permit stage and is younger than 18 years of age
• __________ Exemptions from graduated driver licensing law
Additional Requirements During Both Learner's Permit and
Intermediate Stages
Prohibition enforced as a primary offense on use of a cellular
telephone or any communications device by the driver while driving,
except in case of emergency. Legal citation(s):
Requirement that the driver who possesses a learner's permit or
intermediate license remain conviction-free for a period of not
less than six consecutive months immediately prior to the
expiration of that stage. Legal citation(s):
License Distinguishability (Check one box below and fill in
any blanks under that checked box.)
☐ Requirement that the State learner's permit, intermediate
license, and full driver's license are visually distinguishable.
Legal citation(s):
OR
☐ Sample permits and licenses containing visual features that
would enable a law enforcement officer to distinguish between the
State learner's permit, intermediate license, and full driver's
license, are provided as HSP attachment #____.
OR
☐ Description of the State's system that enables law enforcement
officers in the State during traffic stops to distinguish between
the State learner's permit, intermediate license, and full driver's
license, are provided as HSP attachment #____.