+-------------------+----------------+---+-------------------+---+
| U.S. Department   |                |   |                   |   |
|                   |                |   |                   |   |
| of Transportation |                |   |                   |   |
|                   |                |   |                   |   |
| Motor Carrier     |                |   |                   |   |
| Safety Assistance |                |   |                   |   |
| Program           |                |   |                   |   |
|                   |                |   |                   |   |
| Federal Motor     |                |   |                   |   |
| Carrier           |                |   |                   |   |
|                   |                |   |                   |   |
| Safety            |                |   |                   |   |
| Administration    |                |   |                   |   |
+-------------------+----------------+---+-------------------+---+
|                   |                |   |                   |   |
+-------------------+----------------+---+-------------------+---+
| The               |                |   |                   |   |
| \_\_              |                |   |                   |   |
| \_\_\_\_\_\_\_\_\ |                |   |                   |   |
| _\_\_\_\_\_\_\_\_ |                |   |                   |   |
| \_\_\_\_\_\_\_\_\ |                |   |                   |   |
| _\_\_\_\_\_\_\_\_ |                |   |                   |   |
| \_\_\_\_\_\_\_\_\ |                |   |                   |   |
| _\_\_\_\_\_\_\_\_ |                |   |                   |   |
| \_\_\_\_\_*(State |                |   |                   |   |
| Lead Agency)      |                |   |                   |   |
| *hereby applies   |                |   |                   |   |
| to the Federal    |                |   |                   |   |
| Motor Carrier     |                |   |                   |   |
| Safety            |                |   |                   |   |
| Administration    |                |   |                   |   |
| for a Federal     |                |   |                   |   |
| grant authorized  |                |   |                   |   |
| in Title IV of    |                |   |                   |   |
| the Surface       |                |   |                   |   |
| Transportation    |                |   |                   |   |
| Assistance Act of |                |   |                   |   |
| 1982 (P. L.       |                |   |                   |   |
| 97-424) and       |                |   |                   |   |
| subsequent        |                |   |                   |   |
| amendments        |                |   |                   |   |
| thereto to        |                |   |                   |   |
| enhance a         |                |   |                   |   |
| Commercial Motor  |                |   |                   |   |
| Carrier Safety    |                |   |                   |   |
| Program as        |                |   |                   |   |
| described in this |                |   |                   |   |
| application.      |                |   |                   |   |
|                   |                |   |                   |   |
| -   The State     |                |   |                   |   |
|     Agency plans  |                |   |                   |   |
|     to carry out  |                |   |                   |   |
|     the           |                |   |                   |   |
|                   |                |   |                   |   |
|    implementation |                |   |                   |   |
|     of a Motor    |                |   |                   |   |
|     Carrier       |                |   |                   |   |
|     Safety        |                |   |                   |   |
|     Assistance    |                |   |                   |   |
|     Program       |                |   |                   |   |
|     during        |                |   |                   |   |
|     Federal       |                |   |                   |   |
|     fiscal year   |                |   |                   |   |
|     (FY)[         |                |   |                   |   |
|     ]{.underline} |                |   |                   |   |
|     as described  |                |   |                   |   |
|     in the        |                |   |                   |   |
|     Commercial    |                |   |                   |   |
|     Vehicle       |                |   |                   |   |
|     Safety Plan.  |                |   |                   |   |
|                   |                |   |                   |   |
| -   The State     |                |   |                   |   |
|     Agency plans  |                |   |                   |   |
|     to carry out  |                |   |                   |   |
|     special       |                |   |                   |   |
|     projects of   |                |   |                   |   |
|     the Motor     |                |   |                   |   |
|     Carrier       |                |   |                   |   |
|     Safety        |                |   |                   |   |
|     Assistance    |                |   |                   |   |
|     Program not   |                |   |                   |   |
|     contained in  |                |   |                   |   |
|     the           |                |   |                   |   |
|     B             |                |   |                   |   |
| asic/Supplemental |                |   |                   |   |
|     grant during  |                |   |                   |   |
|     Federal       |                |   |                   |   |
|     fiscal year   |                |   |                   |   |
|     (FY)[         |                |   |                   |   |
|                   |                |   |                   |   |
|   ]{.underline}as |                |   |                   |   |
|     described in  |                |   |                   |   |
|     the attached  |                |   |                   |   |
|     plan.         |                |   |                   |   |
|                   |                |   |                   |   |
| The Federal share |                |   |                   |   |
| will not exceed   |                |   |                   |   |
| 80 percent of the |                |   |                   |   |
| total             |                |   |                   |   |
| participating     |                |   |                   |   |
| costs, unless     |                |   |                   |   |
| otherwise         |                |   |                   |   |
| indicated herein, |                |   |                   |   |
| incurred in       |                |   |                   |   |
| performing the    |                |   |                   |   |
| effort described  |                |   |                   |   |
| in the attached   |                |   |                   |   |
| State Plan. The   |                |   |                   |   |
| State agrees to   |                |   |                   |   |
| submit vouchers   |                |   |                   |   |
| for the           |                |   |                   |   |
| reimbursement of  |                |   |                   |   |
| funds expended.   |                |   |                   |   |
|                   |                |   |                   |   |
| DUNS \#           |                |   |                   |   |
| \                 |                |   |                   |   |
| _\_\_\_\_\_\_\_\_ |                |   |                   |   |
| \_\_\_\_\_\_\_\_\ |                |   |                   |   |
| _\_\_\_\_\_\_\_\_ |                |   |                   |   |
+-------------------+----------------+---+-------------------+---+
|                   |                |   |                   |   |
+-------------------+----------------+---+-------------------+---+
|                   | *(Typed Name)* |   | *(Organizational  |   |
|                   |                |   | Unit)*            |   |
+-------------------+----------------+---+-------------------+---+
|                   | *(Signature)*  |   | *(Address or P.O. |   |
|                   |                |   | Box)*             |   |
+-------------------+----------------+---+-------------------+---+
|                   | *(Title)*      |   | *(City, State &   |   |
|                   |                |   | Zip Code)*        |   |
+-------------------+----------------+---+-------------------+---+
|                   |                |   |                   |   |
+-------------------+----------------+---+-------------------+---+
|                   | *(Date)*       |   | *(Phone Number)*  |   |
+-------------------+----------------+---+-------------------+---+
|                   |                |   |                   |   |
+-------------------+----------------+---+-------------------+---+

The collection of this information is authorized under the provisions of
P.L. 97-424; P.L. 99-570; 49 U.S.C. 31101-31104 and P.L. 105-178.

Public reporting for this collection of information is estimated to be
30 minutes per response, including the time for reviewing instructions
and completing and reviewing the collection of information. All
responses to this collection of information are mandatory, and will be
provided confidentiality to the extent allowed by law. Not withstanding
any other provision of law, no person is required to respond to nor
shall a person be subject to a penalty for failure to comply with a
collection of information subject to the requirements of the Paperwork
Reduction Act unless that collection of information displays a current
valid OMB Control Number. The valid OMB Control Number for this
information collection is 2126-0010. Send comments regarding this burden
estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: Information
Collection Clearance Officer, Federal Motor Carrier Safety
Administration, MC-MBI, U.S. Department of Transportation, Washington,
D.C. 20590.

FMCSA Form MCSAP-1 (Rev. 02/08) OMB 2126-0010 (Exp. 02/11)