APPENDIX B TO PART 1300 –
APPLICATION REQUIREMENTS
FOR SECTION 405 AND SECTION 1906 GRANTS
[Each fiscal year, to apply for a grant under 23 U.S.C. 405 or Section 1906, Pub.
L. 109-59, as amended by Section 4011, Pub. L. 114-94, the State must complete
and submit all required information in this appendix, and the Governor’s
Representative for Highway Safety must sign the Certifications and Assurances.]
State: ___________________________________ Fiscal Year: _______
In my capacity as the Governor’s Representative for Highway Safety, I hereby provide the
following certifications and assurances –
• I have reviewed the above information in support of the State’s application for 23 U.S.C.
405 and Section 1906 grants, and based on my review, the information is accurate and
complete to the best of my personal knowledge.
• As condition of each grant awarded, the State will use these grant funds in accordance with
the specific statutory and regulatory requirements of that grant, and will comply with all
applicable laws, regulations, and financial and programmatic requirements for Federal
grants.
• I understand and accept that incorrect, incomplete, or untimely information submitted in
support of the State’s application may result in the denial of a grant award.
I understand that my statements in support of the State’s application for Federal grant
funds are statements upon which the Federal Government will rely in determining
qualification for grant funds, and that knowing misstatements may be subject to civil or
criminal penalties under 18 U.S.C. 1001. I sign these Certifications and Assurances based
on personal knowledge, and after appropriate inquiry.
________________________________________________ ___________________
Signature Governor’s Representative for Highway Safety Date
____________________________________________________
Printed name of Governor’s Representative for Highway Safety
