TIP Change Request Form
Agency or Jurisdiction Project Sponsor *
Who is requesting the TIP change?
Contact Person *
Contact Email *
Contact Phone *
Please enter work number and extension.
Project *
Please list TIP Number, if known.
Project Title *
Use Project Title in current TIP or suggest a new Project Title, if a new project.
Project Description *
Provide a brief description of the project to be added to changed.
Type of Change Requested (Check all that apply) *
Please see description of Administrative Modification and Amendment Process here - http://goo.gl/Q7PEvg
Required
Please provide additional detail on the requested change. *
Who will makes changes in OTO TIP tool? *
Upon submitting this form, staff will provide an email granting access to the TIP tool. Otherwise, please email change and funding details to staff at nlongpine@ozarkstransportation.org.
If OTO will be making the changes, please provide funding information.
List local and federal funding each needed for Engineering, ROW, Utilities, and Construction.
The project is in the OTO Long Range Transportation Plan, "Transportation Plan 2040." *
Please indicate where in Transportation Plan 2040 this project is located - Page and Project Number
I and partner jurisdictions have conducted the appropriate public input processes. *
By checking yes, I agree.
The project sponsor is financially committed to the submitted project. *
By checking yes, I agree.
I hereby agree/certify that:
A. The information on this application and submitted to the TIP tool is accurate to the best of my knowledge.
B. This information and any additional information I provide for this TIP change may be published directly into the OTO Transportation Improvement Program.
C. The local/state funding submitted to the TIP tool is available for the match of federal funds.
D. This project has been made available for public comment before submittal.
E. Any facility constructed with these funds will be maintained according to an adopted facility maintenance plan.
F. I understand that when utilizing any federal funds for design or right-of-way, that construction must begin within 10 years.
Signed *
Please enter name.
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