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Specialized Transportation Program

 Vehicle Monitoring Report

* Indicates required field

Grantee Name *

Contact Person

Email *

Phone Number *

Fax Number

Address Line 1 *

Address Line 2

City *


Zip *

Project ID *
e.g., PNP-0012-003-456

Agency Sequence # *
e.g., 1234

Vehicle Sequence # *
e.g., 1234

Vehicle Year *

Make *

Vin # *

Report Period *

Report Year *
Calendar year for data being reported

Odometer Mileage *
Mileage entered must be greater than mileage previously submitted.

Miles/Gallon *

Days Operated *
Days in use for the period

One-Way Elderly Trips *
(Over 60)

One-Way Disabled Trips *
(Under 60 and includes wheelchair assisted, mentally challenged, developmentally challenged, etc.)

One-Way Other Trips *
(Not elderly or disabled, includes personal care assistants)

Condition Rating *
Vehicle condition rating from 1 to 5 (1 as the worst and 5 as best)

Maintenance Costs *
(Round to the nearest dollar), should not include fuel costs. Do not include a dollar sign.

Number of Accidents *

Unduplicated Transportation Clients per Agency *
If multiple vehicles, report same number for each vehicle. (Not trips)




Macie Legge
(614) 728-9609