5900-682 J_CHDV Eligibility and Scrappage Statement

OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

2024 Clean Heavy-Duty Vehicles (CHDV) Grants
Vehicle Eligibility and Disposition Statement
Burden Statement for EPA Form 5900-682: This collection of information is approved by OMB under the Paperwork Reduction
Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0754). Responses to this collection of information are voluntary (2 CFR
200 at 2 CFR 1500). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this
collection of information is estimated to be 1-12 hours per response. Send comments on the Agency’s need for this information,
the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory
Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C.
20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Instructions: Please complete Sections I and II, below, for each vehicle selected for replacement. Note:
there are two templates provided under Section II; grantees should only fill out the relevant template.

I. Eligibility Statement
Grant Identification Number:____________________

Existing Vehicle Information
Make

Existing Engine Information
Make

Model

Model

Model Year
Total Mileage
Vehicle Identification
Number
Gross Vehicle Weight
Rating
Registration/Licensing #

Model Year
ID or Serial
EPA Family

Registration/Licensing
State
If School Bus, provide the number of days per week, on
average, that the vehicle provided bus service during the 20222023 school year
If non-School Bus, provide the estimated annual mileage
traveled for the last two years
By signing, I affirm that the following statements are true regarding the existing
vehicle and engine identified above.
☐ The existing vehicle being replaced is a Class 6 or Class 7 heavy-duty highway
vehicle with a Gross Vehicle Weight Rating (GVWR) between 19,501 lbs and
33,000 lbs.
☐ The existing vehicle being replaced is a vehicle model year 2010 or older dieselpowered Class 6/7 vehicle that will be scrapped. If a fleet has no eligible 2010 or
older diesel Class 6/7 vehicles, the existing vehicle being replaced is either:

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

☐ A 2010 or older non-diesel internal combustion engine Class 6/7 vehicle

that will be scrapped; OR
☐ A 2011 or newer diesel or non-diesel internal combustion engine Class
6/7 vehicle that will be scrapped, sold, or donated.
☐ The existing vehicle being replaced was operational at the time of application
submission. Operational vehicles should be able to start, move, and have all
necessary parts to be operational.
☐ If the vehicle listed above is being replaced through the School Bus SubProgram, I certify that the following statements are true regarding the existing
bus and engine identified above:
☐ The existing vehicle being replaced is a “school bus,” defined as a passenger
motor vehicle designed to carry a driver and more than 10 passengers, that
the Secretary of Transportation decides is likely to be used significantly to
transport preprimary, primary, and secondary school students to or from
school or an event related to school.1
☐ The existing vehicle being replaced has provided bus service to a public
school district for at least 3 days/week on average during the 2022/2023
school year at the time of applying, excluding COVID-related or disasterrelated school closures.
☐ If the vehicle listed above is being replaced through the Other Class 6/7 Vehicles
Sub- Program, I certify that the following statements are true regarding the
existing vehicle and engine identified above:
☐ The existing vehicle being replaced is a Class 6 or Class 7 heavy-duty
highway vehicle that does not meet the definition of a school bus given
above.
☐ The existing highway vehicle has accumulated the required program
mileage minimums during the listed timeframe prior to upgrade, which is
at least 7,000 miles/year during each of the two years prior to replacement
for all applicants that are not considered Tribal or territory applicants. For
Tribal and territory applicants, as defined by Section III.A.3., the mileage
minimum is 5,000 miles/year during each of the two years prior to
replacement. The mileage of two or more vehicles may be combined to
reach the mileage minimums listed above where two or more vehicles
will be replaced with a single ZE vehicle.
☐ If a vehicle does not meet the mileage requirement and the
applicant can demonstrate that the vehicle idles the main engine
for long periods to provide power for auxiliary apparatus (e.g.,
firetrucks or utility trucks), the existing vehicle to be replaced must
have idled for at least 500 hours/ year during the two years prior to
replacement.
1

49 U.S.C. § 30125, available at
https://uscode.house.gov/view.xhtml?req=(title:49%20section:30125%20edition:prelim)%20OR%20(gra
nuleid:US C-prelim-title49-section30125)&f=treesort&num=0&edition=prelim

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

Who owned the vehicle that was replaced?
Applicant

Other:

Vehicle Owner Address:

Vehicle Owner Name (Print)

Vehicle Owner (Signature)

Date

Grantee Name

Grantee (Signature)

Date

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

II. Scrappage, Sell, or Donate Statement
The 2024 Clean Heavy-Duty Vehicles (CHDV) Grants program ensures that all vehicles
participating are a vehicle model year 2010 or older diesel-powered Class 6/7 vehicle that
will be scrapped, if selected for funding. If a fleet has no eligible 2010 or older diesel Class
6/7 vehicles, the fleet can either:
a.
b.

Scrap 2010 or older non-diesel internal combustion engine Class 6/7 vehicles;
or
Scrap, sell, or donate 2011 or newer diesel or non-diesel internal
combustion engine Class 6/7 vehicles

Please refer to the CHDV Notice of Funding Opportunity (NOFO) Section III.D for more
information on scrappage, selling, or donation under the CHDV program. Grantees who are
selected for funding must complete one of the following templates below [Template A or
Template B] to certify each individual vehicle is scrapped, sold, or donated before the end of
the project period:
• Template A - Scrappage: Please complete the Template A – Vehicle
Scrappage Statement if the Vehicle on Page 1 has been scrapped.
• Template B – Sell or Donate: Please complete the Template B – Vehicle Sell or
Donate Statement if the Vehicle identified on Page 1 has been sold or donated.

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

Grant ID #:
Existing Vehicle VIN:

0

TEMPLATE A - VEHICLE SCRAPPAGE STATEMENT
Please complete this template if the vehicle identified on Page 1 was scrapped.
By signing, I affirm that on__________, the above engine and chassis were
permanently disabled. Disabling the engine consisted of drilling a three-inch hole in
the engine block, or of another, pre-approved scrappage method.2 Disabling the
chassis consisted of cutting completely through the frame/frame-rails on each side
of the vehicle/equipment at a point located between the front and rear axles, or of
another, pre-approved scrappage method.
The following required digital photos of the disabled engine and chassis are attached:
•

Side profile of the vehicle, prior to disabling

•

VIN

•

Engine label (showing serial number, engine family number, and engine
model year)

•

Engine block, prior to scrappage;

•

Engine block, after scrappage;

•

Chassis after scrappage.

Vehicle Scrappage Evidence Instructions:
Provide the “Old Vehicle Proof of Scrappage” by attaching photos and letter. Attach
photos of the destroyed engine and chassis that clearly displays the last 4 digits of the
vehicle VIN as proof of old vehicle scrappage. Attach a letter signed by a representative
of the scrap yard/entity that performed the scrappage.
Who owned the vehicle that was replaced?
Applicant
Other: Please Specify
VEHICLE OWNER
Email
Phone Number

2

Recipients may request and receive EPA approval for alternative scrappage methods by submitting
an alternative scrappage plan to the regional project officer detailing how the method will destroy
and/or disable the engine.

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

Address

Owner Name (Print)
Signature
Date
GRANTEE NAME (IF DIFFERENT THAN VEHICLE OWNER)
Grantee Name
Address
Authorized Representative
Signature
Date
DISMANTLER/SCRAPPER
Name of Business
Address
Name (Print)
Signature
Date

New Vehicle Photo Information:
Please provide the following for each new bus purchased with Clean Heavy-Duty
Vehicles program funds:
1) Provide a clear photo of the front profile of the new vehicle
2) Provide a clear photo of the side profile of the new vehicle
3) Provide a clear photo of the vehicle information plate that displays the VIN and
manufacturer The photo should be a readable display of the VIN plate rather than a

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

photo of just the bus with the VIN imposed over the photo.
New Infrastructure Photo Information, if applicable:
Please provide the following for charging infrastructure purchased with Clean HeavyDuty Vehicles program funds, if applicable:
1) Provide a clear photo of each charger’s data plate, including the serial number and
manufacturer
2) Provide a clear photo of each installed charger

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

Grant ID #:
Existing Vehicle VIN:

TEMPLATE B – VEHICLE SELL OR DONATE STATEMENT
Please complete this template if the vehicle identified on Page 1 was sold or donated.
Fleets that do not have eligible vehicle model year 2010 or older diesel or non-diesel Class
6/7 vehicles to scrap and that choose to instead replace 2011 or newer Class 6/7 vehicles by
donating or selling those vehicles must retain documentation of that transaction that
includes:
1.
The name of the fleet donating or selling the vehicle
2.
The name, phone number, email, and physical address for the entity taking
ownership of the vehicle
3.
The VIN of the vehicle that was donated or sold
4.
If sold, the dollar amount of the vehicle sale
5.
The date of the transaction
By signing I affirm that on
the vehicle listed above was permanently
and that all five check boxes listed above have been verified to be
included in the transaction attachment to be submitted with this template.
Who owned the vehicle?

Applicant

Was the vehicle sold or donated?

Other: Please Specify
Sold

Donated

o If sold, how much was the vehicle sold for in dollars?
What was the date of transaction to donate or sell the vehicle?
What is the new location (city, zip, county, and state) within which the vehicle will
operate? (include NCES ID, if sold to a school district)
City:
Zip Code:
County:
State:
School District NCES ID (if applicable):

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

PRIOR OWNER OF VEHICLE
Email
Phone Number
Address
Owner Name (Print)
Signature
Date
GRANTEE NAME (IF DIFFERENT THAN PRIOR OWNER OF VEHICLE)
Grantee Name
Address
Authorized Representative
Signature
Date
NEW OWNER OF VEHICLE
Email
Phone Number
Address
Name (Print)
Signature
Date

EPA Form Number: 5900-682

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OMB Control Number: 2060-0754
Expiration Date: 04/30/2027

New Bus Photo Information:
Please provide the following for each new bus purchased with Clean Heavy-Duty
Vehicles program funds:
1) Provide a clear photo of the front profile of the new vehicle
2) Provide a clear photo of the side profile of the new vehicle
3) Provide a clear photo of the vehicle information plate that displays the VIN and
manufacturer The photo should be a readable display of the VIN plate rather
than a photo of just the bus with the VIN imposed over the photo.
New Infrastructure Photo Information, if applicable:
Please provide the following for charging infrastructure purchased with Clean HeavyDuty Vehicles program funds:
1) Provide a clear photo of each charger’s data plate, including the serial number
and manufacturer
2) Provide a clear photo of each installed charger

EPA Form Number: 5900-682

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