5900-686 N_CSB Eligibility and Scrap Sell Donate Statement

OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

Clean School Bus Grants Program
Eligibility and Scrap/Sell/Donate Statement
Burden Statement for EPA Form 5900-686: 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 1.5-12 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 Director, Information Engagement Division, 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 bus 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 Bus Information
Make

Existing Engine Information
Make

Model

Model

Model Year
Model Year
Total Mileage
ID or Serial #
Vehicle Identification
EPA Family
Number (VIN)
Gross Vehicle Weight
Rating (GVWR)
Registration/Licensing
#
Registration/Licensing
State
Number of Years Bus has Served School District
By signing, I affirm 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

1

49 U.S.C. § 30125, available at https://www.govinfo.gov/content/pkg/USCODE-2023-title49/html/USCODE-2023title49-subtitleVI-partA-chap301-subchapII-sec30125.htm

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY
•

The existing vehicle being replaced is a vehicle model year 2010 or older diesel-powered
school bus that will be scrapped. If a fleet has no eligible 2010 or older diesel school buses
and is requesting zero emission school bus replacements, the existing vehicle being replaced
is either:
o A 2010 or older non-diesel internal combustion engine bus that will be scrapped2; OR
o A 2011 or newer diesel or non-diesel internal combustion engine buses that will be
scrapped, sold, or donated.

•

The existing vehicle being replaced has a Gross Vehicle Weight Rating (GVWR) of 10,001 lbs
or more.

•

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.

•

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 disaster-related school closures.

Who owned the vehicle that was replaced?
School District

Other: Please Specify_________________________________________

Vehicle Owner Address: _______________________________________________________

________________________
Vehicle Owner Name (Print)

______________________________
Vehicle Owner (Signature)

_____________
Date

________________________
Grantee Name (Print)

______________________________
Grantee (Signature)

_____________
Date

2

Reference Section III.D.4.i of the 2023 CSB Grant Notice of Funding Opportunity for the funding allowance
policy on bus scrappage.

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

II. Scrappage, Sell, or Donate Statement
The Clean School Bus (CSB) Grants Program ensures that, if selected for funding, all vehicles to be
replaced will be scrapped, sold, or donated per requirements detailed in the Notice of Funding
Opportunity (NOFO) and Terms & Conditions of the applicable funding opportunity.
Please refer to the CSB NOFO for more information on scrappage, selling, or donation under the CSB
Program.
Grantees who are selected for funding must complete one of the following templates below [Template A
or B] to certify each individual bus is scrapped, sold, or donated before the end of the project period:
•
•

Template A - Scrappage: Please complete the Template A – Bus Scrappage Statement if the bus
on Page 1 has been scrapped.
Template B – Sell or Donate: Please complete the Template B – Bus Sell or Donate Statement if
the bus identified on Page 1 has been sold or donated.

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

TEMPLATE A - BUS SCRAPPAGE STATEMENT
Instructions: Please complete this template if the bus identified on Page 1 was scrapped and attach all
evidence described below.
Grant ID Number:
Existing Bus VIN:
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, preapproved scrappage method that permanently disabled the engine. 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 that permanently disabled
the chassis.
The following required digital photos of the disabled engine and chassis are attached:
•

Side profile of the bus, 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 Bus 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 bus VIN as proof of old bus scrappage.
Attach a letter signed by a representative of the scrap yard/entity that performed the scrappage.
Who owned the vehicle that was replaced?
School District
Other: Please Specify _____________________________________

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY
VEHICLE OWNER
Email
Phone Number
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

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

New Bus Photo Information:
Please provide the following for each new bus purchased with Clean School Bus Program funds:
1) A clear photo of the front profile of the new vehicle
2) A clear photo of the side profile of the new vehicle
3) 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 infrastructure purchased with Clean School Bus Program funds:
1) A clear photo of each infrastructure unit’s data plate, including the serial number and
manufacturer
2) A clear photo of each installed infrastructure unit

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

TEMPLATE B - BUS SELL OR DONATE STATEMENT
Instructions: Please complete this template if the bus identified on Page 1 was sold or donated and
attach all evidence described below.
Grant ID Number:
Existing Bus VIN:

Fleets that do not have buses that meet the requirements for scrappage listed in the applicable CSB NOFO
may choose to instead replace eligible vehicles, as specified in the applicable CSB NOFO, by donating or
selling those buses. These fleets must retain documentation of the sale or donation transaction that
includes:
1.

The name of the fleet donating or selling the buses

2.

The name, phone number, email, and physical address for the entity taking ownership of the
buses

3.

The VIN of the bus that was donated or sold

4.

If sold, the dollar amount of the bus sale

5.

The date of the transaction

By signing, I affirm that on ____________ the bus listed above was permanently __________and that all
five checkboxes listed above have been verified to be included in the transaction attachment to be
submitted with this template.
Who owned the vehicle?

School District

Other: Please Specify_______________

Was the vehicle sold or donated?
Sold
Donated
• If sold, how much was the bus sold for in dollars? ___________________________________
What was the date of transaction to donate or sell the bus? __________________________________
What is the new location within which the bus will operate? Please include all fields below, and
include NCES ID, if sold to a school district.
City: __________________________________________________
Zip Code: ______________________________________________
County: ________________________________________________
State: _________________________________________________
School District NCES ID (if applicable): _____________________

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

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
Name of Owner/Owning Entity
Email
Phone Number
Address
Name (Print)
Signature
Date

EPA Form Number 5900-686

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OMB Control Number: 2060-0754
Expiration Date: MM/DD/YYYY

New Bus Photo Information:
Please provide the following for each new bus purchased with Clean School Bus Program funds:
1) A clear photo of the front profile of the new vehicle
2) A clear photo of the side profile of the new vehicle
3) 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 infrastructure purchased with Clean School Bus Program funds:
1) A clear photo of each infrastructure unit’s data plate, including the serial number and
manufacturer
2) A clear photo of each installed infrastructure unit

EPA Form Number 5900-686

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