5900-686 N_CSB Eligibility and Scrap Sell Donate Statement

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

Clean School Bus 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 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 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
Total Mileage
Vehicle Identification
Number
Gross Vehicle Weight
Rating
Registration/Licensing #

Model Year
ID or Serial #
EPA Family

Registration/Licensing
State
Provide the number of days per week, on average, that the vehicle
provided bus service during the 2022-2023 school year
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://uscode.house.gov/view.xhtml?req=(title:49%20section:30125%20edition:prelim)%20OR%20(granuleid:US C-prelimtitle49-section30125)&f=treesort&num=0&edition=prelim

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 dieselpowered 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:
☐
A 2010 or older non-diesel internal combustion engine bus that will be
scrapped2; OR
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

Grantee (Signature)

Date

______________________________
Grant ID

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 Template 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

Grant ID #:
Existing Bus VIN:

TEMPLATE A - BUS SCRAPPAGE STATEMENT
Please complete this template if the bus identified on Page 1 was scrapped.
I certify 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, 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 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

VEHICLE OWNER
Email
Phone Number
Address
Owner Name (Print)
Signature

EPA Form Number: 5900-686

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

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 Bus Photo Information:
Please provide the following for each new bus purchased with Clean School Bus 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 infrastructure purchased with Clean School Bus program
funds:
1) Provide a clear photo of each infrastructure unit’s data plate, including the
serial number and manufacturer.
2) Provide 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

Grant ID #:
Existing Bus VIN:

TEMPLATE B - BUS SELL OR DONATE STATEMENT
Please complete this template if the bus identified on Page 1 was sold or donated.
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
I certify 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

o 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 (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: 5900-686

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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
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) 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 infrastructure purchased with Clean School Bus program
funds:
1) Provide a clear photo of each infrastructure’s data plate, including the serial
number and manufacturer.
2) Provide a clear photo of each installed infrastructure unit.

EPA Form Number: 5900-686

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