5900-693 T_CSB Utility Partnership Agreement

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

________ Clean School Bus (CSB) Grant Program
Electric Utility Partnership Template
Burden Statement for EPA Form 5900-693: 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 1.5-6 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: Planning early for electric charging infrastructure needs is critical for project success and the
EPA urges applicants to initiate this conversation with their utility provider(s) at the start of the
application period. This form was created for the convenience of school districts, applicants, and utility
providers to assist in discussing the potential new bus project, including key components such as anticipated
costs and timelines.
The intent of this form is to promote awareness of all parties involved in the potential new bus project. This
document is not a binding contract between parties signing this form. Information provided by the
utility does not commit the utility to any estimate of the engineering and construction costs and timelines for
utility-owned infrastructure that may be necessary for the proposed project.
Sections 1 through 3 of this form are required to be completed in full when submitted to the EPA; forms
submitted without all applicable signatures will be ineligible for CSB funding. Section 4 is NOT
required to be completed; however, the EPA strongly encourages school districts, applicants, and utility
providers discuss the items listed in Section 4.
School districts and applicants should prepare for this discussion with their electric utility by gathering
charging-related data and information ahead of time. The EPA recommends using the Electric School Bus
Route Analysis Tool and completing the Electric School Bus Charging Station Planning Form, available
on its Clean School Bus Technical Assistance webpage to assist in preparation. The EPA also recommends
reviewing its Electric School Bus Transition Planning Resource and its Coordinating with Electric Utility
Partners Resource as additional resources to help prepare for conversations in general with an electric
utility.
Applicants are also encouraged to request a 1:1 meeting with the Joint Office of Energy and Transportation
(JOET) by emailing cleanschoolbusTA@nrel.gov to receive additional technical support as needed. JOET
provides FREE, tailored hands-on assistance to all CSB applicants, at any stage of its switchover to electric.
Potential technical assistance JOET can provide includes conducting a route analysis for applicants, such
that they can estimate minimum charging needs for their potential new bus fleet.

EPA Form Number: 5900-693

1

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

Applicant Name:___________________
1. School District/Applicant Fleet Information
This section must be filled out by the school district or applicant, for purposes of communicating key details
of the potential new bus project to their utility provider(s).

Requested in Application
[Please provide the number of
buses and chargers requested in
your application.]

Current Electric Fleet at
time of Application
Submission
[Please provide the number of
buses and chargers already in
your electric fleet.]

# of Electric School Buses:
# of Direct Current (DC) Fast
Chargers:
# of Level 2 Alternating
Current (AC) Chargers:
Are you interested in any of
the above chargers and/or
buses providing Vehicle-toGrid (V2G) or Vehicle-toBuilding (V2B)? If yes, how
many?
Expected location (street, city,
state) of charger installations:

EPA Form Number: 5900-693

2

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

2. Utility Provider Information
Applicants must provide the following information for each electric utility they are communicating with
about their potential electric infrastructure project.
Please email the JOET helpline at cleanschoolbusTA@nrel.gov for information on your utility point of
contact, if unknown.

a. Utility Provider #1
Name of the Utility Provider:
Utility Contact Name:
Utility Contact Phone:
Utility Contact Email:
b. Utility Provider #2
Name of the Utility Provider:
Utility Contact Name:
Utility Contact Phone:
Utility Contact Email:
c. Utility Provider #3
Name of the Utility Provider:
Utility Contact Name:
Utility Contact Phone:
Utility Contact Email:
d. Utility Provider #4
Name of the Utility Provider:
Utility Contact Name:
Utility Contact Phone:
Utility Contact Email:

EPA Form Number: 5900-693

3

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

3. School District, Applicant, and Utility Provider Coordination Affirmation
By signing this Affirmation, I certify that I am an Authorized Representative for the School District,
Applicant, or Utility Provider identified below.

School District Affirmation
I have shared information on the key details about the potential new bus project, as outlined in Section 1,
with the Utility Provider, and if applicable, with the Third-Party Applicant, and others as appropriate.

__________________________
School District Name
____________________________
Authorized Representative Title

_________________________________
Authorized Representative (Signature)
_________________
Phone Number

___________
Date

_______________________
Email

Applicant Affirmation [Only needed if applicant is different than the school district.]
I have shared information on the key details about the potential new bus project, as outlined in Section 1,
with the Utility Provider, and if applicable with the School District, and others as appropriate.

__________________________
Applicant Organization Name
____________________________
Authorized Representative Title

EPA Form Number: 5900-693

_________________________________
Authorized Representative (Signature)
_________________
Phone Number

___________
Date

_______________________
Email

4

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

a. Utility Provider #1 Affirmation
Utility Provider Affirmation
I have received information on the key details about the potential new bus project, as outlined in Section 1,
from the School District, and if applicable, the Third-Party Applicant, and others as appropriate.

__________________________
Utility Name
____________________________
Authorized Representative Title

_________________________________
Authorized Representative (Signature)
_________________
Phone Number

___________
Date

_______________________
Email

b. Utility Provider #2 Affirmation
Utility Provider Affirmation
I have received information on the key details about the potential new bus project, as outlined in Section 1,
from the School District, and if applicable, the Third-Party Applicant, and others as appropriate.

__________________________
Utility Name
____________________________
Authorized Representative Title

EPA Form Number: 5900-693

_________________________________
Authorized Representative (Signature)
_________________
Phone Number

___________
Date

_______________________
Email

5

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

c. Utility Provider #3 Affirmation
Utility Provider Affirmation
I have received information on the key details about the potential new bus project, as outlined in Section 1,
from the School District, and if applicable, the Third-Party Applicant, and others as appropriate.

__________________________
Utility Name
____________________________
Authorized Representative Title

_________________________________
Authorized Representative (Signature)
_________________
Phone Number

___________
Date

_______________________
Email

d. Utility Provider #4 Affirmation
Utility Provider Affirmation
I have received information on the key details about the potential new bus project, as outlined in Section 1,
from the School District, and if applicable, the Third-Party Applicant, and others as appropriate.

__________________________
Utility Name
____________________________
Authorized Representative Title

EPA Form Number: 5900-693

_________________________________
Authorized Representative (Signature)
_________________
Phone Number

___________
Date

_______________________
Email

6

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

4. OPTIONAL: Planning for Utility Upgrades
This section is NOT required to be completed, however, the EPA strongly encourages school districts,
applicants, and utility providers to discuss the items listed in Section 4.
If an applicant has listed more than one electric utility in Section 2, any potential utility upgrades listed
below should also identify which of the utilities may be responsible for the work.

Please list the total projected kW needed to support this project
by taking into account the types of charger(s) requested.1
Please work with your utility to provide a rough estimate of the
total engineering and construction cost for utility owned
infrastructure (in front of the meter) for the project based on the $
number of buses and chargers listed in the application:
In the box below, please briefly describe the scope of any utility upgrades that may be
needed for the project. Please consider whether engineering, construction, and/or
permitting is needed, whether an interconnection study may be necessary, and the extent
of services needed for completion. This should include possible needed upgrades for the
following pieces of equipment:
•
•
•
•
•
•

Power transformer
Terminator pole
Service lateral/conductor
Metering
Primary line extension
Any additional equipment

1

Applicants unsure of the power needed for their potential project can contact the Joint Office of Energy and
Transportation at cleanschoolbusTA@nrel.gov to request assistance with completing an electric school bus route
analysis. Applicants can also perform this analysis by using the Electric School Bus Route Analysis Tool, available on
EPA’s Clean School Bus Technical Assistance webpage.
EPA Form Number: 5900-693

7

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

Based on the information provided above, please provide an estimate of time required to
complete the necessary utility-owned infrastructure (in front of the meter) upgrades:

EPA Form Number: 5900-693

8