Application for Payment Request - Private Fleets and Non-profits

Diesel Emissions Reduction Act (DERA) Rebate Program (New Collection)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2060-0686 can be found here:

Documents and Forms

Document Name Document Type
Form in process Application for Payment Request - Private Fleets and Non-profits Form
Application for Payment Request Instructions.docx Instruction
in process Application for Payment Request DERA Payment Request Form.pdf Form

Information Collection (IC) Details

IC Title:	Application for Payment Request - Private Fleets and Non-profits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	in process	Application for Payment Request	DERA Payment Request Form.pdf		No	No	Paper Only
Instruction			Application for Payment Request Instructions.docx		No	No	Paper Only

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	130	130
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.