Application for Payment Request - Private Fleets and Non-profits

Diesel Emissions Reduction Act (DERA) Rebate Program (Renewal)

⚠️ Notice: This information collection may be referencing outdated material.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 5900-261 Application for Payment Request - Private Fleets and Non-profits Form
5900-261 Payment Request 2015-ICR-Renewal-clean-diesel-rebate-payment - 10.27.15.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: Modified

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	5900-261	Payment Request	2015-ICR-Renewal-clean-diesel-rebate-payment - 10.27.15.pdf		Yes	Yes	Fillable Printable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8	-42	50
Annual IC Time Burden (Hours)	18	-112	130
Annual IC Cost Burden (Dollars)	0	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.