Information Collection

State and Local Government (Including Schools)

IC 264798 under ICR 202401-2060-006 · OMB 2060-0686.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5900-261 Payment Request Form State and Local Government (Including Schools)	Form and Instruction
Form 5900-645 Application Form State and Local Government (Including Schools)	Form and Instruction
Form 5900-646 Close-out Form State and Local Government (Including Schools)	Form and Instruction
5900-261 CSB Payment Request Form Summary of Changes.pdf	Other-Screenshots
5900-261 CSB Payment Request Form Summary of Changes.pdf	Other-Screenshots
5900-645 CSB Application Summary of changes Screenshot.pdf	Other-Screenshot
5900-645 CSB Application Summary of changes Screenshot.pdf	Other-Screenshot
5900-646 CSB Close out form screen shots.pdf	Other-Screenshots
5900-646 CSB Close out form screen shots.pdf	Other-Screenshots
5900-261 Payment Request Form 5900-261 CSB Payment Request Form User Guide.pdf app.epa.gov/csb	Form and Instruction
5900-261 Payment Request Form 5900-261 CSB Payment Request Form User Guide.pdf app.epa.gov/csb	Form and Instruction
5900-645 Application Form 5900-645 CSB Application User Guide.pdf app.epa.gov/csb	Form and Instruction
5900-645 Application Form 5900-645 CSB Application User Guide.pdf app.epa.gov/csb	Form and Instruction
5900-646 Close-out Form 5900-646 CSB Close out Form User Guide pdf.pdf app.epa.gov/csb	Form and Instruction
5900-646 Close-out Form 5900-646 CSB Close out Form User Guide pdf.pdf app.epa.gov/csb	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-261	https://app.epa.gov/csb	Yes	Yes	Fillable Fileable Signable
Other-Screenshot			Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-645	https://app.epa.gov/csb	Yes	Yes	Fillable Fileable Signable
Other-Screenshots			Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-646	https://app.epa.gov/csb	Yes	Yes	Fillable Fileable Signable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,080

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,512	5,265	-3,753
Annual IC Time Burden (Hours)	16,368	18,082	-1,714
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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