5900-686 CSB Eligibility and Scrap Sell Donate Statement

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division

___________ Clean School Bus (CSB) Grants Program
Sample 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-NEW). 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 2.25 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: After selecting the year of the program above, please complete the following
templates for each bus selected for replacement.

I. Eligibility Statement
Make
Model

Existing Bus Information

Existing Engine Information
Make
Model

Model Year
Model Year
Total Mileage
ID or Serial #
VIN
EPA Family
GVWR
Registration/Licensing
#
Registration/Licensing
State
Number of Years Bus has Served School District
I certify 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-prelim-title49-section30125)&f=treesort&num=0&edition=prelim

EPA Form Number: 5900-686

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division

☐

The existing vehicle being replaced is a vehicle model year 2010 or older diesel-powered
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
scrapped 2; 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

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

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division

II. Scrappage, Sell, or Donate Statement
The 2023 Clean School Bus (CSB) Grants program ensures that all vehicles participating are a
vehicle model year 2010 or older diesel-powered school buses that will be scrapped, if selected
for funding. If a fleet has no eligible 2010 or older diesel school buses and is requesting zero
emission school bus replacements, the fleet can either:
a.
Scrap 2010 or older non-diesel internal combustion engine buses; or
b.
Scrap, sell, or donate 2011 or newer diesel or non-diesel internal combustion
engine buses
Please refer to the CSB Notice of Funding Opportunity (NOFO) Section III.D 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

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division
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,
pre-approved scrappage method.3 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, pre-approved scrappage method. 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 hole; Engine block, after
hole; and Cut frame rails.
Who owned the vehicle that was replaced?
☐ School District

☐ Other: Please Specify

VEHICLE OWNER
Email
Phone Number
Address
Owner Name (Print)
Signature
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
Recipients may request and receive EPA approval for alternative scrappage methods by submitting an
alternative scrappage plan to the regional project officer detailing how the method will destroy and/or
disable the engine.
3

EPA Form Number: 5900-686

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division
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 eligible vehicle model year 2010 or older diesel or non-diesel buses to
scrap and that choose to instead replace 2011 or newer buses by donating or selling those buses
must retain documentation of that 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 [sold/donated] 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
Was the vehicle sold or donated? ☐ Sold

☐ Other: Please Specify
☐ 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 bus will operate
(include NCES ID, if sold to a school district)?

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
EPA Form Number: 5900-686

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division

Authorized Representative
Signature
Date
NEW OWNER OF VEHICLE
Email
Phone Number
Address
Name (Print)
Signature
Date

EPA Form Number: 5900-686