5900-693 CSB Utility Partnership 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
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-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 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 long-term infrastructure needs is important for project success. 1 This
worksheet is provided for the convenience of applicants, to assist in discussing the proposed project with
the appropriate utility, including key components such as anticipated costs and timelines. When using this
worksheet, applicants should keep fleet electrification expansion plans in mind, as futureproofing for
upcoming needs can ultimately decrease overall utility upgrade costs.
The information identified in this worksheet may be used to support the Project Narrative component of the
CSB grant application package, but is not required. Third-party applicants may include a copy of this
worksheet for each beneficiary included in the application.
Regardless of whether applicants use this worksheet, applicants should coordinate with their electric utility
to determine anticipated costs and timelines.

1. Fleet Information
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.]

Electric Buses:
DC Fast Chargers:
Level 2 AC Chargers:
Expected location (street,
city, state) of charger
installations:

1

Please visit EPA’s Clean School Bus Technical Assistance webpage for further information and resources, including an Electric
School Bus Charging Station Planning Form

EPA Form Number: 5900-693

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division

2. Utility Information
Name of the Utility Company:
Utility Contact Name 2:
Utility Contact
Email:
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 applicant’s 2023 CSB
grant application:
Utility Contact Phone:

In the box below, please briefly describe the scope of any needed utility upgrades for the
project. Please consider whether engineering, construction, and/or permitting is needed,
whether an interconnection study is necessary, and the extent of services needed for
completion. This should include whether upgrades are necessary for the following pieces
of equipment:
•
•
•
•
•

•

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

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:

2

Please email the National Renewable Energy Laboratory (NREL) helpline for information on a utility point of contact (POC) to
facilitate communication throughout the project.

EPA Form Number: 5900-693

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

EPA Office of Transportation and Air Quality
Transportation and Climate Division

3. Utility Coordination Affirmation
By signing this Affirmation, I certify that I am an Authorized Representative for the School
District, Applicant, or Utility identified below.
School District Affirmation
I have discussed the project plan for the fleet and charging infrastructure outlined above with the
Utility Company, and if applicable, with the Third-Party Applicant, and others as appropriate.
__________________________

_________________________________

___________

School District Name

Authorized Representative (Signature)

Date

Applicant Affirmation [Only needed if applicant is different than the school district.]
I have discussed the project plan for the fleet and charging infrastructure outlined above with the
Utility Company, and if applicable with the School District, and others as appropriate.
__________________________

_________________________________

___________

Applicant Organization Name

Authorized Representative (Signature)

Date

Utility Affirmation
I have discussed the project plan for the fleet and charging infrastructure outlined above with the
School District, and if applicable, the Third-Party Applicant, and others as appropriate.
__________________________

_________________________________

___________

Utility Name

Authorized Representative (Signature)

Date

EPA Form Number: 5900-693