5900-689 CHDV Supplemental Application Template

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Overview

1. Instructions_App
2. Fleet Description
3. Infrastructure
4. Data Dictionary

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Sheet 1: 1. Instructions_App

U. S. Environmental Protection Agency
Clean Heavy-Duty Vehicles (CHDV) Grant Program
Supplemental Application Template
Burden Statement for EPA Form Number: 5900-689
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 7.2 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
This supplemental application template should be completed and submitted as part of the application materials for the Clean Heavy-Duty Vehicles Grant Program. Please work with relevant parties (i.e., transportation contractor, bus dealer, etc.) to ensure information submitted is as accurate as feasible at the time of application. The applicant must fill out shaded cells highlighted blue with a diagonal pattern (///) to the best of their ability. Cells highlighted yellow are automatically populated based on previous responses in this spreadsheet. Fields shaded in white are encouraged, but may not be known at the time of application. Additionally, some fields will hash out with a bold diagonal pattern (///) if those fields are not applicable based on the information provided in previous cells. Please complete tabs in this workbook according to the instructions below.
Excel Workbook Tab	Definition
1. Instructions	Basic instructions for all worksheets in this reporting workbook.
2. Fleet Description	The Fleet Description tab should detail all vehicles impacted under the project. The Fleet Description should be completed at the time of application; if selected, awardees will update this table quarterly with all vehicle upgrades completed. The applicant must fill out shaded cells highlighted blue with a diagonal pattern (///) to the best of their ability. Fields in yellow will be automatically populated based on previous responses. Fields shaded in white are encouraged, but may not be known at the time of application. Additionally some fields will hash out with a bold diagonal pattern (///) if those fields are not applicable based on the information provided in previous cells. This Fleet Description is broken into two sections: 1) Current Vehicle Information, and 2) New Vehicle Upgrade Information. The sheet has capacity for 100 vehicles. Please refer to the Fleet Description data definitions on tab 4 (Data Dictionary) for data field definitions.
3. Infrastructure	The Infrastructure tab should detail all electric vehicle supply equipment (EVSE) and other eligible supporting infrastructure planned as part of the project; if selected, awardees will update these tables be updated quarterly as EVSEs and other infrastructure are procured and installed. The applicant must fill out shaded cells highlighted blue with a diagonal pattern (///) to the best of their ability. Fields in yellow will be automatically populated based on previous responses. Fields shaded in white are encouraged, but may not be known at the time of application. Additionally, some fields will hash out with a bold diagonal pattern (///) if those fields are not applicable based on the information provided in previous cells. Additional rows may be add as needed to capture all units of supporting infrastructure. The final text field on this tab may be used to supply information about planned hydrogen fueling infrastructure and other types of eligible infrastructure under this program. Please refer to the Infrastructure data definitions on Tab 4 (Data Dictionary) for data field definitions. Reminder: All Level 2 EVSEs must be ENERGY STAR certified, and all infrastructure must comply with Build America, Buy America (BABA) requirements.
4. Data Dictionary	Please refer to the dictionary on this tab for support in completing the Fleet Description and Infrastructure Tabs.

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Sheet 2: 2. Fleet Description

U. S. Environmental Protection Agency

Clean Heavy-Duty Vehicles (CHDV) Grant Program

Fleet Description

Applicant Name

SAM.gov Unique Entity ID

Project Title

Instructions

The Fleet Description should detail all vehicles anticipated to be replaced under the project and, to the extent details are known at this time, all replacement vehicles that will be purchased using Clean Heavy-Duty Grants funding. Please fill out shaded cells highlighted blue with a diagonal pattern (///) to the best of your ability. Fields in yellow will be automatically populated based on previous responses. Fields shaded in white are highly encouraged, but optional, as these data may not be known at the time of application. Additionally, some fields will hash out with a bold diagonal pattern (///) if those fields are not applicable based on the information provided in previous cells. This Fleet Description is broken into two sections: 1) Current Vehicle Information and 2) New Vehicle Upgrade Information. The sheet has capacity for 100 vehicles. Please refer to the Fleet Description data definitions on tab 4 (Data Dictionary) for data field definitions.

Table 1. CURRENT VEHICLE INFORMATION

Table 2. NEW REPLACEMENT VEHICLE INFORMATION

1a. Basic Fleet Information

1b. Current Vehicle Type Information

1c. Current Vehicle Usage Information

1d. Current Vehicle Place(s) of Performance

1e. Vehicle Disposition Process

2a. Upgrade Vehicle Information

2b. Upgrade Cost

2c. New Vehicle Place(s) of Performance

2d. BABA Compliance

Primary Place of Performance

Secondary Place of Performance (if applicable)

Additional Location Details (if applicable)

Primary Place of Performance

Secondary Place of Performance (if applicable)

Additional Location Details (if applicable)

Optional, but highly encouraged if known*

Vehicle

Group Name

Current Fleet Owner

Vehicle Type (select from dropdown)

Vehicle Class (select from dropdown)

Vehicle Vocation (select from dropdown)

Vehicle Group Sector (select from dropdown)

Vehicle Identification Number

Vehicle Manufacturer

Vehicle Model

Baseline Vehicle Model Year

Baseline Engine Fuel Type (select from dropdown)

Engine Family Name (if unregulated, then enter N/A)

Gross Vehicle Weight Rating (GVWR)

Annual Miles Traveled (miles per vehicle, using the average for the prior 2 years. Please see the NOFO section III.D.2 which describes the minimum mileage required.)

Annual Idling Hours (hours per vehicle, using the average for the prior 2 years.)

Current Odometer (in miles)

Annual Amount of Fuel Used (gallons/year per engine)

School District Name (if applicable)

NCES ID (if applicable)

State (select from dropdown)

County (select from dropdown)

Percentage of Time Operated in County

Place of Performance: City

School District Name (if applicable)_2

NCES ID (if applicable)_2

State_2

County_3

Percentage of Time Operated in County_2

Place of Performance: City_3

Additional Counties Where Vehicle Operates

Percentage of Time Operated in Each Additional County

Anticipated Vehicle Disposition Method

If sold or donated, provide the state in which the existing vehicle is expected to primarily operate (if known)

If sold or donated, provide the county in which the existing vehicle is expected to primarily operate (if known)

Year of Upgrade Action

New Vehicle Fleet Owner

New Vehicle Class (select from dropdown)

New Vehicle Fuel Type

New Vehicle Manufacturer (if known)

New Vehicle Model (if known)

New Vehicle GVWR (if known)

Capable of Bidirectional Charging? (Yes/No/NA)

Estimated Range in Miles

Estimated Acquisition Cost per Vehicle

Total EPA Funds Requested Per Vehicle ($ of Total Cost per Unit)

School District Name (if applicable)_3

NCES ID (if applicable)_3

State (select from dropdown)_3

County (select from dropdown)_3

Percentage of Time operated in County_2 (Enter value between 0-1, where 1 = 100%)

City

School District Name (if applicable)2

NCES ID (if applicable)2

State (select from dropdown)2

County (select from dropdown)2

Percentage of Time operated in County_3 (enter value 0-1, where 1 = 100%)

City_4

Additional Counties Where Vehicle Operates_2

Percentage of Time Operated in Each Additional County_2

Is a waiver being used to fulfill BABA compliance for this vehicle?

Example Vehicle

ESBs for District A

Sarah Smith

Short Haul - Single Unit

Class 6

Drayage

Port

12345678910ABCDEFG

Manufacturer Name

Model Name or #

1995

Diesel

N/A

10150

140000

12000

1500000

6000

Warren 01

123456

SC

Warren

100%

Springhill

Warren 01

123456

SC

Warren

100%

Springhill

Scrapped

CA

Alameda County

2025

Walton School District

Class 6

Battery Electric

Manufacturer Name

Model Name or #

12000

Yes

200

$375,000.00

$325,000.00

Warren 01

123456

SC

Warren

100%

Springhill

Warren 01

123456

SC

Warren

100%

Springhill

Pima County, AZ; La Paz County, AZ

5% in Pima; 5% in La Paz

No - Vehicle meets all BABA requirements

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Vehicle 7

Vehicle 8

Vehicle 9

Vehicle 10

Vehicle 11

Vehicle 12

Vehicle 13

Vehicle 14

Vehicle 15

Vehicle 16

Vehicle 17

Vehicle 18

Vehicle 19

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Vehicle 44

Vehicle 45

Vehicle 46

Vehicle 47

Vehicle 48

Vehicle 49

Vehicle 50

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Vehicle 52

Vehicle 53

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Vehicle 55

Vehicle 56

Vehicle 57

Vehicle 58

Vehicle 59

Vehicle 60

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Vehicle 87

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Vehicle 91

Vehicle 92

Vehicle 93

Vehicle 94

Vehicle 95

Vehicle 96

Vehicle 97

Vehicle 98

Vehicle 99

Vehicle 100

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Sheet 3: 3. Infrastructure

U. S. Environmental Protection Agency

Clean Heavy-Duty Vehicles (CHDV) Grant Program

Infrastructure Description

Instructions

Below are three tables (Table 3, Table 4, and Table 5), and an additional question below Table 5. Please complete all 4. The EVSE Equipment Information (Table 3) should detail all electric vehicle supply equipment (EVSE) and supporting infrastructure purchased under the project. Table 4 focuses on on-site power generation systems and Table 5 on battery storage systems. For school district applicants the infrastructure needs to be listed by school district and/or city. That is, if School District A and School District B are procuring the same EVSE, the EVSE will appear as two separate EVSE Groups. Similarly, for large school districts, if EVSE are being installed in two different locations, the EVSE needs to appear as two separate EVSE Groups. If your project includes hydrogen refueling infrastructure, please describe using the text box after Table 5 at the bottom of this tab, about the following features: the type of station (gas or liquid), where hydrogen will be stored (above or below ground), the total hydrogen storage capacity (in kg), the estimated annual hydrogen to be dispensed (in kg), the hydrogen generation pathway (see Data Dictionary for more options), the total cost for acquisition of each eligible component (e.g., fueling pedestals, tanks, compressors, cooling system, etc.), the total funds requested for each eligible component, the total cost for installation of the system, the total funds requested for installation, and any other eligible expenses related to hydrogen fueling projects. Please fill out shaded cells highlighted blue with a diagonal pattern (///) to the best of your ability. Note, additional rows may be added as needed to capture all equipment. Fields in yellow will be automatically populated based on previous responses. Fields shaded in white are highly encouraged, but optional, as these data may not be known at the time of application. Additionally, some fields will hash out with a bold diagonal pattern (///) if those fields are not applicable based on the information provided in previous cells. Please refer to the Infrastructure data definitions on Tab 4 (Data Dictionary) for data field definitions. Reminder: All Level 2 EVSEs must be ENERGY STAR certified. All EVSE, on-site power generation systems, battery energy storage systems (BESS), and any other infrastructure components must comply with Build America, Buy America (BABA) requirements. See below for more information on BABA.

Build America, Buy America (BABA) requirements

On November 15, 2021, the Infrastructure Investment and Jobs Act ("IIJA"), Pub. L. No. 117-58, which includes the Build America, Buy America Act (BABA), Public Law 117-58, §§ 70901-52, was signed into law. BABA requires that on or after May 14, 2022, all of the iron, steel, manufactured products, and construction materials used in infrastructure project are produced in the United States. If award recipient will be installing, upgrading, or replacing “infrastructure,” then BABA requirements apply to the infrastructure project, regardless of whether or not the infrastructure project was the primary basis for the award. Additionally, BABA requirements apply even if the award recipient will be using another source of funding, whether in part or wholly, for the infrastructure project. For more information, please visit https://www.epa.gov/cwsrf/build-america-buy-america-baba.

Do you attest that you have read the BABA requirements described above?

Table 3. Electric Vehicle Service Equipment

Table 3a. EVSE Equipment Information Overview

Table 3b. Location of EV Infrastructure

Table 3c. Owners & Anticipated Users of EVSE

Table 3d. Infrastructure Installation Information

Table 3e. EVSE Cost Summary

Table 3f. BABA Compliance

Optional, but highly encouraged if known*

Optional, but highly encouraged if known*

Optional, but highly encouraged if known*

Type of Charger

If Level 2, is it ENERGY STAR certified

EVSE Manufacturer

EVSE Model

EVSE Manufacture Year

EVSE Maximum Output Power (kW)

Number of Plugs on EVSE

Will the EVSE Be Capable of Bidirectional Charging?

Will the Vehicle and EVSE be Used for Vehicle to Grid (V2G)?

Number of EVSE Units

Total Estimated Acquisition Cost per EVSE Unit

Total EPA Funds Requested for Acquisition of Each EVSE Unit

Total EPA Funds Requested for EVSE Acquisition

State (Select from dropdown)

County (Select from dropdown)

City

Zip Code

Street Address

Who will own the charger?

Anticipated User(s) of the charger

If serving school districts, will the EVSE serve multiple school districts within this project?

Name of the School District(s) the EVSE will serve (if applicable; use a semicolon between school districts)

NCES ID of School District that the EVSE will serve (if applicable; use a semicolon between school districts)

Total Estimated Cost for EVSE Installation

Total EPA Funds Requested for Installation Cost

Does the Infrastructure Equipment Cost Include Installation?

Total EPA Funds Requested for EVSE Equipment and Installation

Estimated Total Cost for EVSE Equipment and Installation

Is a waiver being used to fulfill BABA compliance for this EVSE?

Example EV Infrastructure

Level 2

Yes

Manufacturer Name

Model Name

2023

24

2

No

No

2

$16,000.00

$12,000.00

$24,000.00

VA

Arlington County

Alexandria

22305

400 1st Street

Walton School District

Electric school buses serving Walton School District

Yes

Walton School District; Franklin School District

1234567; 7654321

$12,000

$7,000

No

$31,000.00

$44,000.00

No - Infrastructure meets all BABA requirements

EVSE Group 1

$-

EVSE Group 2

$-

EVSE Group 3

$-

EVSE Group 4

$-

EVSE Group 5

$-

EVSE Group 6

$-

EVSE Group 7

$-

EVSE Group 8

$-

EVSE Group 9

$-

EVSE Group 10

$-

EVSE Group 11

$-

EVSE Group 12

$-

EVSE Group 13

$-

EVSE Group 14

$-

EVSE Group 15

$-

EVSE Group 16

$-

EVSE Group 17

$-

EVSE Group 18

$-

EVSE Group 19

$-

EVSE Group 20

$-

EVSE Group 21

$-

EVSE Group 22

$-

EVSE Group 23

$-

EVSE Group 24

$-

EVSE Group 25

$-

EVSE Group 26

$-

EVSE Group 27

$-

EVSE Group 28

$-

EVSE Group 29

$-

EVSE Group 30

$-

Note: If the wind or solar power generation includes an energy storage system, information for such system needs to be documented in the table below this one (Table 5).

Table 4. Solar and Wind Power Generation Equipment

Table 4a. Solar and Wind Power Generation Equipment Information Overview

4b. Location of Solar and Wind Power Generation Infrastructure

4c. Ownership and Use of Solar and Wind Power Generation Infrastructure

4d. BABA Compliance

Optional, but highly encouraged if known*

Optional, but highly encouraged if known*

Type of energy generation

Manufacturer of Solar or Wind Power Generation System

Model of Solar or Wind Power Generation

Manufacture Year of Solar or Wind Power Generation

Generation Capacity of the system (please indicate kW or MW)

Total Estimated Acquisition Cost Per Power Generation System

Total EPA Funds Requested Per Power Generation System

Total Estimated Cost for Installation

Total EPA Funds Requested for Installation

Total Estimated Cost of Equipment and Installation

Total EPA Funds Requested for Installation

State

County

City

Zip Code

Street Address

Who owns the equipment?

Anticipated Users of Solar or Wind Power Generation Infrastructure

If serving school districts, Name of the School District(s) the Solar or Wind Power Generation will serve

If serving school districts, NCES ID of School District that the Solar or Wind Power Generation will serve

Is a waiver being used to fulfill BABA compliance for the Solar or Wind Power Generation?

Example Solar or Wind Power Generation

Solar

Manufacturer Name

Model Name

2023

15 kW

$45,000.00

$45,000.00

$7,000.00

$5,000.00

$52,000.00

$50,000.00

VA

Arlington County

Alexandria

22305

400 1st Street

Walton School District

Walton School District & NoVA Community College

Walton School District

1234567

No - Infrastructure meets all BABA requirements

Solar or Wind Power Generation 1

$-

$-

Solar or Wind Power Generation 2

$-

$-

Solar or Wind Power Generation 3

$-

$-

Solar or Wind Power Generation 4

$-

$-

Solar or Wind Power Generation 5

$-

$-

Solar or Wind Power Generation 6

$-

$-

Solar or Wind Power Generation 7

$-

$-

Solar or Wind Power Generation 8

$-

$-

Solar or Wind Power Generation 9

$-

$-

Solar or Wind Power Generation 10

$-

$-

Table 5. Battery Energy Storage System (BESS) Equipment Information

5a. BESS Overview

5b. Location of BESS Infrastructure

5c. Ownership and Use of BESS Infrastructure

5d. BABA Compliance

Optional, but highly encouraged if known*

Optional, but highly encouraged if known*

Type of Battery

Manufacturer of BESS

Model of BESS

Manufacture Year of BESS

Energy Capacity (please indicate kWh or MWh)

Total Estimated Acquisition Cost Per Unit of Equipment:

Total EPA Funds Requested Per Unit:

Total Estimated Cost for Installation:

Total EPA Funds Requested for Installation:

Total Estimated Cost for Equipment and Installation

Total EPA Funds Requested for Equipment and Installation

State

County

City

Zip Code

Street Address

Who owns the equipment?

Anticipated Users of BESS

If serving school districts, Name of the School District the BESS will serve

If serving school districts, NCES ID of School District that the BESS will serve

Is a waiver being used to fulfill BABA compliance for the BESS?

BESS Example

Lithium-Ion

Manufacturer Name

Model Name

2023

36kWh

$48,000.00

$20,000.00

$12,000.00

$10,000.00

$60,000.00

$30,000.00

VA

Arlington County

Alexandria

22305

400 1st Street

Walton School District

Walton School District & NoVA Community College

Walton School District

1234567

No - Infrastructure meets all BABA requirements

BESS Group 1

$-

$-

BESS Group 2

$-

$-

BESS Group 3

$-

$-

BESS Group 4

$-

$-

BESS Group 5

$-

$-

BESS Group 6

$-

$-

BESS Group 7

$-

$-

BESS Group 8

$-

$-

BESS Group 9

$-

$-

BESS Group 10

$-

$-

Are there any other infrastructure projects, including hydrogen fueling projects, associated with this grant that are not listed above?

(Y or N or N/A)

If no, please leave this section blank. If yes, please provide details in the box below on the infrastructure project and describe how BABA compliance was determined. For hydrogen fueling projects, please provide as much detail as known or anticipated at time of application, such as: the type of station (gas or liquid), where hydrogen will be stored (above or below ground), the total hydrogen storage capacity (in kg), the estimated annual hydrogen to be dispensed (in kg), the hydrogen generation pathway (see Data Dictionary for more options), the total cost for acquisition of each eligible component (e.g., fueling pedestals, tanks, compressors, cooling system, etc.), the total funds requested for each eligible component, the total cost for installation of the system, the total funds requested for installation, and any other eligible expenses related to hydrogen fueling projects.

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Sheet 4: 4. Data Dictionary

U. S. Environmental Protection Agency
Clean Heavy-Duty Vehicles (CHDV) Grant Program
Data Dictionary
Please refer to the following data field dictionary for support in completing tabs 2 & 3
Tab 2. Fleet Description
Applicant Name	Enter the name of the applicant associated with this application, as entered into Grants.gov
SAM.gov Unique Entity ID	Enter the SAM.gov Unique Entity ID (UEI) associated with this applicant. The SAM.gov UEI is a 12-character alphanumeric ID assigned to the applying entity by SAM.gov
Project Title	Enter the name of the project's title, as entered into Grants.gov
Table 1. CURRENT VEHICLE INFORMATION
1a. Basic Fleet Information
Group Name	Enter the name of the vehicle group to which the vehicle described on this row of the table belongs; this may refer to a group of vehicles referenced in the application or a fleet to which the vehicle belongs.
Current Fleet Owner	Enter the name of the current vehicle owner
1b. Current Vehicle Information
Vehicle Type (Select from dropdown)	Select the vehicle type from the dropdown menu; options include: Long Haul - Single Unit, Long Haul - Combination, Short Haul - Single Unit, Short Haul - Combination, Refuse Hauler, School Bus, and Transit Bus
Vehicle Class (Select from dropdown)	Select Vehicle Class from dropdown menu: Class 6, Class 7
Vehicle Vocation (select from dropdown)	Select Vehicle Vocation from dropdown menu: Delivery, Drayage, Emergency, Long Haul, Other, Refuse Hauler, School Bus, Shuttle Bus, Transit Bus, Utility
Vehicle Group Sector (select from dropdown)	Select Vehicle Group Sector from dropdown menu: Agriculture, Airport, Construction, Freight, Industrial, Mining, Municipal, Port, Railyard, School Bus
Vehicle Identification Number	Enter the VIN number for each vehicle.
Vehicle Manufacturer	Enter the manufacturer of the existing vehicle.
Vehicle Model	Enter the model of the existing vehicle.
Baseline Vehicle Model Year	Enter the model year of the existing vehicle.
Baseline Engine Fuel Type (select from dropdown)	Select the type of fuel that is currently being used (prior to upgrade); options include: USLD (diesel), Biodiesel 5, Biodiesel 20, CNG (ft3), CNG (lbs), LNG, LPG/Propane, Gasoline
Engine Family Name	Enter the Engine Family name of the existing engine. NOTE: unregulated engines will not have an Engine Family Name. If unregulated, then enter "NA"
1c. Current Vehicle Activity Information
GVWR	Enter the gross vehicle weight rating (GVWR) of the existing vehicle.
Annual Miles Traveled	Enter the average number of vehicle miles traveled per year per vehicle, using the average for the prior 2 years. Please see the NOFO section III.D.2 which describes the minimum mileage required.
Annual Idling Hours	Enter the average number of hours the vehicle idles per year, using the average for the prior 2 years.
Odometer	Enter the existing vehicle's current odometer reading, in miles.
Annual Amount of Fuel Used	Enter the amount of fuel used in gallons per year.
1d. Current Vehicle Place of Performance
Primary Place of Performance
School District Name (if applicable)	Enter the name of the school district in which the vehicle to be scrapped, sold, or donated has operated in.
NCES ID (if applicable)	Enter the name of the National Center for Education Statistics (NCES) ID associated with the school district in which the vehicle to be scrapped, sold, or donated has operated in. If you are unsure of the district's NCES ID, you can search for the district at https://nces.ed.gov/ccd/districtsearch/.
State (select from dropdown)	Select the two letter postal code for the state from the dropdown menu in which the vehicle to be scrapped, sold, or donated has operated in. Note: the state field is required to enter the specific county field.
County (select from dropdown)	Enter the county in which the vehicle to be scrapped, sold, or donated has operated. Note: the list of counties will not populate until the state is selected.
Percentage of Time operated in County	Enter a value from 0 to 1, where 1 = 100%, to reflect the estimated percentage of time this vehicle operated in the listed county.
Place of Performance: City	Enter the city in which the vehicle to be scrapped, sold, or donated has operated in.
Zip Code(s)	Enter the zip codes where the vehicle operates; if there is more than one, separate using a semicolon (ex: 12345; 98765)
Secondary Place of Performance (if applicable)
School District Name (if applicable)	Enter the name of the school district in which the vehicle to be scrapped, sold, or donated has operated in.
NCES ID (if applicable)	Enter the name of the National Center for Education Statistics (NCES) ID associated with the school district in which the vehicle to be scrapped, sold, or donated has operated in. If you are unsure of the district's NCES ID, you can search for the district at https://nces.ed.gov/ccd/districtsearch/.
State (select from dropdown)	Select the two letter postal code for the state from the dropdown menu in which the vehicle to be scrapped, sold, or donated has operated in. Note: the state field is required to enter the specific county field.
County (select from dropdown)	Enter the county in which the vehicle to be scrapped, sold, or donated has operated. Note: the list of counties will not populate until the state is selected.
Percentage of Time operated in County	Enter a value from 0 to 1, where 1 = 100%, to reflect the estimated percentage of time this vehicle operated in the listed county.
Place of Performance: City	Enter the city in which the vehicle to be scrapped, sold, or donated has operated in.
Zip Code(s)	Enter the zip codes where the vehicle operates; if there is more than one, separate using a semicolon (ex: 12345; 98765)
Additional Location Details (if applicable)
Additional Counties where Vehicle Operates	List the county name and state for additional counties where the vehicle operates; if there are more than one, separate using a semicolon (e.g., St. Lucie County, FL; Martin County, FL)
% of time operated in each Additional County	List the estimated percent of time operated in each additional county; if there are more than one, separate using parenthesis and semicolons (e.g., St. Lucie County (10%); Martin County (5%))
1e. Vehicle Disposition Process
Anticipated Vehicle Disposition Method	Select a vehicle disposition option from dropdown menu; options include: Scrapped, Sold, Donated
If sold or donated, provide the state in which the vehicle is expected to primarily operate (if known)	Select the state from the dropdown menu. Note: the state field is required to enter the specific county field.
If sold or donated, provide the county in which the vehicle is expected to primarily operate (if known)	Select the county from the dropdown menu. Note: the list of counties will not populate until the state is selected.
Table 2. New Replacement Vehicle Information
2a. Upgrade Vehicle Information
Year of Upgrade Action:	Enter the year the upgrade is anticipated to happen.
New Vehicle Fleet Owner	Enter the name of the new vehicle fleet owner
New Vehicle Class (select from dropdown)	Select Vehicle Class from dropdown menu: Class 6, Class 7
New Vehicle Fuel Type:	Select the fuel type of the new vehicle: Battery Electric, Fuel Cell Electric
New Vehicle Manufacturer:	Enter the manufacturer of the new vehicle.
New Vehicle Model:	Enter the model of the new vehicle.
New Vehicle GVWR:	Enter the gross vehicle weight rating (GVWR) of the new vehicle.
Capable of Bidirectional Charging? (Yes/No/NA)	Use the dropdown menu to select whether the vehicle will be capable of bidirectional charging.
Estimate Range in Miles	Enter the estimated range in miles for the zero-emission vehicle.
2b. Upgrade Vehicle Information
Upgrade Cost per Bus	Enter the cost of vehicle in dollars per unit.
Total EPA Funds Expended Per Vehicle	Enter the EPA funds expended per vehicle in dollars per unit.
2c. New Vehicle Place(s) of Performance
Primary Place of Performance
School District Name (if applicable)	Enter the name of the school district in which the new vehicle is expected to operate in.
NCES ID (if applicable)	Enter the name of the National Center for Education Statistics (NCES) ID associated with the school district in which the new vehicle is expected to operate in. If you are unsure of the district's NCES ID, you can search for the district at https://nces.ed.gov/ccd/districtsearch/.
State (select from dropdown)	Select the two letter postal code for the state from the dropdown menu in which the new vehicle is expected to operate in. Note: the state field is required to enter the specific county field.
County (select from dropdown)	Enter the county in which the new vehicle is expected to operate in. Note: the list of counties will not populate until the state is selected.
Percentage of Time operated in County	Enter a value from 0 to 1, where 1 = 100%, to reflect the estimated percentage of time this vehicle is expected to operate in the listed county.
Place of Performance: City	Enter the city in which the new vehicle is expected to operate in
Zip Code(s)	Enter the zip codes where the vehicle operates; if there is more than one, separate using a semicolon (ex: 12345; 98765)
Secondary Place of Performance (if applicable)
School District Name (if applicable)	Enter the name of the school district in which the new vehicle is expected to operate in.
NCES ID (if applicable)	Enter the name of the National Center for Education Statistics (NCES) ID associated with the school district in which the new vehicle is expected to operate in. If you are unsure of the district's NCES ID, you can search for the district at https://nces.ed.gov/ccd/districtsearch/.
State (select from dropdown)	Select the two letter postal code for the state from the dropdown menu in which the new vehicle is expected to operate in. Note: the state field is required to enter the specific county field.
County (select from dropdown)	Enter the county in which the new vehicle is expected to operate in. Note: the list of counties will not populate until the state is selected.
Percentage of Time operated in County	Enter a value from 0 to 1, where 1 = 100%, to reflect the estimated percentage of time this vehicle is expected to operate in the listed county.
Place of Performance: City	Enter the city in which the new vehicle is expected to operate in
Zip Code(s)	Enter the zip codes where the vehicle operates; if there is more than one, separate using a semicolon (ex: 12345; 98765)
Additional Location Details (if applicable)
Additional Counties where Vehicle Operates	List the county name and state for additional counties where the vehicle operates; if there are more than one, separate using a semicolon (e.g., St. Lucie County, FL; Martin County, FL)
% of time operated in each Additional County	List the estimated percent of time operated in each additional county; if there are more than one, separate using parenthesis and semicolons (e.g., St. Lucie County (10%); Martin County (5%)
2d. New Vehicle Place(s) BABA Compliance
Is a waiver being used to fulfill BABA compliance for this vehicle?	Please use the dropdown menu to select which of the following best describes how this vehicle's compliance with Buy America Build America (BABA) will be fulfilled. Options include: No - Infrastructure meets all BABA requirements; Yes - EPA's De Minimis Waiver; Yes - EPA's Small Project Waiver; Yes - EPA's Pacific Island Territories General Applicability Waiver; Yes - Project-Level Waiver; and Unsure
Tab 3. INFRASTRUCTURE
Table 3. Electric Vehicle Service Equipment
3a. EVSE Equipment Information Overview
Type of Charger	Enter the type of charger, either Level 2 (AC charging up to 19.2 kW) or DC Fast Charging.
If Level 2, is it ENERGY STAR certified	Confirm and select yes if applicable. Please see https://www.energystar.gov/
EVSE Manufacturer	Enter the manufacturer of the charging equipment
EVSE Model	Enter the model name of the charging equipment.
EVSE Manufacture Year	Enter the year the charging equipment was manufactured.
EVSE Maximum Output Power (kW)	Enter the maximum power output of the charging equipment, measured in kilowatts.
Number of Plugs on EVSE	Enter the number of plugs installed on each unit of the charging equipment.
Is the EVSE Capable of Bidirectional Charging?	Select yes or no into the cell to specify whether the charging equipment is capable of bidirectional charging.
Will the Bus and EVSE be Used for V2G?	Select yes or no into the cell to specify whether the vehicles and charging equipment will be used for vehicle-to-grid (V2G) services.
Number of EVSE Units	Enter the quantity of charging equipment unit acquisition.
EVSE Equipment Cost only Per Unit:	Enter the cost of the charging equipment per unit acquisition.
Total EPA Funds Expended Per EVSE Unit	Enter the total EPA funds expended for charging equipment per unit acquisition.
Total EPA Funds Expended for EVSE	Autopopulated field: This field multiplies the number of EVSE units by the Total EPA Funds Expended per EVSE Unit to calculate the total of EPA funds expended for EVSE acquisition
3b. Location of EV Infrastructure
State (select from dropdown)	Select the two letter postal code for the state from the dropdown menu in which the new vehicle is expected to operate in. Note: the state field is required to enter the specific county field.
County (select from dropdown)	Enter the county in which the new vehicle is expected to operate in. Note: the list of counties will not populate until the state is selected.
City	Enter the city in which the charging equipment will be located.
Zip Code	Enter the zip code in which the charging equipment will be located.
Street Address	Enter the street address in which the charging equipment will be located.
3c. Owners & Anticipated Users of EVSE
Who will own the charger?	Enter the name of the school district or organization that will own the charging equipment.
Anticipated User(s) of the charger	Enter the name(s) of the organization(s) that are anticipated to regularly use the charging equipment.
If serving school districts, will the EVSE serve multiple school districts within this project?	Select from dropdown: Yes, No, or NA- School Districts not served by this equipment
Name of the School District(s) the EVSE will serve (if applicable; use a semicolon between school districts)	Enter the name(s) of school district(s) the EVSE is expected to serve. Use a semicolon to separate entries when entering multiple districts.
NCES ID of School District that the EVSE will serve (if applicable; use a semicolon between school districts)	Enter the NCES ID(s) of school district(s) the EVSE is expected to serve. Use a semicolon to separate entries when entering multiple districts.
3d. Infrastructure Installation Information
Total Funds Expended Installation Cost	Enter the total installation costs for the charging equipment for the EV infrastructure group column.
Total EPA Funds Expended Installation Cost	Enter the total EPA funds expended for installation costs for the charging equipment for the EV infrastructure group column.
Does the Infrastructure Equipment Cost Include Installation?	Please enter yes or no into the cell to specify whether the indicated cost of the charging equipment above includes any installation expenses.
3e. EVSE Cost Summary
Total EPA Funds Expended on EVSE Equipment and Installation	Automated cell that will calculate the total EPA Funds expended for the charging equipment and installation for an EV Infrastructure Group.
Total Funds Expended on EVSE Equipment and Installation	Automated cell that will calculate the total Funds expended for the charging equipment and installation for an EV Infrastructure Group.
3f. BABA Compliance
Is a waiver being used to fulfill BABA compliance for this EVSE?	Please use the dropdown menu to select which of the following best describes how this infrastructure's compliance with Buy America Build America (BABA) will be fulfilled. Options include: No - Infrastructure meets all BABA requirements; Yes - EPA's De Minimis Waiver; Yes - EPA's Small Project Waiver; Yes - EPA's Pacific Island Territories General Applicability Waiver; Yes - Project-Level Waiver
Table 4. Solar and Wind Power Generation Equipment
4a. Solar and Wind Power Generation Equipment Information Overview
Type of energy generation	Select a type of energy generation, solar or wind.
Manufacturer of Solar or Wind Power Generation	Enter the name of the manufacturer of the on-site power generation equipment
Model of Solar or Wind Power Generation	Enter the model name of the on-site power generation equipment
Manufacture Year of Solar or Wind Power Generation	Enter the manufacture year of the on-site power generation equipment
Generation Capacity of the system (please indicate kW or MW)	Enter the generation capacity of the system as either kW or MW. Please indicate unit of measurement.
Total Estimated Acquisition Cost Per Power Generation System	Enter the total estimated cost for the acquisition of each unit of equipment
Total EPA Funds Requested Per Power Generation System	Enter the EPA funds requested for the acquisition of each unit of equipment
Total Estimated Cost for Installation	Enter the total estimated cost for the installation of each unit of equipment
Total EPA Funds Requested for Installation	Enter the EPA funds requested for the installation of each unit of equipment
Total Estimated Cost of Equipment and Installation	Autopopulated field: this field sums the total entered for estimated costs of acquisition and installation of this equipment
Total EPA Funds Requested for Equipment and Installation	Autopopulated field: this field sums the total entered for total EPA funds requested for the acquisition and installation of this equipment
4b. Location of Solar and Wind Power Generation Infrastructure
State	Enter the state in which the On-Site Power Generation Infrastructure will be installed from the dropdown menu
County	Enter the county in which the On-Site Power Generation Infrastructure will be installed from the dropdown menu
City	Enter the city in which the On-Site Power Generation Infrastructure will be installed
Zip Code	Enter the zip code in which the On-Site Power Generation Infrastructure will be installed
Street Address	Enter the street address in which the On-Site Power Generation Infrastructure will be installed
4c. Ownership and Use of Solar and Wind Power Generation Infrastructure
Who owns the equipment?	Enter the name(s) of the organization(s) that own the equipment
Anticipated Users of Solar or Wind Power Generation Infrastructure	Enter the name(s) of the entities and/or organizations that are anticipated to use this equipment
If serving school districts, Name of the School District(s) the Solar or Wind Power Generation will serve	If anticipated users are school districts, provide the name of the districts the On-Site Power Generation equipment will serve; in the event that multiple districts are served, please include a semicolon between district names
If serving school districts, NCES ID of School District that the Solar or Wind Power Generation will serve	If anticipated users are school districts, provide the NCES ID of the districts the On-Site Power Generation equipment will serve; in the event that multiple districts are served, please include a semicolon between NECS IDs
4d. BABA Compliance
Is a waiver being used to fulfill BABA compliance for the Solar or Wind Power Generation?	Please use the dropdown menu to select which of the following best describes how this infrastructure's compliance with Buy America Build America (BABA) will be fulfilled. Options include: No - Infrastructure meets all BABA requirements; Yes - EPA's De Minimis Waiver; Yes - EPA's Small Project Waiver; Yes - EPA's Pacific Island Territories General Applicability Waiver; Yes - Project-Level Waiver
Table 5. Battery Energy Storage System (BESS) Equipment Information
5a. BESS Overview
Type of Battery	Use the dropdown menu to select the type of battery in this BESS. Options include: Lithium-Ion; Lead-Acid; Flow; and Flywheels
Manufacturer of BESS	Enter the name of the manufacturer of the battery energy storage system equipment
Model of BESS	Enter the model name of the battery energy storage system equipment
Manufacture Year of BESS	Enter the manufacture year of the battery energy storage system equipment
Energy Capacity (please indicate kWh or MWh)	Enter the generation capacity of the system as either kW or MW. Please indicate unit of measurement.
Total Estimated Acquisition Cost Per Unit of Equipment:	Enter the total estimated cost for the acquisition of each unit of equipment
Total EPA Funds Requested Per Unit	Enter the EPA funds requested for the acquisition of each unit of equipment
Total Estimated Cost for Installation:	Enter the total estimated cost for the installation of each unit of equipment
Total EPA Funds Requested for Installation:	Enter the EPA funds requested for the installation of each unit of equipment
Total Estimated Cost for Equipment and Installation	Autopopulated field: this field sums the total entered for estimated costs of acquisition and installation of this equipment
Total EPA Funds Requested for Equipment and Installation	Autopopulated field: this field sums the total entered for total EPA funds requested for the acquisition and installation of this equipment
5b. Location of BESS Infrastructure
State	Enter the state in which the On-Site Power Generation Infrastructure will be installed from the dropdown menu
County	Enter the county in which the On-Site Power Generation Infrastructure will be installed from the dropdown menu
City	Enter the city in which the battery energy storage system Infrastructure will be installed
Zip Code	Enter the zip code in which the battery energy storage system Infrastructure will be installed
Street Address	Enter the street address in which the battery energy storage system Infrastructure will be installed
5c. Ownership and Use of BESS Infrastructure
Who owns the equipment?	Enter the name(s) of the organization(s) that own the equipment
Anticipated Users of BESS	Enter the name(s) of the entities and/or organizations that are anticipated to use this equipment
If serving school districts, Name of the School District the BESS will serve	If anticipated users are school districts, provide the name of the districts the battery energy storage system equipment will serve; in the event that multiple districts are served, please include a semicolon between district names
If serving school districts, NCES ID of School District that the BESS will serve	If anticipated users are school districts, provide the NCES ID of the districts the battery energy storage system equipment will serve; in the event that multiple districts are served, please include a semicolon between NECS IDs
5d. BABA Compliance
Is a waiver being used to fulfill BABA compliance for the BESS?	Please use the dropdown menu to select which of the following best describes how this infrastructure's compliance with Buy America Build America (BABA) will be fulfilled. Options include: No - Infrastructure meets all BABA requirements; Yes - EPA's De Minimis Waiver; Yes - EPA's Small Project Waiver; Yes - EPA's Pacific Island Territories General Applicability Waiver; Yes - Project-Level Waiver
Additional Questions
Are there any other infrastructure projects, including hydrogen fueling projects, associated with this grant that are not listed above?	Select Yes or No from dropdown menu to reflect if the applicant's project will feature any other infrastructure components eligible for funding by this program.
If no, please leave this section blank. If yes, please provide details in the box below on the infrastructure project and describe how BABA compliance was determined. For hydrogen fueling projects, please provide as much detail as known or anticipated at time of application.	For projects that include additional eligible infrastructure components, provide details in the box below on the infrastructure project, equipment type, manufacturer, anticipated cost, location, and describe how BABA compliance was determined. For hydrogen fueling projects, please provide as much detail as known or anticipated at time of application, including: the type of station (gas or liquid), where hydrogen will be stored (above or below ground), the total hydrogen storage capacity (in kg), the estimated annual hydrogen to be dispensed (in kg), the hydrogen generation pathway (Options include: Steam Reforming - Natural Gas, Steam Reforming with Carbon Capture & Storage - Natural Gas, Methane cracking - Natural Gas, Gasification - Coal, Gasification with Carbon Capture & Storage - Coal, Gasification - Biomass, Gasification with Carbon Capture & Storage - Biomass, Electrolysis - Electric Grid Mix, Electrolysis - Renewable Energy, Fermentation - Biomass, Thermal water splitting - Nuclear, Thermal water splitting - Renewables, Purchased from Vendor, and Unknown), the total cost for acquisition of each eligible component (e.g., fueling pedestals, tanks, compressors, cooling system, etc.), the total funds requested for each eligible component, the total cost for installation of the system, the total funds requested for installation, and any other eligible expenses related to hydrogen fueling projects.