Information Collection

State, Local or Tribal Government

IC 264500 under ICR 202401-2060-007 · OMB 2060-0754.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2060-0754 can be found here:

2025-08-01 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5900-679 State, Local or Tribal Government	Form and Instruction
5900-679 Clean Ports Supplemental Application Template M_5900-679_Clean Ports Supplemental Application Template.xlsx	Form and Instruction
5900-679 Clean Ports Supplemental Application Template EPA Form Number 5900-679_Clean Ports Supplemental Application Template.xlsx	Form and Instruction
5900-680 CSB Supplemental Application Template P_5900-680_CSB Supplemental Application Template.xlsx	Form and Instruction
5900-680 CSB Supplemental Application Template P_5900-680_CSB Supplemental Application Template.xlsx	Form and Instruction
5900-681 DERA Supplemental Application Template U_5900-681_DERA Supplemental Application Template.xlsx	Form and Instruction
5900-681 DERA Supplemental Application Template U_5900-681_DERA Supplemental Application Template.xlsx	Form and Instruction
5900-682 CHDV Eligibility and Scrappage Statement I_5900-682_CHDV Eligibility and Scrappage Statement.pdf	Form and Instruction
5900-682 CHDV Eligibility and Scrappage Statement I_5900-682_CHDV Eligibility and Scrappage Statement.pdf	Form and Instruction
5900-683 CHDV Project Reporting Template J_5900-683_CHDV Project Reporting Template.xlsx	Form and Instruction
5900-683 CHDV Project Reporting Template J_5900-683_CHDV Project Reporting Template.xlsx	Form and Instruction
5900-684 TCD Scrappage Statement V_5900-684_TCD Scrappage Statement.pdf	Form and Instruction
5900-684 TCD Scrappage Statement V_5900-684_TCD Scrappage Statement.pdf	Form and Instruction
5900-685 TCD Utility Partnership Agreement W_5900-685_TCD Utility Partnership Agreement.pdf	Form and Instruction
5900-685 TCD Utility Partnership Agreement EPA Form Number 5900-685_TCD Utility Partnership Agreement.pdf	Form and Instruction
5900-686 CSB Eligibility and Scrap Sell Donate Statement N_5900-686_CSB Eligibility and Scrap Sell Donate Statement.pdf	Form and Instruction
5900-686 CSB Eligibility and Scrap Sell Donate Statement N_5900-686_CSB Eligibility and Scrap Sell Donate Statement.pdf	Form and Instruction
5900-687 DERA Eligibility Statement R_5900-687_DERA Eligibility Statement.pdf	Form and Instruction
5900-687 DERA Eligibility Statement R_5900-687_DERA Eligibility Statement.pdf	Form and Instruction
5900-688 DERA Scrappage Statement T_5900-688_DERA Scrappage Statement.pdf	Form and Instruction
5900-688 DERA Scrappage Statement T_5900-688_DERA Scrappage Statement.pdf	Form and Instruction
5900-689 CHDV Supplemental Application Template K_5900-689_CHDV Supplemental Application Template.xlsx	Form and Instruction
5900-689 CHDV Supplemental Application Template EPA Form Number 5900-689_CHDV Supplemental Application Template.xlsx	Form and Instruction
5900-690 Clean Ports Project Reporting Template L_5900-690_Clean Ports Project Reporting Template.xlsx	Form and Instruction
5900-690 Clean Ports Project Reporting Template L_5900-690_Clean Ports Project Reporting Template.xlsx	Form and Instruction
5900-691 DERA Project Reporting Template S_5900-691_DERA Project Reporting Template.xlsx	Form and Instruction
5900-691 DERA Project Reporting Template S_5900-691_DERA Project Reporting Template.xlsx	Form and Instruction
5900-692 CSB Project Reporting Template O_5900-692_CSB Project Reporting Template.xlsx	Form and Instruction
5900-692 CSB Project Reporting Template O_5900-692_CSB Project Reporting Template.xlsx	Form and Instruction
5900-693 CSB Utility Partnership Statement Q_5900-693_CSB Utility Partnership Statement.pdf	Form and Instruction
5900-693 CSB Utility Partnership Statement Q_5900-693_CSB Utility Partnership Statement.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State, Local or Tribal Government

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 49 CFR 673 2 CFR 200

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5900-679	Clean Ports Supplemental Application Template	EPA Form Number 5900-679_Clean Ports Supplemental Application Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-680	CSB Supplemental Application Template	P_5900-680_CSB Supplemental Application Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-681	DERA Supplemental Application Template	U_5900-681_DERA Supplemental Application Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-682	CHDV Eligibility and Scrappage Statement	I_5900-682_CHDV Eligibility and Scrappage Statement.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-683	CHDV Project Reporting Template	J_5900-683_CHDV Project Reporting Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-684	TCD Scrappage Statement	V_5900-684_TCD Scrappage Statement.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-685	TCD Utility Partnership Agreement	EPA Form Number 5900-685_TCD Utility Partnership Agreement.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-686	CSB Eligibility and Scrap Sell Donate Statement	N_5900-686_CSB Eligibility and Scrap Sell Donate Statement.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-687	DERA Eligibility Statement	R_5900-687_DERA Eligibility Statement.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-688	DERA Scrappage Statement	T_5900-688_DERA Scrappage Statement.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-689	CHDV Supplemental Application Template	EPA Form Number 5900-689_CHDV Supplemental Application Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-690	Clean Ports Project Reporting Template	L_5900-690_Clean Ports Project Reporting Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-691	DERA Project Reporting Template	S_5900-691_DERA Project Reporting Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-692	CSB Project Reporting Template	O_5900-692_CSB Project Reporting Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-693	CSB Utility Partnership Statement	Q_5900-693_CSB Utility Partnership Statement.pdf	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 229

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,595	1,595
Annual IC Time Burden (Hours)	11,752	11,752
Annual IC Cost Burden (Dollars)	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.