Information Collection

State, Local or Tribal Government

IC 264500 under ICR 202411-2060-001 · OMB 2060-0754.

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
Form 5900-679 G_Clean Ports Supplemental Application Template State, Local or Tribal Government	Form and Instruction
Form 5900-680 H_CSB Supplemental Application Template State, Local or Tribal Government	Form and Instruction
Form 5900-681 I_DERA Supplemental Application Template State, Local or Tribal Government	Form and Instruction
Form 5900-682 J_CHDV Eligibility and Scrappage Statement State, Local or Tribal Government	Form and Instruction
Form 5900-683 K_Clean Heavy Duty Vehicle Project Reporting Template State, Local or Tribal Government	Form and Instruction
Form 5900-684 L_Clean Ports Scrappage Evidence Statement State, Local or Tribal Government	Form and Instruction
Form 5900-685 M_Utility Partnership Agreement State, Local or Tribal Government	Form and Instruction
Form 5900-686 N_CSB Eligibility and Scrap Sell Donate Statement State, Local or Tribal Government	Form and Instruction
Form 5900-687 O_DERA Eligibility Statement State, Local or Tribal Government	Form and Instruction
Form 5900-688 P_DERA Scrappage Statement State, Local or Tribal Government	Form and Instruction
Form 5900-689 Q_CHDV Supplemental Application Template State, Local or Tribal Government	Form and Instruction
Form 5900-691 R_DERA Project Reporting Template State, Local or Tribal Government	Form and Instruction
Form 5900-692 S_Clean School Bus Program Project Reporting Template State, Local or Tribal Government	Form and Instruction
Form 5900-693 T_CSB Utility Partnership Agreement State, Local or Tribal Government	Form and Instruction
Form PFN5900-720 U_Clean Ports Climate and Air Quality Planning Project State, Local or Tribal Government	Form and Instruction
Form PFN5900-721 V_Clean Ports Zero Emissions Technology Project Report State, Local or Tribal Government	Form and Instruction
Form PFN5900-722 W_Funding Program Recipient Story Form State, Local or Tribal Government	Form and Instruction
Form PFN5900-718 X_Clean Ports Scrappage Eligibility Statement State, Local or Tribal Government	Form and Instruction
Form PFN5900-719 Y_Clean Ports Technology Deployment Evidence Statement State, Local or Tribal Government	Form and Instruction
5900-679 G_Clean Ports Supplemental Application Template G_5900-679_Clean Ports Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-679 G_Clean Ports Supplemental Application Template G_5900-679_Clean Ports Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-680 H_CSB Supplemental Application Template H_5900-680_CSB Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-680 H_CSB Supplemental Application Template H_5900-680_CSB Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-681 I_DERA Supplemental Application Template I_5900-681_DERA Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-681 I_DERA Supplemental Application Template I_5900-681_DERA Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-682 J_CHDV Eligibility and Scrappage Statement J_5900-682_CHDV Eligibility and Scrappage Statement_2025.03.28.pdf	Form and Instruction
5900-682 J_CHDV Eligibility and Scrappage Statement J_5900-682_CHDV Eligibility and Scrappage Statement_2025.03.28.pdf	Form and Instruction
5900-683 K_Clean Heavy Duty Vehicle Project Reporting Template K_599-683_Clean Heavy Duty Vehicle Project Reporting Template_7_2025.03.28.xlsx	Form and Instruction
5900-683 K_Clean Heavy Duty Vehicle Project Reporting Template 5900-683 app-k-chdv-grant-project-report- template_2025.08.01.xlsx	Form and Instruction
5900-684 L_Clean Ports Scrappage Evidence Statement L_5900-684_Clean Ports Scrappage Evidence Statement_2025.03.28.pdf	Form and Instruction
5900-684 L_Clean Ports Scrappage Evidence Statement L_5900-684_Clean Ports Scrappage Evidence Statement_2025.03.28.pdf	Form and Instruction
5900-685 M_Utility Partnership Agreement M_5900-685_Utility Partnership Agreement_2025.03.28.pdf	Form and Instruction
5900-685 M_Utility Partnership Agreement M_5900-685_Utility Partnership Agreement_2025.03.28.pdf	Form and Instruction
5900-686 N_CSB Eligibility and Scrap Sell Donate Statement N_5900-686_CSB Eligibility and Scrap Sell Donate Statement_2025.03.28.pdf	Form and Instruction
5900-686 N_CSB Eligibility and Scrap Sell Donate Statement N_5900-686_CSB Eligibility and Scrap Sell Donate Statement_2025.03.28.pdf	Form and Instruction
5900-687 O_DERA Eligibility Statement O_5900-687_DERA Eligibility Statement_2025.03.28.pdf	Form and Instruction
5900-687 O_DERA Eligibility Statement O_5900-687_DERA Eligibility Statement_2025.03.28.pdf	Form and Instruction
5900-688 P_DERA Scrappage Statement P_5900-688_DERA Scrappage Statement_2025.03.28.pdf	Form and Instruction
5900-688 P_DERA Scrappage Statement P_5900-688_DERA Scrappage Statement_2025.03.28.pdf	Form and Instruction
5900-689 Q_CHDV Supplemental Application Template Q_5900-689_CHDV Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-689 Q_CHDV Supplemental Application Template Q_5900-689_CHDV Supplemental Application Template_2025.03.28.xlsx	Form and Instruction
5900-691 R_DERA Project Reporting Template R_5900-691_DERA Project Reporting Template_2025.3.28.xlsx	Form and Instruction
5900-691 R_DERA Project Reporting Template R_5900-691_DERA Project Reporting Template_2025.3.28.xlsx	Form and Instruction
5900-692 S_Clean School Bus Program Project Reporting Template S_5900-692_Clean School Bus Program Project Reporting Template_2025.03.28.xlsm	Form and Instruction
5900-692 S_Clean School Bus Program Project Reporting Template S_5900-692_Clean School Bus Program Project Reporting Template_2025.03.28.xlsm	Form and Instruction
5900-693 T_CSB Utility Partnership Agreement T_5900-693_CSB Utility Partnership Agreement_2025.03.28.pdf	Form and Instruction
5900-693 T_CSB Utility Partnership Agreement T_5900-693_CSB Utility Partnership Agreement_2025.03.28.pdf	Form and Instruction
PFN5900-720 U_Clean Ports Climate and Air Quality Planning Project U_PFN5900-720_Clean Ports Climate and Air Quality Planning Project Reporting Template.xlsx	Form and Instruction
PFN5900-720 U_Clean Ports Climate and Air Quality Planning Project 5900-720 app-u-clean-ports-report-template_2025.08.01.xlsx	Form and Instruction
PFN5900-721 V_Clean Ports Zero Emissions Technology Project Report V_PFN5900-721_Clean Ports Zero Emissions Technology Project Reporting Template.xlsx	Form and Instruction
PFN5900-721 V_Clean Ports Zero Emissions Technology Project Report 5900-721 app-v-clean-ports-zero-emission-tech-report-template_2025.08.01.xlsx	Form and Instruction
PFN5900-722 W_Funding Program Recipient Story Form 5900-722 funding-recipient-story-form_revised_2025.07.29.pdf	Form and Instruction
PFN5900-722 W_Funding Program Recipient Story Form 5900-722 funding-recipient-story-form_revised_2025.07.29.pdf	Form and Instruction
PFN5900-718 X_Clean Ports Scrappage Eligibility Statement X_PFN5900-718_Clean Ports Scrappage Eligibility Statement.pdf	Form and Instruction
PFN5900-718 X_Clean Ports Scrappage Eligibility Statement X_PFN5900-718_Clean Ports Scrappage Eligibility Statement.pdf	Form and Instruction
PFN5900-719 Y_Clean Ports Technology Deployment Evidence Statement Y_PFN5900-719_Clean Ports Technology Deployment Evidence Statement.pdf	Form and Instruction
PFN5900-719 Y_Clean Ports Technology Deployment Evidence Statement Y_PFN5900-719_Clean Ports Technology Deployment Evidence 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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 2 CFR 1500 2 CFR 200

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5900-679	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-680	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-681	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-682	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-683	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-684	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-685	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-686	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-687	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-688	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5900-689	Yes	Yes	Fillable Fileable
Form and Instruction	5900-691	Yes	Yes	Fillable Fileable
Form and Instruction	5900-692	Yes	Yes	Fillable Fileable
Form and Instruction	5900-693	Yes	Yes	Fillable Fileable
Form and Instruction	PFN5900-720	Yes	Yes	Fillable Fileable
Form and Instruction	PFN5900-721	Yes	Yes	Fillable Fileable
Form and Instruction	PFN5900-722	Yes	Yes	Fillable Fileable
Form and Instruction	PFN5900-718	Yes	Yes	Fillable Fileable
Form and Instruction	PFN5900-719	Yes	Yes	Fillable Fileable

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: 2,411

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	Previously Approved
Annual Number of Responses for this IC	804	-40	-751	1,595
Annual IC Time Burden (Hours)	6,455	-265	-5,032	11,752
Annual IC Cost Burden (Dollars)	0	658,380	-658,380	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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