State Government

Diesel Emissions Reduction Act (DERA) Rebate Program (Renewal)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2060-0686 can be found here:

Documents and Forms

Document Name Document Type
Form 5600-261 State Government Form and Instruction
5600-260 Rebate Application fy18-clean-diesel-rebate-application.pdf www.epa.gov/sites/production/files/2018-10/... Form and Instruction
5600-261 Rebate Payment Request Attachment B- Payment Request Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	State Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5600-261	Rebate Payment Request	Attachment B- Payment Request Form.pdf		Yes	Yes	Fillable Printable
Form and Instruction	5600-260	Rebate Application	fy18-clean-diesel-rebate-application.pdf	https://www.epa.gov/sites/production/files/2018-10/...	Yes	Yes	Fillable Printable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	32	-649	681
Annual IC Time Burden (Hours)	108	-2,276	2,384
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.