5900-682 CHDV Eligibility and Scrappage Statement

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

2024 Clean Heavy-Duty Vehicles (CHDV) Grants
Sample Vehicle Eligibility and Disposition Statement
Burden Statement: 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: Please complete both Section I and Section II, below, for each vehicle selected for
replacement. Please note, there are two templates available for Section II; grantees need only fill out the
relevant template.

I. Eligibility Statement

Make

Existing Vehicle Information

Existing Engine Information
Make

Model

Model

Model Year
Model Year
Total Mileage
ID or Serial
VIN
EPA Family
GVWR
Registration/Licensing
#
Registration/Licensing
State
(If School Bus): Number of Years Bus Has Served School
(If non-School Bus): Number of Years Vehicle Has Been in
Fleet
I certify that the following statements are true regarding the existing vehicle and engine
identified above.
☐

The existing vehicle being replaced is a Class 6 or Class 7 heavy-duty highway vehicle
with a Gross Vehicle Weight Rating (GVWR) between 19,501 lbs and 33,000 lbs.
The existing vehicle being replaced is a vehicle model year 2010 or older diesel-powered
Class 6/7 vehicle that will be scrapped. If a fleet has no eligible 2010 or older diesel Class
6/7 vehicles, the existing vehicle being replaced is either:
☐ A 2010 or older non-diesel internal combustion engine Class 6/7 vehicle that
will be scrapped; OR
A 2011 or newer diesel or non-diesel internal combustion engine Class 6/7
vehicle that will be scrapped, sold, or donated.
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EPA Form Number: 5900-682

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

☐

The existing vehicle being replaced was operational at the time of application
submission. Operational vehicles should be able to start, move, and have all necessary
parts to be operational.
If the vehicle listed above is being replaced through the School Bus Sub-Program, I
certify that the following statements are true regarding the existing bus and engine
identified above:
☐ The existing vehicle being replaced is a “school bus,” defined as a passenger
motor vehicle designed to carry a driver and more than 10 passengers, that
the Secretary of Transportation decides is likely to be used significantly to
transport preprimary, primary, and secondary school students to or from
school or an event related to school. 1
☐ The existing vehicle being replaced has provided bus service to a public
school district for at least 3 days/week on average during the 2022/2023
school year at the time of applying, excluding COVID-related or disasterrelated school closures.
If the vehicle listed above is being replaced through the Other Class 6/7 Vehicles SubProgram, I certify that the following statements are true regarding the existing vehicle
and engine identified above:
The existing vehicle being replaced is a Class 6 or Class 7 heavy-duty
highway vehicle that does not meet the definition of a school bus given
above.
The existing vehicle being replaced has accumulated at least 7,000
miles/year during the two years prior to replacement. The mileage of two or
more vehicles may be combined to reach 7000 miles/year where two or
more vehicles will be scrapped and replaced with a single zero-emission
vehicle. Note, Tribal applicants, as defined by Section III.A.3 are exempted
from this mileage requirement.
If a vehicle does not meet the mileage requirement and the
applicant can demonstrate that the vehicle idles the main engine for
long periods to provide power for auxiliary apparatus (e.g.,
firetrucks or utility trucks), the existing vehicle to be replaced must
have idled for at least 500 hours/year during the two years prior to
replacement.

1

49 U.S.C. § 30125, available at
https://uscode.house.gov/view.xhtml?req=(title:49%20section:30125%20edition:prelim)%20OR%20(granuleid:US
C-prelim-title49-section30125)&f=treesort&num=0&edition=prelim

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EPA Form Number: 5900-682

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

Who owned the vehicle that was replaced?
☐ Applicant

Other: Please Specify

Vehicle Owner Address:
Vehicle Owner Name (Print)

Vehicle Owner (Signature)

Date

Grantee Name

Grantee (Signature)

Date

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EPA Form Number: 5900-682

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

II. Scrappage, Sell, or Donate Statement
The 2024 Clean Heavy-Duty Vehicles (CHDV) Grants program ensures that all vehicles
participating are a vehicle model year 2010 or older diesel-powered Class 6/7 vehicle that will be
scrapped, if selected for funding. If a fleet has no eligible 2010 or older diesel Class 6/7 vehicles,
the fleet can either:
a.
Scrap 2010 or older non-diesel internal combustion engine Class 6/7 vehicles; or
b.
Scrap, sell, or donate 2011 or newer diesel or non-diesel internal combustion
engine Class 6/7 vehicles
Please refer to the CHDV Notice of Funding Opportunity (NOFO) Section III.E for more
information on scrappage, selling, or donation under the CHDV program. Grantees who are
selected for funding must complete one of the following templates below [Template A or
Template B] to certify each individual vehicle is scrapped, sold, or donated before the end of the
project period:
• Template A - Scrappage: Please complete the Template A – Vehicle Scrappage
Statement if the Vehicle on Page 1 has been scrapped.
• Template B – Sell or Donate: Please complete the Template B – Vehicle Sell or Donate
Statement if the Vehicle identified on Page 1 has been sold or donated.

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EPA Form Number: 5900-682

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

Existing Vehicle VIN:

TEMPLATE A - VEHICLE SCRAPPAGE STATEMENT

Please complete this template if the vehicle identified on Page 1 was scrapped.
I certify that on
, the above engine and chassis were permanently disabled.
Disabling the engine consisted of drilling a three-inch hole in the engine block, or of
another, pre-approved scrappage method.2 Disabling the chassis consisted of cutting
completely through the frame/frame-rails on each side of the vehicle/equipment at a point
located between the front and rear axles, or of another, pre-approved scrappage method.
The following required digital photos of the disabled engine and chassis are attached: Side
profile of the vehicle, prior to disabling; VIN; Engine label (showing serial number,
engine family number, and engine model year); Engine block, prior to hole; Engine block,
after hole; and Cut frame rails.
Who owned the vehicle that was replaced?
Applicant

Other: Please Specify

VEHICLE OWNER
Email
Phone Number
Address
Owner Name (Print)
Signature
Date
GRANTEE NAME (IF DIFFERENT THAN VEHICLE OWNER)
Grantee Name
Address
Authorized Representative
Signature
Date
DISMANTLER/SCRAPPER
Name of Business
Address
Name (Print)
Signature
Date

Recipients may request and receive EPA approval for alternative scrappage methods by submitting an
alternative scrappage plan to the regional project officer detailing how the method will destroy and/or
disable the engine.
2

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EPA Form Number: 5900-682

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

Existing Vehicle VIN:

TEMPLATE B – VEHICLE SELL OR DONATE STATEMENT

Please complete this template if the vehicle identified on Page 1 was sold or donated.
Fleets that do not have eligible vehicle model year 2010 or older diesel or non-diesel Class 6/7
vehicles to scrap and that choose to instead replace 2011 or newer Class 6/7 vehicles by donating
or selling those vehicles must retain documentation of that transaction that includes:
1.
The name of the fleet donating or selling the vehicle
2.
The name, phone number, email, and physical address for the entity taking ownership
of the vehicle
3.
The VIN of the vehicle that was donated or sold
If sold, the dollar amount of the vehicle sale
4.
5.
The date of the transaction
I certify that on
, the vehicle listed above was permanently
_ and that all five checkboxes listed above have been verified to be included
in the transaction attachment to be submitted with this template.
Other: Please Specify
Who owned the vehicle? Applicant
Was the vehicle sold or donated?
Sold
Donated
o If sold, how much was the vehicle sold for in dollars?

What was the date of transaction to donate or sell the vehicle?
What is the new location (city, zip, county, and state) within which the vehicle will operate
(include NCES ID, if sold to a school district)?
PRIOR OWNER OF VEHICLE
Email
Phone Number
Address
Owner Name (Print)
Signature
Date
GRANTEE NAME (IF DIFFERENT THAN PRIOR OWNER OF VEHICLE)
Grantee Name
Address
Authorized Representative
Signature
Date
NEW OWNER OF VEHICLE
Email
Phone Number
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EPA Form Number: 5900-682

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

Address
Name (Print)
Signature
Date

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EPA Form Number: 5900-682