2022 EPA Clean School Bus Rebate Forms Payment Request User Guide


EPA CLEAN

SCHOOL BUS

2022 EPA Clean School Bus Rebate Forms:

Payment Request User Guide

November 2022

United States
Environmental Protection
* W -i	Agency

EPA-420-B-22-049

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Table of Contents

1.	Sign In/Register	4

2.	Create/Edit a New Payment Request Form	4

2.1	Start a New Payment Request Form	5

2.2	Welcome Screen	6

2.3	Information Icons 	7

2.4	Application Information 	7

2.5	Saving and Editing Your Information 	9

2.6	Add Purchase Orders	8

2.7	Purchase Order Information 	11

2.8	Complete a Purchase Order 	12

2.9	New Bus Information 	13

2.10	Add New Bus Information 	14

2.11	Exclude a Bus	17

2.12	Complete Bus Information 	18

2.13	Infrastructure Information 	19

2.14	Signature 	20

2.15	Next Steps	21

Appendix A. Glossary	22

Appendix B. List of Fields in Payment Request Form	26

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Before You Begin



This guide will walk you through the steps needed to create, edit, submit, and view an online payment request
form for a Clean School Bus rebate application when you have been selected for an award. This guide also
includes detailed definitions of key fields found in the online form and a printable list of all fields required in
the form. Plan to spend approximately an hour completing the payment request form, depending on the
number of buses and purchase orders you need to enter.

Follow these steps to prepare for completing the payment request form:

1.	Review the glossary of terms used in the payment request form (see	).

2.	Compile all required data. Appendix E provides a printable list of all necessary data fields.

3.	Confirm the Point of Contact. Confirm the email of the person completing the payment request form
is registered as a designated Primary or Alternate Government Point of Contact, or Primary or Alternate
Electronic Point of Contact in your entity's SAM.gov account by logging on to SAM.gov. Otherwise, the
person will not be able to log into the payment request form from the system.

4.	Check your browser version. Before filling out the payment request form, make sure your web
browser version meets or exceeds the following versions:

—	Chrome 38

—	Safari 7.1

—	Internet Explorer 11

—	Firefox 13

Note: The following pages correspond to the payment request form screen sequence.

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1. Sign In/Register

Use your existing SAM.gov credentials to log in to your applicant dashboard. If you are unable to sign in,
please :lick here to refer to the instructions in the rebate application User Guide.

2. Create/Edit a New Payment Request Form

If you plan to replace old buses other than those identified in your original application, you will need to ask EPA
to re-open your application before starting your payment request form. EPA will only allow this on a case-by-
case basis, as changes can impact funding level and eligibility. To re-open your application, contact the help
desk at cleanschoolbus@epa.aov detailing the request. Be sure to provide the Rebate ID, applicant name, and
school district name. Once you have edited the application, please resubmit and EPA will re-review for errors
and completeness. Once EPA has re-approved the edited application, you can start the payment request form.

Note: Your connection to the payment request form system will time out unless you interact with the screen
at least once every 15 minutes. "Interacting" can mean entering or deleting information, or even moving your
cursor on the screen. If your connection times out, you risk losing data entered since the last save.

Ik

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2.1 Start a New Payment Request Form

After signing in using your Login.gov account, you will see the Clean School Bus Rebate Forms screen.

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Clean School Bus

Clean School Bus Rebate Forms

Clean School Bus Rebate Program
Online Rebate Application Information

csb-test@erg.com I

Your Rebate Forms

Select a button below to Edit or View an existing rebate form.

• Form Type
O Form Status

) EFT Indicator

9 Applicant
0 School District

O Updated By
O Date Updated

Application
O Selected

123456000007
1234

CSB TESTER INC.
Wounded Knee District

csb-test@erg.com
10/6/2022

O New Payment Request

Application 123456000011 CSB TESTER INC. csb-test@erg.com

Payment Request csb-test@erg.com

- Draft 11/4/2022

Application 123456000011 CSB TESTER INC. csb-test@erg.a

Payment Request csb-test@erg.a

~ Submitted 11/4/2022

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0686). Responses to this collection of information
are voluntary (Title XI, Section 71101 of the Infrastructure Investment and Jobs Act (Public Law 117-58)). 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
4.3 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.

Expiration Date: 8/31/2025

Select the "New Payment Request" button to begin.

Note: If you opened a new payment request form and then asked EPA to re-open your application to make
edits, that form will be deleted from the Clean School Bus Rebate Forms screen and you will need to start a
new payment request form once the edited application has been re-approved.

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2.2 Welcome Screen

Review the text on the Welcome screen and select "Next" to proceed.

IMote: Use of the browser's back, forward, or refresh buttons while in the payment request form will result in
loss of work. Please navigate using the "Next," "Previous," and "Save" buttons on the screen.

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Clean School Bus

Clean School Bus Rebate Forms

• Clean School Bus Rebate Program

Edit Your Payment Request

^ Rebate ID:010716

I of 6 Welcome

n of the purchase order(s) for the new school buses and eligible

Payment Request Form - Basic Information

As a rebate application award selectee, you must submit an online Payment Request Form that includes an attached si
charging infrastructure by April 28,2023.

The following information will help you complete this Payment Request Form accurately and efficiently.

• In form help text is provided below the data entry fields and in the next to the field names.

• For additional assistance, please refer to the Program Guide and supporting documents at School Bus Rebates: Clean School Bus Program, or contact the help desk at
cleanschoolbusf5iepa.gov (include the Applicant Name, Payment Request Form ID, the Rebate ID, Unique Entity Identifier (UEI), Electronic Funds Transfer (EFT) Indicator, and the School
District Name).

To complete this form, you will need the following information:

• Review your submited application (access it from the Applicant Dashboard) to confirm what buses are associated with purchase orders you will add to this form.

• The primary contact information foryour organization

• Purchase Order number and date

• Purchaser information including name, address and phone number

• Vehicle/equipment vendor information including name, address and phone number

• New bus information including make, model, model year, gross vehicle weight rating (GVWR), estimated delivery date, and purchase price

• Electric bus charging infrastructure information (if applicable), including number of Level 2 chargers and hardware costs, number of DC Fast chargers and hardware costs, and other
eligible charging infrastructure costs

• File(s) containing image of the purchase order on vendor letterhead. Acceptable file formats include .pdf, .png, .jpeg, and .jpg.

To save your work on the form, you must select the "Save" or "Next" button. You will be able to return later to finish your payment request form without losing information.

To submit your payment request form to EPA, complete alt screens and then sign and submit the form. Make sure to provide a complete signature and check the "I confirm I have provided my
signature above" box before selecting the "Submit Form" button. Your payment request form status will then be displayed on the dashboard.

Note: only Government Business (and alternate) and Electronic Business (and alternate) Points of Contact from SAM.gov can access the dashboard. The Government Business (and alternate)
and Electronic Business (and alternate) Points of Contact, and the Primary and/or Alternate Contacts will also receive a submittal email confirmation.

EPA or its authorized representatives may contact selectees to clarify any information provided in the Payment Request Form. If. upon review, the Payment Request Form is accurate and
includes all required information, EPA will issue the rebate payment to the bank account associated with the SAM.gov Unique Entity Identifier (UEI) and Electronic Funds Transfer (EFT)
Indicator associated with the application. EPA anticipates disbursing funds within approximately 60 days of the submission of a complete Payment Request Form.

I NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

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2.3 Information Icons

Hover your mouse over the information icons, found
throughout the payment request form screens, for
additional information regarding specific fields.

Applicant Name CSB TESTER

School District Prioritized? Yes

School District Name © Wounded Knee District

National Center for Education Statistics (NCES) District ID ©

Total Rebate Funds Requested In Applicatioi^^ $700,000.00

2.4 Application Information

The Primary and Alternate Contact information fields will pre-populate with information from the associated
Application. Double-check that your Primary and Alternate Contact information is correct. The information can
be edited if changes are necessary. Select "Next" to continue.

Clean School Bus Rebate Forms

csb-test@erg.com

Edit Your Payment Request

Rebate ID:010716

^^of6 Application Info

' denotes required field

Applicant Name

CSB TESTER

School District Prioritized?

Yes

School District Name 0

Wounded Knee District

National Center for Education Statistics (NCES) District ID ©

BIE0013

Total Rebate Funds Requested In Application 0

$700,000.00

Applicant Primary Contact

NOTE - Update contact information if it has changed.
Name ©'

Applicant Alternate Contact

NOTE - Update contact information if it has changed.
Name©

| Joan Smith

| Mike Doe

Title©'

Title©

| Contactee

| Contactee In Training

Business Phone Number©'

Business Phone Number©

| (123)456-7890

| (987) 654-3210

Business Email©-

Business Email ©

| primary@email.com

| alternate@email.com

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work Please navigate using the buttons at the bottom of the form.

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2.5 Saving and Editing Your Information

You can save your work while filling out the payment request form and return to it later to finish and submit.
Data entered on each screen will be saved automatically when the "Next" button is selected. In addition, you
can use the "Save" buttons to save information before proceeding to the next page.

Business Email©'

Business Email 0

primary@email.com

alternate@email.com

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

Contact Us to ask a question, provide feedback, or report a problem.

Note: Use of the browser's back, forward, or refresh buttons while in the payment request form will result in
loss of work. Please navigate using the "Next," "Previous," and "Save" buttons on the screen.

Ek

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After saving and exiting the payment request form, you can return to the Clean School Bus Rebate Forms
screen later, open the draft form by selecting the "Edit" button, and proceed by navigating to where you left
off. Selecting forms with a "Submitted" or "Selected" status will allow you to view, but not edit, your entries.

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Clean School Bus contact us

Clean School Bus Rebate Forms

• Clean School Bus Rebate Program

• Online Rebate Application Information

Search EPA.gov

csb-test@erg.com I

Your Rebate Forms

Select a button below to Edit or View an existing rebate form.

0 Form Type O UEI © Applicant O Updated By

6 Form Status 0 EFT Indicator © School District © Date Updated

010716

Application

123456000007

CSB TESTER INC.

csb-test@erg.com

0 Selected

1234

Wounded Knee District

10/6/2022

Application
0 Selected

123456000011
1234

CSB TESTER INC.
Wounded Knee District

csb-test@erg.com
8/23/2022

Payment Request
••• Draft

csb-test@erg.com
11/4/2022

¦ © View 1

010651

Application
0 Selected

123456000011
1234

CSB TESTER INC.

Winstow Residential Hall

csb-test@erg.com
8/23/2022

¦ O View 1

Payment Request
~ Submitted

csb-test@erg.com
11/4/2022

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0686). Responses to this collection of information
are voluntary (Title XI, Section 71101 of the Infrastructure Investment and Jobs Act (Public Law 117-58)). 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
4.3 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.

Expiration Date: 8/31/2025

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2.6 Add Purchase Orders

Select"+ Add a Purchase Order" to add a purchase order. A purchase order contains the information and
specifications for bus and/or electric bus charging infrastructure procured from a single vendor. Multiple
purchase orders can be added on this screen for additional vendors, for additional buses, or for electric bus
charging infrastructure.

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Clean School Bus

Clean School Bus Rebate Forms

•	Clean School Bus Rebate Program

•	Online Rebate Application Information

Edit Your Payment Request

^ Rebate 10;010716

^^of6 Purchase Orders

Add purchase order information and upload purchase orders for new buses and infrastructure (if applicable) on this screen.
* denotes required field

+ Add a Purchase Order

Search EPA.gov

csb-test@erg.com I

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

Contact Us to ask a question, provide feedback, or report a problem.

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2.7 Purchase Order Information

Fill in the number and date for the purchase
order. Select a purchase order purpose by
checking the box for "Bus" and/or "Electric
Bus Charging Infrastructure." Then select
the "Purchaser Name" using the drop-down
menu. If your purchaser's name is not listed,
select "Other" from the drop-down menu and
fill in the appropriate information. Then enter
the required data fields with the information
for the purchaser and vendor. Lastly, attach
a PDF or image of the purchase order. The
image file size must be between 1 KB and
5MB. Accepted file types include .pdf, .png,
.jpeg, and .jpg. When all fields have been
entered, click the "Complete" button for
the purchase order. Note that this button
does not save your form, and you must
click the "Save" or "Next" button to save
your information.

Add another purchase order by selecting
"+ Add a Purchase Order" at the bottom of
the screen. You may add as many purchase
orders as you need and delete or edit them
at any time. Deleting a purchase order is
permanent, so please do not do so unless
you are sure it is necessary. We encourage
you to delete purchase orders that are not
used to document new buses or electric bus
charging infrastructure to eliminate unneeded
information. You must click the "Complete"
button at the bottom of the purchase order
before moving on.

The "Cancel" button should be used to revert
back to the previously saved purchase order
if changes were made (and the "Complete"
button was not selected), or to review what
you entered for a saved purchase order.

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Clean School Bus

Clean School Bus Rebate Forms

. Clean School Bl s Reba:; I

Edit Your Payment Request

^ Rebate ID: 010716

Qofe

Purchase Orders

orders for new buses: rid in1

Purchase Order Tiiformatini

Purchase Order Purpose (Choose all that apply) * 9
Bus Flertric Rus Charging Infrastructure

Purchaser Information

Vendor Information

Purchase Order Attachment

NOTE: Use of Ihe browser back, forward, or refresh bullous will resulL in loss of work. Please navigate using llie bullous al llie bolloin of llie form.

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2.8 Complete a Purchase Order

Once you have completed your purchase orders, select "Next" to continue.

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Clean School Bus Rebate Program
Online Rebate Application Information

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Edit Your Payment Request

^ Rebate ID:010716

^^of6 Purchase Orders

Add purchase order information and upload purchase orders for new buses and infrastructure (if applicable) on this screen.
' denotes required field

Purchase Order

Purchase Order

Applicant Purchase Order Number: 1111111
Purchase Order Date: 2022-11-16
Vendor Name: 123

Note: This bus Purchase Order (PO) has not yet been assigned to a New Bus. You
can assign POs to buses on the next screen (4) ofthis form. Delete this PO if not
planning to use.

Applicant Purchase Order Number: 2222222
Purchase Order Date: 2022-11-24
Vendor Name: 234

+ Add a Purchase Order

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2.9 New Bus Information

Select "Edit" to complete the required Bus Information for each bus from your application.

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Edit Your Payment Request

^ Rebate ID:010716

of 6 Buses

This screen shows the buses that were submitted in your rebate application. Update Old Bus information and add New Replacement Bus information here.
* denotes required field

Bus Number Old Bus VIN: 34534534534543534

1 Old Bus Fuel Type: Diesel

New Bus Fuel Type: Electric

New Bus Information is Incomplete

Click the "Edit" button for this row, and complete all
included fields.

Bus Number Old Bus VIN: 34545345345343453

2 Old Bus Fuel Type: CNG

New Bus Fuel Type: Electric

New Bus Information is Incomplete

Click the "Edit" button for this row, and complete all
included fields.

Number of Buses Requested From Application 0
Number of Buses Ordered

Total Purchase Price for All Replacement Buses 0 $0.00

Total Bus Rebate Amount 0 $0.00

Total Applicant Bus Cost Responsibility 0 $0.00

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

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2.10 Add New Bus Information

The data fields associated with old and
new buses are shown in the list below,
with required data fields marked with an
asterisk. Enter the required information
then click "Complete."

1. The bus VIN is prepopulated from
the information in the Application
and is not editable. See the

Create/Edit a New Payment
Request Form if you need to
change information for an old bus
to be replaced.

2. Old Bus FuelType is prepopulated
from the information in the
Application and is not editable. See

the >eate/Edit a New Payment
Request Form section if you need
to change information for an old
bus to be replaced.

3. See information on Excluding
a Bus in Section 2.11. If a bus
is to be excluded, entering the
remaining bus information fields
for this bus is not needed.

4. Bus ModelYear is prepopulated
from the information in the
Application and is not editable. See

the >eate/Edit a New Payment
Request Form section if you need
to change information for an old
bus to be replaced.

Clean School Bus

Clean School Bus Rebate Forms

teABRlica

Edit Your Payment Request

Buses

Old Bus Information

1™°

3 ~E„ud,!„0
0 Estimated Regaining Life (years) O '

please verify wi
Q Confirm Lh

New Bus Information

JslingNewBus©*

PO#: 11111111 PO Date: 2022-11-161 Vendor Name: Electric Bus Emp

~ "i#: 1

9—
12

| New Bus Model YearC

10-

-nr

X ~ $205,000.00
» - | $350,000.00

ISi—-"1""""-".-'-01 116-"

11/19/2025 B5 25,001

ius Rebate Amount©
$235,000.00

rof Bu

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5. The Old Bus NCES District ID*

field will prepopulate with the School District ID from the application, but you may change the value
if the old bus served a different school district than the district listed on your application. The new
replacement bus must serve the school district that was listed on your application. Changing the Old
Bus NCES ID from the default value will require you to confirm that the new value is accurate. If you
need to look up an NCES ID, please click here to refer to the instructions in Section 2.10 of the rebate
application User Guide.

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6. The Estimated Remaining Life* field is for your best estimate of the years of remaining operational
life of the old bus starting from the time of application submittal. This figure should be inclusive of
the years of operation the bus may have had if not for the scrappage requirements and the years of
operation the bus may have had even if it were sold to another fleet.

7. Purchase Order Listing New Bus* In this field, select the purchase order that is associated with this
new bus from the purchase orders entered on Screen 3 with a Purchase Order Purpose of "Bus."

If you don't see the purchase order associated with this new bus, go back to Screen 3 and enter the
purchase order, or make sure you selected a Purchase Order Purpose of "Bus" if it is a purchase order
that contains new buses.

8. The Max. Rebate Amount field is read-only and displays the applicable rebate amount for this bus. If a
GVWR is provided that would reduce the awarded rebate amount, the updated value will display here.
The maximum rebate cannot increase based on information in the Payment Request Form, but it may
decrease due to a lower GVWR as noted.

9. New Bus Fuel Type is prepopulated from the information in the Application and is not editable.

10. New Bus Make* provides a list of bus manufacturers to choose from. If the manufacturer of your new
bus is not shown, choose the "Other" option and an additional field will appear allowing you to enter
the make of your new bus.

11. New Bus Purchase Price* should include the total price of the new bus and must be between
$30,000 and $700,000. The total purchase price of the ordered replacement school bus should include
tax and any eligible training/consulting/warranty line-item expenses associated with the individual bus
in the purchase order. Do not include charging infrastructure costs here.

12. New Bus ModelYear* is the manufacturing year of the new bus, which must be 2021 or later.

13. New Bus Model* is the model name (not the bus type) of the new bus.

14. The Bus Rebate Amount field is read-only and displays the amount of the designated rebate for this
bus, based on the Max. Rebate Amount and the New Bus Purchase Price.

15. The New Bus Estimated Delivery Date* field is for the best estimate of the bus delivery date
provided by the vendor. If the delivery date is past 10/31/2024, the form will let you know that an
extension is required, although this will not prevent you from submitting your payment request form.
EPA's payment request form reviewer will reach out to you to request documentation for a delivery
date extension if needed.

16. The New Bus GVWR* field is for the bus gross vehicle weight rating in pounds. The form will provide
a notice if a value entered warrants a lower rebate value. This could happen if the Rebate Application
had a GVWR of >26,000 lbs. for this bus, but the bus is actually <=26,000 lbs.

17. The Applicant Bus Cost Responsibility field is read-only and displays the amount that the applicant
will be responsible for paying, based on the Max. Rebate Amount and the New Bus Purchase Price.

-------
When editing a purchase order or providing bus information, you must click the "Complete" button (shown
below) prior to "Save" or the data will be lost. The "Cancel" button, next to the "Complete" button, should
be used to revert back to the previously saved bus information if changes were made (and the "Complete"
button was not selected), or to review what you entered for a saved purchase order.

1
4

Old Bus Information

VINO

34534534534543534

Model Year ©

1982

Old Bus Fuel Type©

Diesel

C Old Bus NCES District ID © "

The District ID above is inconsistent with
application District ID. If this is intentional,
please verify with the NCES district search tool.

Confirm the above NCES District ID change
above is accurate"

^ ~ Exclude Bus©
g Estimated Remaining Life (years) © *

New Bus Information

Purchase Order Listing New Bus © "

PO#: 1111111 PO Date: 2022-11-161 Vendor Name: Electric Bus Emporium

9

12
15

New Bus Fuel Type ©
Electric

New Bus Model Year©'

10

43

New Bus Make © '

Lion Electric Company

New Bus Model © *

New Bus Estimated Delivery Date © '

16

m

New BusGVWR©'

8

3'

Max. Rebate Amount©
$285,000.00

I New Bus Purchase Price© '

44

47

Bus Rebate Amount ©

$285,000.00

Applicant Bus Cost Responsibility ©
$65,000.00

The New Bus Est. Delivery Date is beyond
10/31/24 and will require an extension.

The GVWR entered has changed the Maximum
Rebate Amount due a change in weight class for
this bus from what was entered in the
application.

Old Bus VIN:34545345345343453
Old Bus Fuel Type: CNG
New Bus Fuel Type: Electric

Bus Excluded from Rebate

EEk

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2.11 Exclude a Bus

If a bus that was previously entered in the Rebate Application wiii not be included in your Payment Request
Form, you can select the Exclude Bus checkbox at the upper right of the Old Bus Information screen. No
further information will be required for this bus, and the costs and awards for this bus and any associated
electric charging infrastructure will not be included in totals presented elsewhere on the form.

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Environmental Protection
Agency

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Clean School Bus Rebate Forms

Search EPA.gov

CONTACT US

Online Rebate Application Information

csb-test@erg.com I

Edit Your Payment Request

^ Rebate ID:010716

^^of6 Buses

This screen shows the buses that were submitted in your rebate application. Update Old Bus information and add New Replacement Bus information here.
' denotes required field

Old Bus VIN:34534534534543534
Old Bus Fuel Type: Diesel
New Bus Fuel Type: Electric

New Bus Rebate Amount: $285,000
New Bus Purchase Price: $350,000

Old Bus Information

VINO

34545345345343453

Model Year©

1985

Old Bus Fuel Type ©

CNG

Old Bus NCES District ID O *

- Q Exclude Bus ©

Complete

N umber of Buses Requested From Application ©

Number of Buses Ordered

Total Purchase Price for All Replacement Buses©

Total Bus Rebate Amount ©

Total Applicant Bus Cost Responsibility ©

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Contact Us to ask a question, provide feedback, or report a problem.

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2.12 Complete Bus Information

Once information has been entered completely for the buses, the fields at the bottom of the page will
calculate totals based on this information. This information includes the total number buses from the
application and the number ordered, in case a bus(es) is excluded. The total price of all buses, the total rebate
amount for all buses, and the total applicant cost responsibility (if the total price is higher than the rebate
amount) are also presented.

Once your new bus information has been entered, select "Next" to continue.

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Clean School Bus

Clean School Bus Rebate Forms

•	Clean School Bus Rebate Program

•	Online Rebate Application Information

csb-test@erg.com I

Edit Your Payment Request

^ Rebate ID: 010716

^Jof6 Buses

This screen shows the buses that were submitted in your rebate application. Update Old Bus information and add New Replacement Bus information here.
' denotes required field

Bus Number	Old Bus VIN: 34534534534543534

1	Old Bus Fuel Type: Diesel

New Bus Fuel Type: Electric

New Bus Rebate Amount: $285,000
New Bus Purchase Price: $350,000

Bus Number	Old Bus VIN: 34545345345343453

2	Old Bus Fuel Type: CNG

New Bus Fuel Type: Electric

Bus Excluded from Rebate

Number of Buses Requested From Application ©

Number of Buses Ordered

Total Purchase Price for All Replacement Buses 0	$350,000.00

Total Bus Rebate Amount©	$285,000.00

Total Applicant Bus Cost Responsibility ©	$65,000.00

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

Contact Us to ask a question, provide feedback, or report a problem.

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2.13 Infrastructure Information

If any of the replacement buses have a New Bus Fuel Type of "Electric," the Infrastructure step will be
included in the Payment Request form. Enter the applicable data fields for Level 2 or DC Fast Charging
systems, as well as other eligible costs related to charging infrastructure. Level 2 charging infrastructure must
be Energy Star8 certified, and EPA encourages DC fast chargers to be listed by a Nationally Recognized Testing
Laboratory. The form will then display the following fields to provide totals based on the information entered:

Maximum Infrastructure Rebate Funds Based on Application - Prefilied based on information from
the Application, and not editable. If you excluded an old bus associated with new electric replacement
bus infrastructure rebate funds, that amount will be deducted from the Maximum Infrastructure
Rebate Funds Based on Application field.

Total of All Eligible Charging Infrastructure Costs - Calculated field summarizing the three "Cost"
fields above.

¦ Total Infrastructure Rebate Amount -The amount of the rebate that will be utilized, based on the
entered costs.

Applicant Infrastructure Cost Responsibility -The amount that the applicant will be responsible
for paying, based on the Total of All Eligible Charging Infrastructure Costs and the Maximum
Infrastructure Rebate Funds Based on Application.

Select "Next" to continue.

If infrastructure costs are entered,
you must confirm that purchase
orders have been entered in the
Payment Request Form to account
for those costs. If there are
infrastructure costs, at least one
Electric Bus Charging Infrastructure
purchase order is required.

Any purchase order indicated
with a "Purchase Order Purpose"
of "Electric Bus Charging
Infrastructure" will be listed on this
screen for your reference. If there is
a problem, such as a purchase order
that was not entered, or a purchase
order that needs the "Purchase
Order Purpose" corrected, select
"Back to PO Entry."

Edit Your Payment Request

^ Rebate ID:013716

^)of6 Infrastructure

tnterelig ble electric bus charging infrastructure information below.
* denotes required field
Number of Level 2 Chargers ©

Level 2 chargers must be Energy Star Certified.

Number of DC Fast Chargers 0

lotal of Level 2 Charger Hedestal costs ©

Total of DC Fast Charger Pedestal Costs ©

Total of Other Eligible Charging Infrastructure Costs ©

Infrastructure Purchase Orders

Purchase Orders (PO) listed below were identified on the PO entry (Screen 3) as including

"Electric Bus Charging Infrastructure". Total of All Eligible Charging Infrastructure Costs©

PO Number PODate Vendor Name

2222222 2022-11-24 Charger Empcriun

[~1 I conlirm that expenses entered above, it any, are accurate."

Select the " Back to PO Entry" button below, if other PO's need to be entered for th

Total Infrastructure

Back to PO Entry

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

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2.14 Signature

To complete your payment request form, you must read and agree to the "Total Bus and Infrastructure Rebate
Amount" and the "Total Applicant Bus and Infrastructure Cost Responsibility" shown at the top of the screen
as well as certify to the items listed on this page by signing, confirming your signature, and clicking "Submit
Form."The "Name" and "Title" fields on this page are auto-filled for the individual that initiated the form based
on their SAM.gov Point of Contact information.

If you sign and confirm your signature, but then return to a previous screen to make edits, you will need to
repeat the signature and confirmation steps.

If a different user wishes to sign and
submit the form, they must also be
a SAM.gov point of contact for your
organization and will need to use
Login.gov to enter the Clean School
Bus Rebate Forms site to complete
the payment request form (saved
as a draft). In this case, they must
edit the "Name" and "Title" fields
to show their full name and title
before signing and submitting.

Once you submit the payment
request form, the Primary and
Alternate SAM.gov Government
and Electronic Points of Contact,
and the Primary and Alternate
Applicant Contacts will receive an
email confirmation that the form has
been submitted. Additionally, the
applicant dashboard for this payment
request form will show the form as
"Submitted."

If you submit the payment request
form and then later need to
edit the form before review has
started, contact the help desk
at cleanschoolbus@epa.aov and
include the Applicant Name, Rebate
ID, Unique Entity Identifier (UEI),
Electronic FundsTransfer (EFT)
Indicator, and School District Name.

V>EPA

Clean School Bus

Clean School Bus Rebate Forms

» Clean School bit

te Prceram

ic Rebate Application Informatior

Edit Your Payment Request

^ Rebate ID:010716

of G Signature

Signature and Certification

The individual liste
notify the author s

it this payment request before it will be considered for funding by the EPA. If you d<

'¦;ion anrl/or dpharm

alternate), or Electronic Business (and alternate) Point of Contact in SAM.gov to access this payment request.

By signing and submitting this payment request, applicants certify that:

1. I hey have read and agree to comply with the requirements and terms and conditions in the2U22 Clean School
rpprpspntarinn that FPA will rply upon in providing fund? for vphirlp rpplarpmpnt rpbarps. Fake certifications n
thpFalsp Claims Art,.1? 1 U.S.C. §37?9Ptseq. and/or-hp Program Fraud Civil Rpm?rlip<; Art, 31 U.S.C. 538(11 Pts
other criminal, civil or administrative penalties, sanctions, and remedies available to the Federal government

2. Old buses listed to be replaced and new replacement buses must meet the eligibility requirements in the 2022 CSB Rebates Program Gui

3. Replacement buses and associated charging/fueling infrastructure funded in this program was not ordered until after official notificatior

5. The public school system that will bo served by the replacement buses for at least five years has been notified anc

6. The statements and information provided in this application are true and accurate to the best of their knowledge.

7. They will respcrd to EPAorits representatives it contacted to clarity information submitted in this payment reque

Sign the form by using your mouse cursor asa pen.

Once this payment request form is submitted, you, the other SAM.gcv points of contact listed in the first paragraph or
receive an email confirmation. The applicant dashboard will show submitted db the status.

le Government Busi

t selected for funding, ol

>5cfthe proposed bus -eplacem<

n, and the Primary and Alternate applicant co

lit Signature of Authorised Rt

Q I confirm I have provided my signature above '

I NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the bottom of the form.

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2.15 Next Steps

EPA will review submissions for completeness and accuracy and follow up with questions as needed.

If EPA needs clarification or needs you to edit your payment request form during the review process, the
Primary and Alternate SAM.gov Government and Electronic Points of Contact and the Primary and Alternate
Applicant Contacts will be notified by email.

If edits are requested, when you login to the applicant dashboard, the status of your payment request form
will either be "Draft" or "Edits Requested." These statuses will allow you to go back into your form and make
additions and edits as needed.

If your payment request form has a status of "Submitted" or "Needs Clarification" on the applicant dashboard,
you will be able to view but not edit the form. In the latter case, you will be instructed to provide clarifications
by email.

£2

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Appendix A. Glossary

The following provides definitions of terms and abbreviations used throughout the payment request form and
system screens.

Your Rebate Forms Screen: Definitions

¦ Form Type—Application, Payment Request, or Close-Out Form.

¦ UEI—Unique Entity ID from SAM.gov.

¦ EFT Indicator—Electronic FundsTransfer Indicator for the associated bank account from SAM.gov.

¦ Applicant—Legal Business Name from SAM.gov for this UEI.

¦ School District—School District represented by the applicant.

¦ Updated by—Last person to update the form.

¦ Date Updated—Last date this form was updated.

¦ Status—submitted, draft, needs clarification, edits requested, or withdrawn.

Payment Request Form Screens: Definitions

¦ Applicant Bus Cost Responsibility-Auto-filled with the calculated value, based on the cost of the bus,
that the applicant will be responsible to pay for that exceeds the rebate.

¦ Applicant Infrastructure Cost Responsibility-This number represents the amount, based on the costs
provided in this form, that the applicant will be responsible to pay after the rebate.

¦ Applicant Name - Name auto-filled from the previously submitted application form.

¦ Attach Purchase Order - Attach a file or scan of the purchase order for the bus and/or eligible charging
infrastructure. Allowed file types: *.pdf, *.png, *.jpeg, *.jpg.The maximum file size is 5MB and the
minimum file size is 1 KB.

¦ Bus Rebate Amount -This field will be auto-filled with the rebate dollar amount. If the actual bus
cost from the purchase order is greater than or equal to the rebate amount from the application, then
this will display the rebate amount from the application. If the actual bus cost is less than the rebate
amount from the application, this will display the actual bus cost.

¦ Bus # - Incremental bus identifier auto-filled for this form.

¦ Business Email (Primary and Alternate) - Verify that the Primary and Alternate Contact business emails
for your organization are correct. If not, update them with the current business emails.

¦ Business Phone Number (Primary and Alternate) - Verify that the Primary and Alternate Contact
business phone numbers for your organization are correct. If not, update them with the current
business phone numbers.

¦ Electronic Signature of Authorized Representative - Sign the form by using your mouse cursor
as a pen.

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¦ Estimated Remaining Life (years) - Provide your best estimate of the years of remaining operational
life of the old bus starting from the time of application submittal. This figure should be inclusive of
the years of operation the bus may have had if not for the scrappage requirements and the years of
operation the bus may have had even if it were sold to other fleets.

¦ Exclude Bus - Check the box if you want to exclude the bus and its replacement bus rebate from this
payment request form.

¦ Max Rebate Amount - Auto-filled with the maximum rebate amount for the replacement bus, as
determined by the GVWR, fuel type, and school district priority.

¦ Maximum Infrastructure Rebate Funds Based on Application -Total of infrastructure funding available
for all requested electric school bus replacements based on the number of electric buses ordered and
the prioritization of the school district that the buses will serve. If you excluded an old bus associated
with new electric replacement bus infrastructure rebate funds, that amount will be deducted from the
Maximum Infrastructure Rebate Funds Based on Application field.

¦ Name (Primary and Alternate) - Verify that the Primary and Alternate Contact names for your
organization are correct. If not, update them with the current names.

¦ Name, Title -The name and title of the authorized representative are automatically filled in from SAM.
gov information.

¦ National Center for Education Statistics (NCES) District ID -The seven-character NCDES District ID
that was entered for this school district in the application. Auto-filled from the previously submitted
application form.

¦ New Bus Estimated Delivery Date - Enter the date of your estimated delivery date from the purchase
order in the format of MM/DD/YYYY

¦ New Bus Fuel Type - Auto-filled with the replacement bus fuel type selected in your application.

¦ New Bus GVWR - Enter the gross vehicle weight rating (GVWR) in pounds for the ordered
replacement bus.

¦ New Bus Make - Select or enter the manufacturer of the ordered replacement bus.

¦ New Bus Model - Enter the model (not the bus type) of the ordered replacement bus.

¦ New Bus Model Year - Enter the vehicle model year of the ordered replacement bus.

¦ New Bus Purchase Price - Enter the purchase price of the ordered replacement school bus, including
tax and any eligible training/consulting/warranty line-item expenses associated with the individual bus
in the purchase order. Do not include charging infrastructure costs here.

¦ Number of Buses Requested from Application -The number is automatically filled from your
application.

¦ Number of DC Fast Chargers - Enter the number of DC Fast chargers ordered based on the number of
bus charging plugs. A DC charger with two plugs would be considered two chargers.

¦ Number of Level 2 Chargers - Enter the number of Level 2 AC chargers ordered based on the number
of bus charging plugs. A Level 2 charger with two plugs would be considered two chargers.

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¦ Number of Replacement Buses Ordered -The number is automatically filled from your application.

¦ Old Bus Fuel Type - Auto-filled from the application with the fuel type of the bus to be replaced.

¦ Old Bus Model Year-Auto-filled from the application with the vehicle model year of the bus to
be replaced.

¦ Old Bus NCES District ID - Auto-filled with the NCES ID from the application.

¦ Old Bus VIN - Auto-filled with the vehicle identification number (VIN) of the bus to be replaced from
the application.

¦ Private Fleet Name - Name auto-filled from the previously submitted application form.

¦ Purchase Order Date - Enter the purchase order date displayed on your purchase order in the format of
MM/DD/YYYY.

¦ Purchase Order Number - Enter the purchase order number that appears on this purchase order.

¦ Purchase Order Purpose - Indicate the purpose for this purchase order (bus, electric charging
infrastructure, or both). Note that propane and CNG vehicles are not eligible for an
infrastructure rebate.

¦ Purchaser Address - Enter the street address of the purchaser.

¦ Purchaser Business Phone Number - Enter the business phone number of the bus purchaser.

¦ Purchaser City - Enter the city of the purchaser.

¦ Purchaser Name - Select the organization from your application that is purchasing the new bus or
select "Other" and manually fill in the purchaser organization information.

¦ Purchaser State orTerritory - Enter the state or territory from the drop-down list for the purchaser.

¦ Purchaser Zip - Enter the five-digit zip code or the five-digit zip plus 4 (e.g., NNNNN-NNNN) for the
purchaser.

¦ Rebate ID -This number is a unique identifier that was automatically generated when you submitted
your rebate application and is used to track all required forms for this rebate.

¦ School District Name - Name auto-filled from the previously submitted application form. This is the
school district name that corresponds to the NCES District ID that was submitted for this application.

¦ School District Prioritization - Priority level auto-filled from the application.

¦ School District Prioritized? - "Yes/No" value auto-filled from the previously submitted application form.

¦ Title (Primary and Alternate) - Verify that the Primary and Alternate Contact titles for your organization
are correct. If not, update them with the current titles.

¦ Total Applicant Bus and Infrastructure Cost Responsibility -This field is automatically filled with a
number that represents the dollar amount, based on the costs provided in this form, that the applicant
will be responsible to finance after the rebate.

¦ Total Applicant Bus Cost Responsibility - Auto-filled with the calculated dollar value, based on the costs
provided in this form, that the applicant will be responsible to pay for that exceeds the rebate.

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¦ Total Bus and Infrastructure Funds to be Paid -This field is automatically filled from your application.
This is the sum of the "Total Bus Rebate Amount" and "Total Infrastructure Funds" fields.

¦ Total Bus Rebate Amount - Auto-filled with the calculated dollar value that is the sum of all the Bus
Rebate Amounts values for each bus ordered.

¦ Total Infrastructure Funds to be Paid -This field is automatically filled from your application. If total
infrastructure costs from the purchase order are greater than or equal to the rebate amount from the
application, then this will display the total infrastructure rebate amount from the application. If total
actual infrastructure costs are less than the rebate amount from the application, this will display the
total actual infrastructure costs.

¦ Total of All Eligible Charging Infrastructure Costs -This is the total of the purchase order costs for Level
2 and DC Fast Chargers, as well as any other eligible infrastructure costs entered in previous fields.

¦ Total of DC Fast Charger Pedestal Costs - Enter the total of ordered DC Fast Charger pedestal costs
reflected in the purchase order(s).This total is for the pedestal hardware alone and should not include
other costs like installation or running electricity to the site of the charger.

¦ Total of Level 2 Charge Pedestal Costs - Enter the total of ordered Level 2 charger pedestal costs
reflected in the purchase order(s).This total is for the pedestal hardware alone and should not include
other costs like installation or running electricity to the site of the charger.

¦ Total of Other Eligible Charging Infrastructure Costs - Enter the other eligible charging infrastructure
costs that are reflected in the purchase order(s). Eligible infrastructure costs are limited to
infrastructure from the electrical meter through the plug for the bus and can include design,
engineering, and installation costs such as trenching, wiring and electrical upgrades, labor, and
permitting. These costs must not include charging pedestal hardware costs that are entered elsewhere
in the Payment Request Form.

¦ Total Purchase Price for All Replacement Buses - Auto-filled with the calculated dollar value based on
the actual cost of all the buses ordered.

¦ Total Rebate Funds Requested in Application -This is the total bus and infrastructure (if applicable)
funds requested based on your application.

¦ Vendor Address - Enter the street address of the vendor.

¦ Vendor Business Phone Number - Enter the business phone number of the vendor.

¦ Vendor City - Enter the city of the vendor.

¦ Vendor Name - Enter the name of the vendor whom the buses and equipment are being
purchased from.

¦ Vendor State orTerritory - Enter the state or territory from the drop-down list for the vendor.

¦ Vendor Zip - Enter the five-digit zip code or the five-digit zip plus 4 (e.g., NNNNN-NNNN) for
the vendor.

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Appendix B. List of Fields in

Payment Request Form

The payment request form requires some or all of the following information. Fields with an asterisk are
required. Some required fields are automatically filled from information submitted in your application.

Application Info (Screen 2)

Applicant Name

School District Prioritized?

School District Name

NCES District ID

Total Rebate Funds Requested in the Application

Primary Contact Information

Name

Title

Business Phone Number

Business Email

Alternate Contact Information

Name

Title

Business Phone Number

Business Email

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Purchase Orders (Screen 3)

Purchase Order Information

Purchase Order Number	Purchase Order Date

Purchase Order Purpose (circle one or both): Bus Electric Charging Infrastructure
Purchaser Information

Purchaser Organization

Purchaser Address

Purchaser Business Phone Number

Purchaser City

Purchaser State orTerritory	Purchaser Zip

Vendor Information

Vendor Name

Vendor Address

Vendor Business Phone Number

Vendor City

Vendor State orTerritory

Vendor Zip

Attachment of Purchase Order (.pdf, .png, .jpeg, .jpg).

Minimum file size: 1 KB. Maximum file size: 5MB.

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Buses (Screen 4)

Bus Information:

Make copies for additional buses if needed
Old Bus

VIN	ModelYear	Old Bus Fuel Type

Old Bus NCES District ID	Estimated Remaining Life (years)

Exclude Bus: Yes/No
New Bus

Purchase Order Number	Purchase Order Date

Vendor Name

New Bus Make	New Bus Model	New Bus Model Year

New Bus Purchase Price	New Bus Estimated Delivery Date New Bus GVWR

New Bus Fuel Type	Max Rebate Amount	Bus Rebate Amount

Applicant Bus Cost Responsibility

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Infrastructure (Screen 5)

Only if any of the replacement buses have an electric fuel type

Number of Level 2 Chargers

Number of DC Fast Chargers

Total of Other Eligible Charging Infrastructure Costs

Signature (Screen 6)

Name

Total of Level 2 Charger Pedestal Costs

Total of DC Fast Charger Pedestal Costs

Title

Electronic Signature of Authorized Representative
I confirm I have provided my signature above: Yes/No

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