Registration of Fuels and Fuel Additives: Requirements for Manufacturers - Fuel Manufacturer Annual Report for Motor Vehicle Gasoline or Diesel Fuel

EPA Form 3520-12A - Fuel Manufacturer Annual Report Instructions (8-2003)

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Instructions
Fuel Manufacturer Annual Report
for Motor Vehicle Gasoline or Diesel Fuel
GENERAL INFORMATION
Any manufacturer of a fuel registered by the Environmental Protection Agency must submit a Fuel Manufacturer Annual Report
for that fuel in order to keep the registration in force.
Fuel Manufacturer Annual Reports are to be submitted on or before March 31 for the preceeding year or part thereof.
One copy of an Annual Report should be completed and submitted for each registered fuel.
Completed form(s) should be sent:
Via U.S. Postal Service
U.S. Environmental Protection Agency
Attn: Fuel Registration/Suite L-103
Mail Code - 6406J
1200 Pennsylvania Avenue, NW
Washington, DC 20460-0001

or

Via Courier
U.S. Environmental Protection Agency
Attn: Fuel Registration/Suite L-103
Mail Code - 6406J
501 Third Street, NW
Washington, DC 20001

Telephone: (202) 564-9754
Fax: (202) 565-2153
email: [email protected], [email protected]

Specific instructions for completing the form follow.
The EPA is responsible for assessing the impact on public health and welfare from exposure to motor vehicle emissions.
Knowledge of fuel composition, as reported by each manufacturer, is an important aspect of this program.
SPECIFIC INSTRUCTIONS
Please type (best results are obtained using standard fonts such as Courier or Arial) or print the information using a dark-colored
ink. If using a photocopied version of the form, please ensure the copy is clean and has been copied to 100% of the original page
size.
Item 1.

Company Name: Enter the company's legal name.

Item 1a.

Company ID : If known, enter the EPA assigned Company ID.

Item 2.

Address : Enter the address of the company office responsible for submiting this form.

Item 3.

Report Year: Enter the year for which the company is submitting the report.

Item 4.

Fuel ID: Enter the EPA assigned Fuel ID. If you do not know it, leave blank.

Item 5.

Brand Name: List the brand name under which your company markets the fuel described on this form. If you market it
under more than one name, list the first name listed on the "Fuel Manufacturer Notification for Motor Vehicle Fuel," EPA
Form 3520-12.

Item 6.

Fuel Properties: To the extent known, provide the highest, lowest, and average concentrations, in weight percent, for the
listed characteristics/properties. Also, mark whether methods of analysis for (a) through (f) are the same as previously
reported.
If not, provide the correct method of analysis for the affected item. For any item for which measurements are not
available, enter "Not Measured." If a standard method of analysis is used, identify it (e.g., ASTM D1319), otherwise
describe the method used on a seperate sheet. Please use metric measurements.
Also provide characteristics (g) through (m) for the gasoline or diesel fuel you are reporting.

Item 7.

Mechanisms of Action: Self-explanatory.

Item 8.

Confidential Business Information: Check the number(s) of those items for which your company asserts a claim of
confidentiality.

EPA Form 3520-12A - Fuel Manufacturer Annual Report Instructions (8-2003)
Item 9.

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Certification: The notification form must be signed and dated by the fuel manufacturer or its authorized agent. The
printed name of the signer and the signer's telephone number should be given. If the form is signed by an authorized
agent, the company must provide a letter authorizing such agent.

The public reporting burden for this Environmental Protection Agency (EPA) collection of information
is estimated to average 3 hours per response. This includes time for reviewing instructions and
regulations, searching company records, gathering the needed data, and completing, reviewing,
copying, and transmitting the collection of information.
Burden means the total time, effort, or financial resources expended by persons to generate,
maintain, retain, disclose, or provide information to or for a Federal agency. This includes the time
needed to review instructions; develop, acquire, install, and utilize technology and systems for the
purposes of collecting, validating, and verifying information, processing and maintaining information,
and disclosing and providing information; adjust the existing ways to comply with any previously
applicable instructions and requirements; train personnel to be able to respond to a collection of
information; search data sources; complete and review the collection of information; and transmit or
otherwise disclose the information. 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 OMB control numbers for EPA's regulations are listed in 40 CFR Part 9 and 48 CFR
Chapter 15.
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, including through the use
of automated collection techniques to the Director, OPPE Regulatory Information Division, U.S.
Environmental Protection Agency (2137) 401 M St., S.W., Washington, DC 20460; and to the Office
of Information and Regulatory Affairs, Office of Management of Budget, 725 17th Street, NW,
Washington, DC 20503, Attention, Desk Officer for EPA. Include the EPA ICR number 0309.10 and
OMB control number 2060-0150 in any correspondence.

NOTE: This office is operated by a contractor, MACI (Arlington, VA) for the EPA, under contract number 68-W-01-050. Information
submitted with this form will be provided to MACI for processing into a database at the registration office.