3520-8 Application for Final Admission of Nonconforming Importe

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United States Environmental Protection Agency
Application for Final Admission of Nonconforming Imported Vehicle or Engine

&EPA
Warning:

Any person who knowingly makes any false or fraudulent statement, or omits or conceals a material fact can be fined up to $250,000 or imprisoned
for up to 5 years, or both (18 United States Code 1001). This form is required to be submitted to EPA under 40 CFR 85.1505, 85- 1509, 89.605, 89.609.

1. Port of entry

2. Entry date
(mo/dy/yr)

5. Date of original manufacture
(mo/yr)

3. Customs entry number:

4. Vehicle Identification Number (VIN), or engine serial number

7. Model

6. Original manufacturer

8. Declaration code (letter or box number from EPA form 3520-1 or 3520-21)

Names, Addresses,
10. Importer

11.

(ICI)

Telephone number

9. EPA certificate no. and model year and expiration date of certificate applicable
to this importation

and Telephone

Numbers of Relevant Parties

Owner

12. Vehicle/engine

Taxpayer 10 #

Telephone number

13. Person to receive oral or written notification that EPA has not approved
final admission

16. Designate the provisions
under which the vehicle/engine
was modified and tested.

storage location (no P.O. boxes)

15. Modification date

14. Telephone number

For vehicle or engine modified under a certificate, write sequence number in
this box beginning with the first one imported under the certificate, which is the
certified prototype. Ordinarily, every 3rd one is tested (1st, 4th, 7th, 10th, etc.)

CJ

For modification/test

vehicle or engine,
mark "X" in this box.

Name of test laboratory
Initial test results: (circle applicable units and pollutants)
Date of test
glmi or g/kW-hr

Deterioration

HC or

factor

Test results adjusted by the
deterioration
factor and rounded to
two significant figures using ASTM E
29-67 rounding procedures:
glmi or glkW-hr

NOx+HC

g/mi or g/kW-hr

g/mi or g/kW-hr

CO
g/mi or g/kW-hr

glmi or glkW-hr
NOx

gltest

g/test
Evap.

g/mi or g/kW-hr

glmi or glkW-hr
Particulate

17. Second test results, if applicable:

(circle applicable units and pollutants)

Date of test
g/mi or g/kW-hr

Deterioration

HC or NOx+HC

glmi or glkW-hr

factor

glmi or glkW-hr

g/mi or g/kW-hr
CO

g/mi or g/kW-hr
NOx
g/test

glmi or glkW-hr

gites!

Evap.
g/mi or g/kW-hr

glmi or glkW-hr
Particulate

EPA Form 3520-8 (Rev. 3-01)

Previous versions are obsolete

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18. Combined Fuel Economy (For vehicles only
include certified vehicles).

mi/gal (For vehicles only - round fuel economy
to the nearest tenth using ASTM E 29-67)

- ICls

report the combined fuel economy value from the last test for a modification and test vehicle. This does not

19. For EPA use only
Date final admission form received

20. Place an "X" in only one box

D

I certify that the vehicle or engine has been modified in accordance with the provisions of a currently valid certificate of conformity. If applicable, a Federal
Test Procedure was performed on the vehicle or engine in accordance with procedures in 40 CFR Part 86 or Part 89 as applicable at a laboratory in the
U.S. (40 CFR 85.1505(a)(2)(ii), 89.605(a)(2)(ii».

D

I certify that the vehicle or engine has been modified and the Federal Test Procedure was performed on the vehicle or engine in accordance with
procedures in 40 CFR Part 86 or 89 at a laboratory in the U.S. For a vehicle, the emission testing and development of Fuel Economy data were performed
after modification to Department of Transportation safety standards. (40 CFR 85.1509(g)(2). 89.609(b)(2».

D

I certify that the vehicle or engine has been modified in accordance with the provisions of a currently valid certificate of conformity. EPA has approved the
plan for me to receive information concerning OEM running changes that affect emissions and therefore testing was not required. (40 CFR
85.1505(a)(2)(i), 89.605(a)(2(i».

21. I certify that as the certificate holder I have provided or will provide to the purchaser or owner of the vehicle or engine, as applicable: (1) written instructions for
maintenance and use as required by 40 CFR 85.1510(a). 89.61 O(a); and (2) an emissions warranty as described in 40 CFR 85.1510(b), 89.61 O(b), Part 85 Subpart
V and Clean Air Act sections 207(a) and (b); (3) an emission label as required by 40 CFR 85.1510(c), 89.610(c) and Part 600 Subpart D; (4) a fuel economy label
as required by 40 CFR 85.151 Old) and Part 600 Subpart D. I certify that as the certificate holder I have complied with the applicable provisions of the Energy Act of
1978, 26 USC 4064 (gas guzzler tax) and for vehicles not owned by me I have provided the applicable tax forms to the owner; I have complied with the
requirements of 40 CFR 80.24 as applicable to affix applicable unleaded fuel labels; I am responsible for the vehicle or engine compliance with Federal emission
requirements regardless of whether I own the vehicle or engine; I certify that I have read and understand the warning above regarding the submission of false or
fraudulent statements or concealing a material fact, and the prohibited acts in 40 CFR 85.1513, 89.612 as applicable, and that the information I have provided is
correct. I understand that EPA Enforcement Officers are authorized to conduct inspections or testing otherwise permitted by 40 CFR Parts 85 or 89 or other
applicable provisions of the law. I will hold this vehicle or engine at least 15 working days from the date of EPA's receipt of the final admission information unless
otherwise notified by EPA.

Signature of ICI corporate officer

Print or type name

Date signed

Mailing Instructions
Mail this form to the following address
when using certified U.S. Express Mail,
or regular mail:

For delivery by a courier service
(e.g., Federal Express, DHL, etc.)
Only use the following address:

Attn: FINAL ADMISSION
U.S. Environmental Protection Agency
Certification and Compliance Division (6405-J)
1200 Pennsylvania Avenue, N.W.
Washington, D.C. 20460 (202) 564-9240

Attn: FINAL ADMISSION
U.S. Environmental Protection Agency
Certification and Compliance Division (6405-J)
5013'" Street N.W.
Washington, D.C. 20001 (202) 564-9240

For mail other than certified (Courier
Service, U.S. Express or regular mail)
include a self-addressed and stamped
post card for EPA to stamp with our
receipt date. For more information
please call EPA at (202) 564-9240

Privacy Act Statement
Collection of the information on this form is authorized by the Clean Air Act, 42 USC 7401 et seq. (see 40 CFR 85.1501 et. seq. and 89.601 et. seq.) The
Environmental Protection Agency (EPA) uses this information to determine compliance of noncomplying imported vehicles with U.S. emission requirements and for
investigations with respect to EPA's import regulations. The information will be supplied to the internal Revenue Service for the purpose of collecting the gas guzzler
tax where applicable. Disclosure of this information may also be made to other Federal, State, or local law enforcement agencies when there is a violation of civil or
criminal law. Furnishing the information on this form, including your Social Security Number, is voluntary but failure to do so may result in disapproval of the importation
of the vehicle identified on this form.
Paperwork Reduction Act Notice
This information is collected to ensure that motor vehicles and engines imported into the U.S. conform with applicable emission requirements. Responses to this
collection are mandatory (40 CFR 85.1501 et seq., and Clean Air Act Sections 203 and 208). Information submitted to the Agency under a claim of confidentiality will
be safeguarded according to policies set forth in Title 40, Chapter 1, Part 2, Subpart B. The public reporting and recordkeeping burden for this collection of information
is estimated to average 30 minutes per response. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or
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. 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, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 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.
EPA Form 3520-8 (Rev. 3'01)

Previous versions are obsolete

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