3520-29 On-Highway Fee Filing Form

EPA MVECP On-Highway Fee Filing Form

EPA Form#:3520-29

OMB NO.2060-0104

U.S. ENVIRONMENTAL PROTECTION AGENCY
MOTOR VEHICLE AND ENGINE COMPLIANCE PROGRAM
CY 2006 ON-HIGHWAY FEE FILING FORM
Applicant’s Corporate Name________________________________________________________
Address __________________________________________________________________________
City/State/Zip Code/Country_______________________________________________________
On-Highway Certification Request Type (check one)
____LDV/LDT/MDPV/HDV (Chassis cert) FEDERAL ($34,724)

____HDV EVAP-ONLY ($839)

____LDV/LDT/MDPV/HDV (Chassis cert) CAL-ONLY ($18,138)

____HDE CALIF-ONLY ($839)

____HDE (Engine Dyno cert) FEDERAL ($29,201)

____MOTORCYCLE ($2,164)
____LD/MDPV/HDV ICI ($16,594)

EPA standard engine family or test group name:

Amount paid (U.S. Funds Only):
(Make checks payable to: “U.S. ENVIRONMENTAL PROTECTION AGENCY”)

$

Enter the check number, or the statement “EFT/WIRE” or “EFT/ACH”:
Indicate in the EFT message field:
Wire: Location Code# “68010099", “EPA MVECP Fee”, ABA# “021030004"
ACH: RDFI-US BANK, Routing Transit# “081000210", Account#: 1001091030, Account Name: EPA
(Include in field: engine family/test group name, corporate name, and “MVECP Fees”)
Reduced Fee Section (40 CFR 85.2406)
Reduced Fee Calculation (minimum $750): Total number of vehicles/engine covered?__________________
Aggregate retail sales price of the vehicles/engines? $_________________ x 1% = $__________________
Check box if an Independent Commercial Importer?

List the VIN of imported vehicles/engines below:

Company Representative:________________________________ Signature:___________________________
Title:______________________ Phone/Fax:_________________/________________ Date:____/____/____
Current E-mail Address:______________________________________________________________________
Addresses: Send checks and all Fee Filing Forms for checks, wires and ACH payments by mail to:
Environmental Protection Agency
Motor Vehicle and Engine Compliance Program
P.O. Box 954472
St. Louis, MO 63195-4472
See instruction page for sending checks and forms by private mail service (e.g., Federal Express).
Transmit EFT/Wire payments to the New York Federal Reserve Bank.
Transmit EFT/ACH to the US Bank.
Current Form Expires: 1/1/07

EPA MVECP On-Highway Fee Filing Form

EPA Form#:3520-29

OMB NO.2060-0104

Fee Filing Form Instructions
Note: This form applies to complete certification applications that are received in Calendar Year (CY) 2006.
Corporate Name and Address
List the applicant’s corporate name and corporate address which will appear on the Certificate of Conformity.
Certification Request Type
Check the box that specifies the certification request type. The medium-duty passenger vehicles (MDPV) are
included with LDV/LDT. If paying a reduced fee still mark the appropriate certification request type.
EPA Standard Engine Family or Test Group Name
Enter the appropriate EPA standardized engine family or test group name that will appear on the Certificate of
Conformity. For placeholder engine family/test group names go to www.epa.gov/otaq/fees.htm for instructions.
Amount Paid
Enter the appropriate fee amount for the designated certification request type. The full fee, payable in U.S.
dollars, is to accompany the filing form. Reduced fee amount (if applicable) is also entered in this box.
Check Number, EFT/ACH, or EFT/WIRE
Enter the number of the corporate check, money order, bank draft, certified check, or enter the letters
“EFT/ACH” or “EFT/WIRE” if sending an electronic funds transfer. Indicate the standard engine family or test
group name on the check. Indicate in the EFT message field the information:
For Wire: Location Code# “68-01-0099", “EPA MVECP Fee”, ABA# “021030004"
For ACH: RDFI- US BANK, Routing Transit# “081000210", Account#: 1001091030, Account Name: U.S.
Environmental Protection Agency (EPA).
Please include in wire or ACH message fields the following: engine family/test group name(s), corporate name,
and MVECP Fees.
Reduced Fee Section (if applicable)
Reduced fee submissions must be supported by a reduced fee calculation and relevant supporting information
available to EPA at the time of application review. Enter the number of vehicles/engines projected for sale under
the engine family/test group. Enter the aggregate projected retail sales price of the vehicles or engines and
multiply that value by 1% (.01). Enter and pay the reduce fee amount (minimum $750). If you are an ICI, please
enter the VIN for any vehicles/engines already (or soon to be) in your possession. For any additional VINs,
please use a separate page. For further information see reduced fee provisions under 40 CFR 85.2406.
Company Representative (please include an e-mail address)
Enter the representative’s name, signature, title, phone/fax, and date and current e-mail address.
Bank Address for Private Mail Shipment (other than U.S. Postal Service)
If using a private shipping service such as Federal Express (or other service), send checks and fee filing forms for
all payment types to:
US BANK
Government Lock Box Division
Mail Station SLMOC1GL, Operations Center
1005 Convention Plaza
St. Louis, MO. 63101-1200