3520-29 MVECP Correction Form

EPA Form#:3520-29
OMB No. 2060-0104

U.S. Environmental Protection Agency
Motor Vehicle and Engine Compliance Program
Correction Form
Date:
Manufacturer Name:
Engine Family Name:
Original Payment Date:
Original Amount Paid:

$

Check here if IMO/Annex Engine Family:
Revised Engine Family Name:
Authorized Company Representative:

Contact Name:

Phone:

Email Address:

Fax:

(optional)

Reason for Correction:
Typographical error in original engine family or test group name.
Overpayment for original family name, please apply the overpayment to the revised engine family name.
Assignment of new engine family name to existing placeholder "dummy" name.
Other (explain in comments box):

Comments:

Send Correction Form to:
Environmental Protection Agency- NVFEL
Fees Team
Compliance and Innovative Strategies Division
2565 Plymouth Road
Ann Arbor, Michigan 48105

Current Form Expires: 1/1/07

MVECP Fee Correction Form Instructions
This form is used to make typographical and other corrections to an engine family or test group name, to apply an overpayment on one
engine family to certification fee payment for a different engine family, to assign a proper engine family or test group name to a
placeholder name (for an explanation of placeholder names, see http://www.epa.gov/otaq/fees.htm), and to make other changes to
previously submitted fee filing forms. For corrections requiring additional payment, use the MVECP Miscellaneous Payments Due
Form in addition to this one, to submit the payment. For corrections requiring a refund, the refund can be treated as an overpayment
using this form, or a separate Fee Refund Request Form can be used. All corrections are subject to EPA approval.
Instructions:
Manufacturer Name:
Please enter the name of the company or manufacturer.
Engine Family Name:
Enter the original test group or engine family name. If you are using the form to apply overpayments (credit balance) on more than
one engine family to the "revised" engine family name below, list the additional engine families in the comment box.
Original Payment Date:
Enter the date of the online credit card or ACH payment, or the date of the offline check, wire, or ACH payment for the original test
group or engine family. Use the best information available.
Original Amount Paid:
Indicate the amount you paid for this engine family or test group when the initial fee payment was made, if applicable.
IMO/Annex Engine Family:
Check the box if the revised engine family name is an IMO/Annex engine family.
Revised Engine Family Name:
Indicate the revised or new engine family name or test group name. If you are using the form to correct a typographical or other
mistake in the name, enter the correct name. If you are using the form to assign a name to a previous placeholder name, enter the
assigned name. If you are using the form to apply an overpayment to a new engine family, put down the new engine family you want
the overpayment applied to.
Authorized Company Representative:
Enter the authorized company representative information including a contact name, email, address, telephone number, and fax
number. An email address is mandatory. The contact should be a person familiar with the correction who can be reached for
clarification of any issues. Foreign manufacturers may find that having a contact person in the U.S. will expedite resolution of fee
payment issues.
Reason for Correction:
Select the reason for correction:
-- Typographical error in original engine family or test group name.
-- Overpayment for original family name, please apply the amount to the revised engine family name.
Select this button if you wish to transfer an overpayment on the original engine family or test group to the "revised"
engine family or test group. Selecting this button will result in a prompt to enter information about the original
payment(s) in the Comments box. This will help EPA confirm the overpayment.
-- Assignment of new engine family or test group name to existing placeholder "dummy" name.
(This serves the same function as filling out EPA's offline "MVECP Fees Placeholder Correction Form.")
-- Other (explain in comments box)
For any other corrections enter your explanation in the Comments box.
Comments:
Enter any information necessary or helpful in explaining the correction.
Send Correction Form to:
Environmental Protection Agency- NVFEL
Fees Team
Compliance and Innovative Strategies Division
2565 Plymouth Road
Ann Arbor, Michigan 48105