EPA's In-Use Vehicle and Engine Testing Programs

2005 FORD 5FMXT02.31J2 Control # K 142/ 143

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TELEPHONE QUESTIONNAIRE OMB No. 2060-0086

For Surveillance Class K-142 / 143 (Expires (09/31/07)

2005 Ford 5FMXT02.31J2

VEHICLE CONTROL NUMBER DATE

ADMINISTERED BY

OWNER'S NAME

STREET ADDRESS

CITY

STATE ZIP

(CALL NUMBER BELOW THAT IS MARKED WITH AN "X")

TELEPHONE (Home) / / (Business) / /

BEST TIME TO CALL

"WE ARE AUTHORIZED BY FEDERAL LAW TO COLLECT THIS INFORMATION. WHILE YOU ARE NOT REQUIRED TO RESPOND, YOUR COOPERATION IS NEEDED TO MAKE THE RESULTS OF THIS INVESTIGATION VALID."

DATE OF CONTACT _______________________ TIME OF CONTACT __________________

INDIVIDUAL CONTACTED_______________________________________________________

TO BE COMPLETED ___________________ DATE AND TIME OF COMPLETION___________

You have been selected from a list of vehicle owners living in the Detroit/Ann Ann Arbor metropolitan area to participate in a study of vehicle emissions being conducted by the U.S. Environmental Protection Agency.

EPA is authorized by law to conduct this study and to offer incentives to you for your cooperation should you decide to participate. Your participation in this program is strictly voluntary.

The accuracy of the information that you provide is important. The information that you provide will be used by EPA along with emission results for your vehicle to determine whether the automobile manufacturer has complied with clean air standards established by Congress. The test results from your vehicle will not be used by EPA to take action against you. Your cooperation will help EPA's efforts to control air pollution due to motor vehicle emissions.

Public reporting burden for this collection of information is estimated to vary from 1 to 60 minutes per response, with an average of 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency,40l M St., S.W. Washington, DC. 20460; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC. 20503.

These are the conditions of the program:

- we ask that you bring your vehicle into our testing facility where you will receive either a cash incentive for each day we keep your vehicle or a late model loaner car which will have a full tank of gas and unlimited mileage. This vehicle is yours to use without charge for the duration of the testing, which may take approximately 2 to 3 weeks. During this time, we will be performing a series of tests on your vehicle to measure vehicle emissions.

At the time the vehicle is delivered to us for testing, you will be required to sign an affidavit stating that the answers to the questions you will be asked are true and accurate to the best of your knowledge.

We will provide you the following incentives for participating in our program:

- If your vehicle is accepted into he program, a full tank of gas and a cash incentive will be awarded. You will be receive $20 per day for each day your vehicle is at NVFEL, and the use of a fully-insured loan car; or $50 per day for every day your vehicle is at NVFEL in lieu of a loan car.

However, if your vehicle is rejected after you bring it to the lab, but before you leave, you will receive a $20 payment.

The compensation will be based upon whole days, beginning with the day your vehicle arrives. It will end one day after you are notified your vehicle is ready for return.

The maintenance performed on your vehicle will depend on program requirements.

You will be given a list of any parts that are replaced.

Are you willing to participate? YES / / NO / /

If you are not, may we ask why not?

IF RESPONSE IS POSITIVE:

For the purpose of this study, I am going to ask you some questions about your vehicle's maintenance and usage history. You should answer these questions to the best of your knowledge and indicate when you are not sure of something.

FOR “MPF PERSONNEL” ONLY

SENTENCES IN CAPITAL LETTERS ARE INSTRUCTIONS TO THE CLERK

AND ARE NOT INTENDED TO BE READ TO THE OWNER.

1. a. What are the model year, transmission type, vehicle identification number and engine family of your vehicle? The engine family can be found on a Vehicle Emission Control Information decal located underside of the hood.

The engine family should start with the letters 5 D S

/ / Owner is unable to locate.

/ / Owner located. ENGINE FAMILY _____________________

/ / Engine family located when vehicle arrived at the Lab.

ENGINE FAMILY

Engine Family must be = 5FMXT02.31J2

b. MODEL _________________ VEHICLE ID NO._______________________

MODEL YEAR ___________________

TRANSMISSION: AUTOMATIC / / AIR CONDITIONED: YES / / NO / /

MANUAL / / ODOMETER MILEAGE:_________________

PLEASE PROCURE THREE VEHICLES HAVING ODOMETER MILEAGES BELOW 75,000 MILES. THOSE ABOVE 50,000 MILES SHOULD BE ASSIGNED TO CLASS K-143.

c. Has the odometer ever not functioned properly?

YES / / NO / /

If yes, approximately how long (months/miles) was it inoperable? ________________

CONSULT EPA FOR ELIGIBILITY IF THE RESPONSE IS "YES"

2. Has your vehicle’s catalyst ever been replaced?

YES / / NO / /

If yes, CALL EO.

3. Have you kept records of the maintenance and repairs performed on your vehicle?

YES / / NO / /

4. Would you allow them to be reviewed and duplicated?

YES / / NO / /

IF RECORDS ARE AVAILABLE, INFORM OWNER THAT: It is important that they are brought to the lab for review. DUPLICATE THE RECORDS.

INFORM THE OWNER THAT: All valuables should be removed from the vehicle (including those in the glove box) prior to bringing the vehicle to the lab.

ALSO INFORM THE OWNER THAT: Due to the location of some systems, the glove box and trunk may need to be opened during maintenance by MPF and EPA personnel. Any records pertaining to the vehicle's maintenance history found in the vehicle may need to be copied.

5. This question concerns the fuel-economy of your vehicle.

Can you estimate your gas-mileage during city driving:__________mpg.

Can you estimate your gas mileage during highway driving:_______mpg.

How do these estimates compare to the published values in the EPA Fuel-Economy Guide?_

6. Has any major repair work been done on the engine in your vehicle?

If so, what: Date:

7. Is your vehicle equipped with a trailer - hitch ?___ Yes ____ No ____

If yes, how much total weight has been hauled:

trailer + cargo = _____________________________________________