3520-29 Highway Fee Filing Form

EPA Form 3520-29

OMB Control No. 2060-0545; approval expiration date: 7/31/2010

U.S. ENVIRONMENTAL PROTECTION AGENCY
MOTOR VEHICLE AND ENGINE COMPLIANCE PROGRAM
ON-HIGHWAY FEE FILING FORM
FOR CERTIFICATION APPLICATIONS RECEIVED IN CALENDAR YEAR 2010
Manufacturer Name
Address
City/State/Zip Code/Country
On-Highway Certification Request Type (check one)
LDV/LDT/MDPV/HDV (Chassis cert) FEDERAL ($34,849)

HDV EVAP-ONLY ($511)

LDV/LDT/MDPV/HDV (Chassis cert) CAL-ONLY ($17,591)

HDE CALIF-ONLY ($511)

HDE (Engine Dyno cert) FEDERAL ($35,967)

MOTORCYCLE ($1,210)
LD/MDPV/HDV ICI ($47,928)

EPA standard engine family or test group or
HDV Evaporative family name:

$

Amount paid (U.S. Funds Only):

Enter the check number, or the statement AEFT/WIRE@ or AEFT/ACH@:

Reduced Fee Section (40 CFR §1027.120)
Reduced fee calculation (minimum initial payment $750): Total number of vehicles/engines covered:
Aggregate retail sales price of the vehicles/engines: $
x 1% = $
List the VIN of imported vehicles/engines below:
Check box if an Independent Commercial Importer:

Company Representative:
Title:

Signature:
Phone/Fax:

/

Date:

/

/

E-mail Address:
Submission of payments and forms:
(1) Online: Forms may be found and submitted with or without payments online at www.Pay.gov.
(2) Send checks and this form to:
Environmental Protection Agency
Motor Vehicle and Engine Compliance Program
P.O. Box 979032
St. Louis, MO 63197-9000
(3) Transmit offline EFT/Wire payments to the New York Federal Reserve Bank. (See Instructions, p.2)
(4) Transmit offline EFT/ACH payments to the Federal Reserve Bank of Cleveland. (Instructions, p.2)
(5) Forms not submitted under (1) and (2) above can be sent as email attachments to [email protected].
Forms and payments sent in ways other than the above may be delayed or ineffective. See the
Instructions for sending checks and forms by private mail service (e.g., Federal Express).
The public reporting and recordkeeping burden for this collection of information is estimated to average 18 minutes per response. Send comments
on EPA’s need for this information, the accuracy of the provided burden estimate, 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
(2822T), 1200 Pennsylvania Ave., N.W., Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the
completed Form 3520-29 to this address.
This form expires: 1/1/2011

EPA Form 3520-29

OMB Control No. 2060-0545; approval expiration date: 7/31/2010

Page 2
Instructions
NOTE: This form applies to complete certification applications that are received in Calendar Year (CY) 2010.
Fee amounts due are subject to change every year. Use of the form for the wrong calendar year can cause incorrect
payments and delays. Get the form for the calendar year of your application submission at
www.epa.gov/otaq/fees.htm or www.Pay.gov. Forms and payments may be submitted online at www.Pay.gov.
Manufacturer Name and Address
List the applicant=s corporate name and corporate address as it will appear on the Certificate of Conformity.
Certification Request Type
Check the box that specifies the certification request type. If you are paying a reduced fee, still mark the appropriate
certification request type.
EPA Standard Engine Family or Test Group or HDV Evaporative Family Name
Enter the appropriate EPA standardized engine family or test group name as it will appear on the Certificate of
Conformity. Forms and payments for Modification and Test vehicles under 40 CFR 85.1509 must list the engine
family for the currently valid Certificate of Conformity under which the vehicles are being imported.
Amount Paid
Enter the appropriate fee amount for the designated certification request type. The full fee, payable in U.S. dollars,
along with a properly completed fee filing form, must be received before certification review can begin. All banking
fees are the responsibility of the manufacturer. The reduced fee amount (if applicable) is also entered in this box.
Check Number, EFT/ACH, or EFT/WIRE (for offline payments)
The check number is mandatory for check, money order, bank draft, or certified check; or enter the letters
"EFT/WIRE" or "EFT/ACH" if sending an electronic funds transfer. Indicate the standard engine family or test group
name on the check. Make checks payable to “U.S. Environmental Protection Agency”.
Indicate in the EFT message field the information:
For Wire: RDFI: Federal Reserve Bank; Location Code (Same as EPA Account Number): 68-01-0099; "EPA
MVECP Fee"; ABA number: 021030004. (ABA number is same as Swift Code or Routing Number for participating
banks. For further information, email [email protected]). Note: the wire detail corresponding to ABA 021030004 is
“TREAS NYC”; this is the same as the Federal Reserve Bank.
For ACH: RDFI: Federal Reserve Bank, Routing Transit number: 051036706, Account number: 540006, Account
Name: U.S. Environmental Protection Agency (EPA). Note: the 051036706 company name appears as “U.S. EPA”;
the receiving bank is still the Federal Reserve Bank of Cleveland.
Please include in wire or ACH message fields the following: the words “MVECP Fees”, manufacturer name, and
engine family/test group/HDV evaporative group name(s). If space is limited, list one name and the number of
families.
Reduced Fee Section (if applicable)
Reduced fee submissions must be supported by the reduced fee calculation on Page 1 of this form and any relevant
supporting information requested by 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 the reduced fee provisions under 40 CFR §1027.120.
Company Representative
Enter the representative's name, signature, title, phone/fax, date, and an e-mail address. Note: an acknowledgment of
fees received will be sent to this e-mail address. No other receipts will be sent.
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 with fee filing forms to:
U.S. Bank
Government Lockbox 979032
1005 Convention Plaza
SL-MO-C2-GL
St. Louis, MO 63101