3520-29 MVECP Certification Fee Filing Form

U.S. Environmental Protection Agency
Motor Vehicle and Engine Compliance Program Fee Filing Form
Date:01/17/2013

Manufacturer Contact Information:
Manufacturer Name:

Fax Number:

Contact Name:

Email Address:

(optional)

Phone Number:

Calendar Year:
Family Name:
For dual U.S. / IMO Marine only, also give IMO name:
Certification Request Type:

On Highway

Nonroad

On-Highway Certification Types:
LDV
LDT
MDPV
HDV

Light-duty Vehicles (Chassis Certification - Federal Certificate)
Light-duty Trucks (Chassis Certification - Federal Certificate)
Medium-duty Passenger Vehicles (Chassis Certification - Federal Certificate)
Heavy-duty Vehicles(Chassis Certification - Federal Certificate)

HDE

Heavy-duty Engine (Engine Dynamometer Certification - Federal Certificate)

LD ICI
MDPV ICI
HDV ICI

Light-duty Vehicles for Independent Commercial Importers
Medium-duty Passenger Vehicles for Independent Commercial Importers
Heavy-duty Vehicles for Independent Commercial Importers

MOTORCYCLE On-highway Motorcycles
LDV
LDT
MDPV
HDV

Light-duty Vehicles (Chassis Certification - California-Only)
Light-duty Trucks (Chassis Certification - California-Only)
Medium-duty Passenger Vehicles (Chassis Certification - California-Only)
Heavy-duty Vehicles(Chassis Certification - California-Only)

HDE CALIF-ONLY Heavy-duty Engine California-Only Certification
HDV EVAP Heavy-duty Evaporative System

Nonroad Certification Types:
NR CI Nonroad Engine Compression-Ignition (excludes Locomotives, Marine and Recreational)
NR SI Nonroad Engine Spark-Ignition
Locomotives All Locomotives
Recreational Recreational Vehicles (except marine engines)
All Marine
Component Certification for Evaporative Emmissions

Fee Payment Information:
Do you qualify for reduced fee?
Are you an Independent Commercial Importer?
Make of the model(s) (list all that apply, separated by commas):
Model name(s) of vehicle or engine under this engine family/test group (list all that apply, separated by commas):
Year of the vehicle(s) or engine(s) (list all that apply, separated by commas):
VIN(s) of the model(s) (list all that apply, separated by commas. Enter "TBD" if unknown):

Has a certificate been issued?
What is the total number of the vehicles, engines or units covered?
What is the aggregate total retail value of the vehicles, engines or units covered?

$

Payment Details:
Amount Owed (U.S. Funds Only):

$

Payment Type:
Enter the check number:
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