3520-29 MVECP Highway Fee Filing Form

EPA Form 3520-29

OMB Control No. 2060-0545

U.S. Environmental Protection Agency
Motor Vehicle and Engine Compliance Program
On-Highway Fee Filing Form
For Certification Applications Received In Calendar Year 2013
Manufacturer Name
Address
City/State/Zip Code/Country
On-Highway Certification Request Type (check one)
LDV/LDT/MDPV/HDV (Chassis cert) FEDERAL ($29,848)

HDV EVAP-ONLY ($563)

LDV/LDT/MDPV/HDV (Chassis cert) CAL-ONLY ($15,704)

HDE CALIF-ONLY ($563)

HDE (Engine Dyno cert) FEDERAL ($44,215)

MOTORCYCLE ($1,427)
LD/MDPV/HDV ICI ($68,737)

EPA standard family or test group:

$

Amount paid (U.S. Funds Only):

Enter the check number, or the statement "WIRE" or "ACH":

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

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) By mail: For check payments only, 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 Wire payments to the New York Federal Reserve Bank.(See Instructions, p.2)
(4) Transmit offline 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: 1/1/2014

EPA Form 3520-29

OMB Control No. 2060-0545

Page 2
Instructions
NOTE: This form applies to complete certification applications that are received in Calendar Year (CY) 2013.
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 Family Name
Enter the appropriate EPA standardized family, test group, or HD evaporative 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, ACH, or WIRE (for offline payments)
The check number is mandatory for check, money order, bank draft, or certified check; or enter the letters "WIRE"
or "ACH" if sending an electronic funds transfer. Indicate the family name on the check. Make checks payable to
“U.S. Environmental Protection Agency”.
Indicate in the message field the information:
For Wire: Receiver FI: TREAS NYC (this is the short name for the US Treasury's routing number). Routing Number
(ABA number or Swift Code for participating banks. For further information, email [email protected]): 021030004.
Beneficiary (Agency Location Code [ALC] or EPA Account Number): 868010099000. Beneficiary Name: US
Environmental Protection Agency. Originator Information: MVECP Fees, manufacturer name, family name(s). If
space is limited, list one family and the number of families.
For ACH: Standard Entry Class: CCD; Transaction Code: 22; Receiving DFI ID (ABA number): 051036706;
Account Number: 868010099000; Receiving Company Name: US Environmental Protection Agency. Payment
Related Information: family name(s).
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/units
projected for sale under the family. Enter the aggregate projected retail sales price of the vehicles or units and
multiply that value by 1% (.01). Enter and pay the reduce fee amount (first payment minimum $750, later
refundable). 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. The person named should be
someone familiar with the payment who can be contacted for clarification of any issues. 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