Information Collection

Form 3520-21, Individuals

IC 184205 under ICR 201607-2060-001 · OMB 2060-0320.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2060-0320 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3520-21 Form 3520-21, Individuals	Form and Instruction
3520-21 Engine Declarations Form Form3520-21.pdf www.epa.gov/otaq/imports/forms/3520-21.pdf	Form and Instruction

IC Title:

Form 3520-21, Individuals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 40 CFR 94 40 CFR 90 40 CFR 85 40 CFR 91 40 CFR 92 40 CFR 89 40 CFR 1068

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3520-21	Engine Declarations Form	Form3520-21.pdf	http://www.epa.gov/otaq/imports/forms/3520-21.pdf	Yes	No	Fillable Printable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

Number of Respondents for Small Entity: 4,000

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	8,000	8,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.