Fuel Additive Manufacturer Annual Report, Supplemental Additive Manufacturers Annual Report

EPA Form 3520-13A - Fuel Additive Manufacturer Annual Report Instructions (11-2013)

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Instructions

Fuel Additive Manufacturer Annual Report

GENERAL INFORMATION
The manufacturer of a fuel additive registered by the Environmental Protection Agency under 40 CFR 79 is required to submit
a Fuel Additive Manufacturer Annual Report (EPA Form 3520-13A) in order to keep the registration in force. One 3520-13A form is
required for each manufacturer.
Fuel Additive Manufacturer Annual Reports are to be submitted on or before March 31 for the preceding year or part thereof.
Completed form(s) should be sent:
Via U.S. Postal Service
U.S. Environmental Protection Agency
William Jefferson Clinton Building
Mail Code - 6405A
1200 Pennsylvania Ave, NW
Washington, DC 20460

or

Via Courier
U.S. Environmental Protection Agency
William Jefferson Clinton Building
Room 6520V; (202) 343-9038
1200 Pennsylvania Ave, NW
Washington, DC 20004

Telephone: (202) 343-9648
Fax: (202) 343-2825
email: [email protected]
[email protected]
Specific instructions for completing the form follow.
The EPA is responsible for assessing the impact on public health and welfare from exposure to motor vehicle emissions.
Knowledge of fuel additive production is an important aspect of this program.
SPECIFIC INSTRUCTIONS
Please type (best results are obtained using standard fonts such as Courier or Arial) or print the information using a dark-colored
ink. If using a photocopied version of the form, please ensure the copy is clean and has been copied to 100% of the original page
size.
Item 1.

Company Name: Enter the company's legal name.

Item 1a.

Company ID: If known, enter the EPA assigned company ID.

Item 2.

Report Year: Enter the year for which the company is submitting the report.

Item 3.

Report Type: Check "Original" if this is the first submission for the stated year and additive(s) listed. Check

"Resubmission" if this is an update or correction to the original submission.

Item 4.

Impurities: Self-explanatory.

Item 5.

Additive Mechanisms: Self-explanatory.

Item 6a. Additive ID: Enter the EPA assigned additive ID.
Item 6b. Market: To the best of your knowledge, check the box indicating the additive's use. If the additive was registered with
more than one Market category, it must be reported separately for each market category and its corresponding
production.
Item 6c. Production Volume: Enter the number of units produced of this additive for the report year.
Item 6d. Production Units: Enter the appropriate unit abbreviation for each entry.
Item 7.

Confidential Business Information: Enter the number(s) of those items for which your company asserts a claim of
confidentiality.

Item 8.

Assurance: The notification form must be signed and dated by the fuel manufacturer or its authorized agent. The printed
name of the signer and the signer's telephone number should be given. If the form is signed by an authorized agent, the

EPA Form 3520-13A - Fuel Additive Manufacturer Annual Report Instructions (11-2013)
company must provide a letter authorizing such agent.
Item 9.

Self-explanatory.

OMB Control No. 2060-0150
Approval expires 10-31-16
The public reporting and recordkeeping burden for this collection of information is estimated to
average 1 hour per response. Send comments on the Agency's need for this information, the
accuracy of the provided burden estimates, 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., NW,
Washington, D.C. 20406. Include the OMB control number in any correspondence. Do not send the
completed form to this address.
NOTE: This office is operated by a contractor, SRA International for the EPA. Information submitted with this
form will be provided to SRA International for processing into a database at the registration office.

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