Form 5900-242 TPEM Equipment Manufacturer Notification

						United States
						US Environmental Protection Agency
						Office of Air and Radiation, Office of Transportation and Air Quality
						Transition Program for Equipment Manufacturers (40 CFR Part 1039.625)
						Equipment Manufacturer Notification
						Last Revision: August 2018 Version Number: 1.3.2
Please submit forms as an Excel file to: [email protected] DO NOT EMAIL PDF FILES OR MAIL HARD COPIES. DO NOT ADD TABS OR MODIFY THIS FORM IN ANY WAY. If you have questions, please contact the TPEM Help Desk at [email protected] or by phone at 734-214-4100. Please note that you must submit an annual report for each year you use the TPEM provisions. The report is due by March 31 of the year after you used a TPEM allowance. (§1039.625(g)(2)) Submit your reports using the Equipment Manufacturer Annual Report template found at: http://www.epa.gov/otaq/certdat2.htm#tpem.
Equipment Manufacturer Basic Information					Submission Date:					http://www.epa.gov/otaq/certdat2.htm#tpem
	Manufacturer (Company) Name:					If Notification submitted by 3rd Party, provide the following information:
	Manufacturer Contact Name:					3rd Party Contact Name:
	Manufacturer Email Address:					3rd Party Email Address:
	Manufacturer Phone #:					3rd Party Phone #:
	Manufacturer Address:					3rd Party Address:
		Address 1:					Address 1:
		Address 2:					Address 2:
		City:					City:
		State:					State:
		ZIP:					ZIP:
		Country:					Country:
	If your company is part of another (Parent Company), provide the following information:
	Parent Company Name:
	Parent Company Address:
		Address 1:
		Address 2:
		City:
		State:
		ZIP:
		Country:
	Other Companies Operating under Parent Company:
	All Companies:
	Does this Notification contain Confidential Business Information (CBI)?
	Small Volume Manufacturer:
	Foreign Equipment Manufacturer:
	Are you planning on applying for additional exemptions for technical or engineering hardship? (§1039.625(m))
	Are you generating additional TPEM allowances under the provisions of §1039.627 (early Tier 4 engine incentive)?
	Did you use the allowances under §1039.625 for engines that are not yet subject to Tier 4 standards (early allowances)? (§1039.625(d)(4))
	Did you use the technical or engineering hardship provisions of §89.102(i)?
	Comments:
TPEM Notification Data
	For all equipment manufacturers:				For future Calendar Years, please provide your best estimate of the number of units in each power category that you will produce under TPEM.
	Please provide the name and address of each company you expect to produce engines for the equipment you manufacture under the TPEM provisions of Part 1039.
	Engine Manufacturer				Expected TPEM Equipment Volume for Part 1039
	Manufacturer Name	Contact	Corporate Address		TPEM Start Year	TPEM End Year	Power Category	TPEM Production Volume	TPEM Allowance Type
					For previous model years, enter the number of units in each power category you have sold under §89.102(d).
					Historical TPEM Equipment Volume Under Part 89
					TPEM Start Year	TPEM End Year	Power Category	TPEM Production Volume	TPEM Allowance Type
	Paperwork Reduction Act Notice
	The public reporting and recordkeeping burden for this collection of information is estimated to average 9 hours 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. 20460. Include the OMB Number 2060-0369 in any correspondence. Do not send the completed Form 5900-242 to this address.