5900-431 TPEM Importers Annual Report

					United States
					US Environmental Protection Agency
					Office of Air and Radiation, Office of Transportation and Air Quality
					Transition Program for Equipment Manufacturers (TPEM)
					Equipment Importer Annual Report (Non-Manufacturer) - §1039.626(b)(2)
					Last Revision: August 2018 Version Number: 1.1
This form is for IMPORTERS ONLY. Please submit forms to: [email protected] DO NOT MAIL HARD COPIES. NOTE: This Annual Report must be preceded by a Notification per §1039.626(b)(1) and is due by March 31 of the year after you import the equipment. (See: §1039.626(b)(2)) Submit your reports using the electronic template found at: {INSERT WEB ADDRESS}.
Importer Basic Information					Submission Date:
	Importer (Company) Name:					If Annual Report submitted by 3rd Party, provide the following information:
	Importer Contact Name:					3rd Party Contact Name:
	Importer Email Address:					3rd Party Email Address:
	Importer Phone #:					3rd Party Phone #:
	Importer Address:					3rd Party Address:
		Address 1:					Address 1:
		Address 2:					Address 2:
		City:					City:
		State:					State:
		ZIP:					ZIP:
		Country:					Country:
	If the importer 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:
	Other Information:
	Does this Annual Report contain Confidential Business Information (CBI)?
	Comments:
TPEM Annual Report Data for Importers
	Please provide the manufacturer name, type, contact name, corporate address, and number of engines imported for equipment covered under the TPEM provisions of Part 1039.
	Equipment Manufacturer Name	Engine Manufacturer Name	Number of Engines Imported	Contact Information				Notes
				Name	Phone#		Email
	Paperwork Reduction Act Notice
	The public reporting and recordkeeping burden for this collection of information is estimated to average XX 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.