5900-257 Template for Light-duty Conversion of Outside Useful Lif

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Overview

Instructions
Applicability
Data Form
Compliance Statements (du.e)

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Sheet 1: Instructions

Light Duty Vehicle/Outside Useful Life Notification Package:

Instructions for Clean Alternative Fuel Conversion Manufacturers

This workbook contains data forms and compliance statements to be used by clean alternative fuel

conversion manufacturers submitting a light duty vehicle/outside useful life notification package to EPA.

The notification package includes test data, compliance statements, and all other information necessary

to support the outside useful life vehicle demonstration requirements set forth in 40 CFR Part 85 subpart F.

Please refer to the regulations for detailed compliance requirements. Outside useful life vehicles have

exceeded their regulatory useful life. Refer to the OEM certificate to determine the applicable useful life.

Paper Work Reduction Act Notice

A conversion system becomes eligible for exemption from the Clean Air Act tampering prohibition upon

EPA receipt of a complete notification package. Please note that EPA does not issue a certificate of

The public reporting and recordkeeping burden for this collection is estimated to average 18,244 hours

conformity to conversion systems that qualify for exemption under the outside useful life program.

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

Excel Macros

through the use of automated collection techniques to the Director, Collection Strategies Division,

This form uses Excel macros. Please make sure that macros are enabled on your computer before trying

U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington,

to fill out the form. Different versions of Excel require different steps to enable macros. Please search the

Washington, DC, 20460 and to the Office of Management and Budget (OMB), Paperwork

Excel help function for "Enable Macros" to get instructions on how to enable the interactive elements of this

Reduction Project (1910-1800), Washington, D.C. 20503. Include the OMB control number(s)

form.

in any correspondence. Do not send the completed form to this address.

Entering Data on the ‘Data Form’ Worksheet

On the worksheet labeled "Data Form", fill out all grey-bordered fields that are not shaded green.

EPA Form Number 5900-257

OMB Control Number 2060-0104

Each notification package is identified by a unique conversion ID number. To generate a conversion ID

Expires XX/XX/XXXX

number, click the "Generate Conversion ID Number" button the first time you fill out the data form. If a

EPA ICR Number 0783.65

previous submission needs to be corrected and resubmitted, do not generate a new Conversion ID number,

but use the same number as in the original submission so that the corrected form will be recognized as a

replacement for the original submission.

Entering Information on the ‘Applicability’ Worksheet

After the ’Data Form’ worksheet is complete, use the ‘Applicability’ worksheet to enter the test groups and

and evaporative/refueling families, if applicable, that these data will be applied to. You must follow

the regulations in 40 CFR 85.520(b)(2) to determine appropriate combinations.

Compliance Statements

The submission form will generate compliance statements based on the conversion type and conversion

fuel selections on the 'Data Form' worksheet. These statements appear on the 'Compliance Statements'

worksheet. Review the compliance statements and electronically sign and date that sheet by typing in your

name and the date. Note that if your selection for conversion type and conversion fuel changes, the

compliance statements may change. In this case, any signatures would be erased and would have to be

re-entered.

A complete notification package must include the appropriate justifications for these compliance

statements as well as all requirements in 40 CFR 85.520.

Embedding related/supporting documents

All documents required to be submitted as part of the data submission process must be embedded in

this worksheet (see 40 CFR 85.520 for required documents). To embed a file, generally you

would need to go to Insert -> Object -> Create From File (check the "Display as icon" box, but NOT the

"Link to File" box). After browsing for the appropriate file, an icon representing the file should appear on this

page. Click and drag the icon into the box below. A submission without all necessary documents will be

considered incomplete.

Embedded documents go here

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Sheet 2: Applicability

Light Duty Vehicle/Outside Useful Life Notification Package: Clean Alternative Fuel Conversion Applicability

New Conversion Test Group:

New Conversion Evaporative/Refueling Family:

This conversion applies only to outside useful life vehicles with the OEM test group and evaporative family combinations listed below

#

OEM Test Group

OEM Evap Family

OEM Manufacturer

OEM MY

CYang: If multiple engine displacements, then separate with comma and space Displacement (L)

Orig. Fuel

CYang: If multiple models, separate each model name with comma and space Models

EPA Form Number 5900-257

OMB Control Number 2060-0104

Expires XX/XX/XXXX

EPA ICR Number 0783.65

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Sheet 3: Data Form

Light Duty Vehicle/Outside Useful Life Notification Package: Clean Alternative Fuel Conversion Data Form
Conversion Information
Converter Name:						Conversion ID #
Conversion Type:						Original Fuel:
Converting to use:
Additional Information
EPA Form Number 5900-257
OMB Control Number 2060-0104
Expires XX/XX/XXXX
EPA ICR Number 0783.65

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Sheet 4: Compliance Statements (du.e)

Light Duty Vehicle/Outside Useful Life Notification Package:

Clean Alternative Fuel Conversion Compliance Statements

By electronically signing my name, I confirm/attest that I comply with applicable regulations in 40 CFR part 85.

I also confirm/attest:

>

I have submitted a document that describes how the conversion system qualifies as a clean alternative fuel

conversion and have submitted OBD scan tool results as applicable. 40 CFR 85.520(b(4)(i), (ii), (iii) and

85.520(b)(6)(i)

>

I have submitted an OBD scan tool report, as applicable, showing results from the procedure set forth in 40

CFR 85.520(b)(4)(ii), The results do not demonstrate a failed test. I have included the VIN of the test

vehicle on the report. 40 CFR 85.520(b)(4)(ii)

>

The test group converted to an alternative fuel has fully functional OBD systems (if the OEM vehicles are

required to be OBD equipped) and therefore meets the OBD requirements in 40 CFR 86, subpart S when

operating on the alternative fuel. The OBD system properly detects and identifies malfunctions in all

EPA Form Number 5900-257

monitored emission-related powertrain systems or components including any new monitoring capability

OMB Control Number 2060-0104

necessary to identify potential emission problems associated with the new fuel. These include but are not

Expires XX/XX/XXXX

limited to: fuel trim lean and rich monitors, catalyst deterioration monitors, engine misfire monitors, oxygen

EPA ICR Number 0783.65

sensor deterioration monitors, EGR system monitors, if applicable, and vapor leak monitors, if applicable.

No original OBD system monitor that is still applicable to the converted vehicle is aliased, removed,

bypassed, or turned off. No MILs are illuminated after the conversion. Readiness flags are properly set for

all monitors that identify any malfunction for all monitored components. 40 CFR 85.520(b)(4)(i) and (iii).

>

I attest that I have taken steps to ensure that fuel conversion systems will be properly installed and adjusted

such that the vehicle operates consistent with the principles of good engineering judgment and are expected

to maintain or improve upon emission levels in a worst case vehicle. 40 CFR 85.520(b)(6)(i) and (7).

>

I have submitted a document that describes the conversion test group that is covered by this notification.

40 CFR 85.520(b)(6)(ii)

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I have submitted detailed information confirming the durability of all relevant new and existing

components and explaining why the conversion system will not harm the emission control system or

degrade the emissions. 40 CFR 85.520(b)(6)(iii)(E)

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I attest that based on development data or an engineering evaluation, converted vehicles are expected to

maintain or improve upon emission levels when operated at high altitude. 40 CFR 85.520(b)(6)(i)

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I attest that the test group converted to dual-fuel or mixed fuel operation retains all the OEM fuel system,

engine calibration, and emission control system functionality when operating on the fuel with which the

vehicle was originally certified. 40 CFR 85.520(b)(6)(iii)(B)

>

I attest that the test group converted to dual-fuel or mixed fuel operation retains all the functionality of the

OEM OBD system (if required to be so equipped) when operating on the fuel with which the vehicle was

originally certified. 40 CFR 85.520(b)(6)(iii)(C)

>

I attest that the test group converted to dual-fuel or mixed fuel operation properly purges hydrocarbon

vapor from the evaporative emission canister when the vehicles are operating on the alternative fuel. 40

CFR 85.520(b)(6)(iii)(D)

Signed:

Date: