5900-457 NRSI SSI Equipment Certification

Small SI Equipment Manufacturer Certification 5900-457

Manufacturer:

Equipment Family Name:

Projected Sales Volume:

Paperwork Reduction Act Notice

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0338). Responses to this collection of information are mandatory (40 CFR 1054). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Engine or Equipment Model

Exhaust Engine Family Name

Fuel Tank EPA Family Name

Fuel Line EPA Family Name

Manufacturer Comments

OMB No. 2060-0338

Approval Expires on

1/31/2022

EPA Form 5900-457