Fuel Annual 2

EPA Form 3520-12Q - Fuel Manufacturer Quarterly Report Instructions (05-02-2018)

Page 1 of 2

Instructions
Fuel Manufacturer Quarterly Report
for Motor Vehicle Gasoline or Diesel Fuel
GENERAL INFORMATION
Any manufacturer of a fuel registered by the Environmental Protection Agency must submit a Fuel Manufacturer Quarterly
Report for that fuel in order to keep the registration in force.
Fuel Manufacturer Quarterly Reports are to be submitted by the required deadline as shown in the following table.

TABLE 1 TO §79.5—QUARTERLY REPORTING DEADLINES
Calendar quarter

Time period covered

Quarterly report deadline

Quarter 1

January 1-March 31

June 1.

Quarter 2

April 1-June 30

September 1.

Quarter 3

July 1-September 30

December 1.

Quarter 4

October 1-December 31

March 31.

One copy of a Quarterly Report should be completed and submitted for each registered fuel.
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 - North
Room 5512D; (202) 343-9038
1200 Pennsylvania Ave, NW
Washington, DC 20004

Program Support and Registration Contact Form
(https://www.epa.gov/fuels-registration-reporting-and-compliance-help/forms/fuels-program-helpdesk#contactform)
Telephone: (202) 343-9648
Fax: (202) 343-2825
Jim Caldwell: (202) 343-9303 or [email protected]
Jose Solar: (202) 343-9027 or [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 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 darkcolored 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.

Address: Enter the address of the company office responsible for submitting this form.

Item 3.

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

Item 4.

Quarter: Check the appropriate quarter for which the company is submitting the report.

Item 5.

Quarterly Production Volume: Enter the number of gallons produced of this fuel for the quarter.

EPA Form 3520-12Q - Fuel Manufacturer Quarterly Report Instructions (05-02-2018)

Page 2 of 2

Item 6.

Fuel ID: Enter the EPA assigned fuel ID. Leave blank if you don't know this number.

Item 7.

Brand Name: List the brand name under which your company markets the fuel described on this form. If you market it under
more than one name, use the first name listed on the "Fuel Manufacturer Notification for Motor Vehicle Fuel" EPA Form
3520-12.

Item 8.

Additive Content: List of all US EPA registered additives previously reported for the fuel and their highest, lowest, and
average concentrations in milligrams per liter, even if usage was 0 in a particular quarter. If you are not reporting in units of
milligrams per liter, enter the concentration unit in which you are reporting in column (d). To have an additive dropped from
your listing, notify this office in writing.

Item 9.

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

Item 10.

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
company must provide a letter authorizing such agent.

OMB Control No. 2060-0150
Approval expires 01-31-20
The public reporting and recordkeeping burden for this collection of information is estimated to
average 3 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. 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, CSRA LLC, a General Dynamics Information Technology company
for the EPA. Information submitted with this form will be provided to the contractor for processing into a
database at the registration office.