![](media/image1.wmf){width="0.59375in"
height="0.2708333333333333in"}U.S. Environmental Protection Agency

![](media/image1.wmf){width="0.59375in"
height="0.2708333333333333in"}Motor Vehicle and Engine Compliance
Program

Correction Form

Date: [  /  /    ]{.underline}

Manufacturer Name:      

Engine Family Name:                        

Original Payment Date:   /  /    

Original Amount Paid: \$      

Check here if IMO/Annex Engine Family:

Revised Engine Family Name:                        

Authorized Company Representative:

Contact Name:       Phone:      

Email Address:       Fax:       (optional)

Reason for Correction:

Typographical error in original engine family or test group name.

Overpayment for original family name, please apply the overpayment to
the revised engine family name.

Assignment of new engine family name to existing placeholder \"dummy\"
name.

Other (explain in comments box):

Comments:      

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Send Correction Form to:

Environmental Protection Agency- NVFEL

Fees Team

Compliance and Innovative Strategies Division

2565 Plymouth Road

Ann Arbor, Michigan 48105

Current Form Expires: 1/1/07

**MVECP Fee Correction Form Instructions**

This form is used to make typographical and other corrections to an
engine family or test group name, to apply an overpayment on one engine
family to certification fee payment for a different engine family, to
assign a proper engine family or test group name to a placeholder name
(for an explanation of placeholder names, see
http://www.epa.gov/otaq/fees.htm), and to make other changes to
previously submitted fee filing forms. For corrections requiring
additional payment, use the MVECP Miscellaneous Payments Due Form in
addition to this one, to submit the payment. For corrections requiring a
refund, the refund can be treated as an overpayment using this form, or
a separate Fee Refund Request Form can be used. All corrections are
subject to EPA approval.

[Instructions:]{.underline}

**Manufacturer Name:**

Please enter the name of the company or manufacturer.

**Engine Family Name:**

Enter the original test group or engine family name. If you are using
the form to apply overpayments (credit balance) on more than one engine
family to the \"revised\" engine family name below, list the additional
engine families in the comment box.

**Original Payment Date:**

Enter the date of the online credit card or ACH payment, or the date of
the offline check, wire, or ACH payment for the original test group or
engine family. Use the best information available.

**Original Amount Paid:**

Indicate the amount you paid for this engine family or test group when
the initial fee payment was made, if applicable.

**IMO/Annex Engine Family:**

Check the box if the revised engine family name is an IMO/Annex engine
family.

**Revised Engine Family Name:**

Indicate the revised or new engine family name or test group name. If
you are using the form to correct a typographical or other mistake in
the name, enter the correct name. If you are using the form to assign a
name to a previous placeholder name, enter the assigned name. If you are
using the form to apply an overpayment to a new engine family, put down
the new engine family you want the overpayment applied to.

**Authorized Company Representative:**

Enter the authorized company representative information including a
contact name, email, address, telephone number, and fax number. An email
address is mandatory. The contact should be a person familiar with the
correction who can be reached for clarification of any issues. Foreign
manufacturers may find that having a contact person in the U.S. will
expedite resolution of fee payment issues.

**Reason for Correction:**

Select the reason for correction:

> \-- Typographical error in original engine family or test group name.
>
> \-- Overpayment for original family name, please apply the amount to
> the revised engine family name.
>
> Select this button if you wish to transfer an overpayment on the
> original engine family or test group to the \"revised\" engine family
> or test group. Selecting this button will result in a prompt to enter
> information about the original payment(s) in the Comments box. This
> will help EPA confirm the overpayment.

\-- Assignment of new engine family or test group name to existing
placeholder \"dummy\" name.

> (This serves the same function as filling out EPA\'s offline \"MVECP
> Fees Placeholder Correction Form.\")

\-- Other (explain in comments box)

> For any other corrections enter your explanation in the Comments box.

**Comments:**

Enter any information necessary or helpful in explaining the correction.

**Send Correction Form to:**

Environmental Protection Agency- NVFEL

Fees Team

Compliance and Innovative Strategies Division

2565 Plymouth Road

Ann Arbor, Michigan 48105