Form Approved OMB 2060-0095 Approval Expires 7/31/2010 

### United States Environmental Protection Agency

Declaration Form Importation of Motor Vehicles and Motor Vehicle Engines Subject to Federal Air Pollution Regulations U.S. E.P.A., Compliance & Innovative Strategies Division, 2000 Traverwood Drive, Ann Arbor, MI 48105 http://www.epa.gov/otaq/imports Phone (734) 214-4100; Fax (734) 214-4676. This form must be submitted to the U.S. Customs and Border Protection (Customs) ( 42 USC 7522 , 7601 : 19 CFR 12.73 ) for each motor vehicle (including motorcycles, disassembled vehicles, kit cars, light-duty vehicle/motorcycle engines) imported into the U.S., except that this form is not required for motor vehicles that are imported by their original manufacturer and are new and are covered by an EPA certificate of conformity and bear an EPA emission control label. One form per shipment may be used, with attachments including all information required to fully describe each vehicle or engine as below. Check the box below indicating the provisions under which you are importing this vehicle or engine. Offroad vehicles/engines and heavy-duty engines must use form 3520-21. Note: Although only imports using codes G, I, K, L, M-3, and O require specific written authorization from EPA, Customs may request EPA review of importer documentation and eligibility for any import using this form. A nonconforming vehicle that is ineligible for the exemptions or exclusions listed below, must be imported through an independent commercial importer (ICI) under codes A, C, J, or Z. For codes A, C, J, and Z, EPA does not authorize the release to the vehicle owner.

Penalties: Any person who knowingly makes any false or fraudulent statement, or omits or conceals a material fact can be fined up to $250,000 or imprisoned for up to 5 years, or both (18 USC 1001). Any person who improperly imports a motor vehicle (including a motorcycle) or engine may be fined up to $32,500 per vehicle or engine ( 42 USC 7524 ), and may be subject to forfeiture of the entire importation bond, if applicable ( 40 CFR 85.1513 ), and the U.S. Customs Service may seize the vehicle or engine ( 19 CFR 162.21 ).

Description and Declaration of Motor Vehicle or Motor Vehicle Engine (Note: Heavy-duty Engines must use form 3520-21 )

1. Port code: 2. Entry date: (mm/dd/yyyy) 3. Customs entry number: 4. Vehicle Identification Number (VIN), or engine serial number:

5. Manufacture date (m m /y yyy ): 6. Manufacturer (make): 7. Mo del:

8. ICI impo rts only, codes A, C, J, Z - EPA certificate no., model year and expiration date of applicable certificate: Names, Addresses, and Telephone Numbers of Relevant Parties Certification: I certify that I have read and understand the purpose of this form, the penalties for falsely declaring information, or for providing misleading information, or for concealing a material fact. The information I have provided is correct, and all required attachments are appended to this form. I authorize EPA Enforcement Officers to conduct inspections or testing permitted by the Clean Air Act. I am the owner, importer, or agent for the owner or importer.
9. Importer (code B: must be certificate holder or their agent for shipments of new vehicles prior to introduction into commerce; codes A, C, J, Z: must be ICI ): 10. Owner: 11. Storage location: 12. Signature:

13. Date:

14. Name, company and phone (type or print):



### U.S. conforming and “identical” vehicles G code B - U.S. certified - unmodified vehicle bearing a U.S. EPA emission control label in engine compartment (or on motorcycle frame) in English.



### G code F - U.S. certified, catalyst restoration - U.S. certified vehicle as described above, except that the catalyst, oxygen sensors or fuel filler neck restrictor were removed or damaged. The importer attests that the catalyst and oxygen sensors and fuel filler neck restrictor, as applicable, will be re-installed or replaced after importation. If leaded gasoline was used, the importer attests that after importation (1) the fuel tank will be drained and refilled with unleaded gasoline, (2) the catalyst and oxygen sensors, if they were left on the vehicle during use of the leaded gasoline, will be replaced, and (3) the fuel filler neck restrictor will be checked and replaced as necessary. No bond or EPA approval is required.



### G code EE - identical in all material respects to a U.S. certified version - either 1) Canadian vehicle (proof required e.g. Canadian emission control label, registration or title, or letter from the U.S. or Canadian manufacturer representative on letterhead verifying manufacture for sale in Canada) on EPA list of Canadian "identical" models, or 2) vehicle from any country with letter attached to this form from the manufacturer’s U.S. representative on letterhead (not a dealer or mechanic) stating that the vehicle is identical to a U.S. EPA certified version with respect to emissions. The importer attests that vehicle is being imported for purposes other than resale or lease. For import of “identical” Canadian vehicles for resale, use code FF

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### G code FF - Canadian “identical” models imported for resale or lease - Canadian vehicle as described above appearing on EPA list of Canadian “identical” models , imported for resale or lease. The importer attests that the importer will satisfy applicable labeling, warranty and CAFÉ requirements as specified by EPA. 

### EPA exempted vehicles G code M - miscellaneous exemption, either 1) Canadian vehicle as described above (proof required) and the importer is either permanently emigrating to the U.S. or will reside in the U.S. for greater than one year under a worker or student visa, or 2) Canadian vehicle received by U.S. resident through inheritance, or 3) EPA hardship letter based on unforseen and extraordinary circumstances is attached to this form.



### G code E - vehicle at least 21 years old (calendar year of manufacture subtracted from year of importation) and in original unmodified configuration is either exempted or excluded from EPA emission requirements, depending on age. Vehicles at least 21 years old with replacement engines are not eligible for this exemption unless they contain equivalent or newer EPA certified engines. Customs may require proof of vehicle age. EPA Form 3520-1 (Rev. 4-10) Previous editions are obsolete Pg 1 of 2

### United States

Environmental Protection Agency

Excluded vehicles G code L - racing vehicle as determined by EPA and may not be registered or licensed for use on or operated on public roads or highways ( 40 CFR 85.1511(e) ). EPA letter of approval must be attached to this form.



### G code U -2005 model year (or older) motorcycle, scooter or moped with engine displacement less than 50cc and with rated speed greater than 5000 rpm.



### G code W - non-chassis-mounted engine to be used in a light-duty vehicle or light-duty truck or motorcycle which is currently covered by an EPA certificate or will be covered by an EPA certificate prior to introduction into commerce.



### G code Y - unregulated fuel - a vehicle that: (1) for model years earlier than 1991 operates on fuel other than gasoline or diesel fuel, or (2) for 1991- 1996 model years operates on fuel other than gasoline or diesel or methanol fuel, or (3) for 1997 and later model years operates on fuel other than gasoline or diesel or methanol or ethanol or compressed natural gas (CNG) or liquid petroleum gas (LPG), including propane. This exemption does not apply to 2004 and later model year vehicles. 

### Temporary imports G code G - imported for repair or alteration in accordance with 40 CFR 85.1511(b)(1) . May not be registered or licensed for use on, or operated on public roads or highways, or sold or leased in the U.S. Customs bond required. EPA requests that the vehicle be bonded for at least its full value. EPA letter of approval must be attached to this form.



### G code I -

imported for testing purposes in accordance with 40 CFR 85.1511(b)(2) . May not be registered or licensed for use on or operated on public roads or highways (except operation that is integral to the purpose of the testing program) or sold or leased in the U.S. Customs bond required. EPA requests that the vehicle be bonded for at least its full value. EPA letter of approval must be attached to this form.



### G code K - imported for display (solely for public or business purposes, and not for private purposes or U.S. market sales promotions) in accordance with 40 CFR 85.1511(b)(4) . May not be registered or licensed for use on or operated on public roads or highways (except operation that is integral to the purpose of the display) or sold or leased in the U.S. Customs bond required. EPA requests that the vehicle be bonded for at least its full value. EPA letter of approval must be attached to this form.



### G code N - imported for up to one year by member of the armed forces or personnel of a foreign government on assignment to the U.S., for whom free entry has been authorized in writing by the U.S. Department of State, or a member of the armed forces of a foreign country with official orders for duty in the U.S.



### G code O - imported by nonresident for personal use by an individual for a period up to a year. EPA letter of approval must be attached to this form. 

### Independent commercial importer ( ICI ) imports G code A - imported by an ICI for modifications in accordance with a valid EPA certificate of conformity issued for the specific make, model, and model year in accordance with 40 CFR 85.1505

. 

### G code C - imported by an ICI for modification and testing in accordance with 40 CFR 85.1509 . Vehicle must be at least 6 years old.



### G code J -

imported by an ICI for the purpose of pre-certification testing in order to obtain an EPA certificate of conformity. No EPA approval is required. The ICI has 180 days to obtain a certificate or export ( 40 CFR 85.1511(b)(3) ). Customs bond required

. 

### G code Z - imported by an ICI for the purpose of modifying to be identical to an original equipment manufacturer (OEM) certified version in accordance with written instructions from the OEM that are specific to the vehicle being imported.


### OEM imports G code H - imported, owned, and controlled directly by an original equipment manufacturer (OEM) on EPA list of OEM certificate holders provided to Customs, for research, development or testing purposes in accordance with 40 CFR 85.1706 . This is a temporary exemption without time limit. If the vehicle is subsequently covered by an applicable EPA certificate of conformity, it is released from the restrictions of this exemption.



### G code Q - imported, owned, and controlled directly by an original equipment manufacturer (OEM) on EPA list of OEM certificate holders provided to Customs, for storage pending receipt of the applicable EPA certificate of conformity, which is pending and imminent. Use of this code is no longer permitted once EPA has issued the applicable certificate of conformity. 

### U.S. Department of Transportation Requirements

Note: Importers of vehicles that are primarily manufactured for use on public roads must also file an HS-7 Declaration form to identify the basis for the vehicle's admission under the laws administered by the U.S. Department of Transportation. For more information, see www.nhtsa.dot.gov/cars/rules/import/

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### Paperwork Reduction Act Notice This information is collected to ensure that motor vehicles and engines imported into the U.S. conform with applicable emission requirements. Responses to this collection are mandatory (40 CFR 85.1501 et seq., and Clean Air Act Sections 203 and 208). Information submitted to the Agency under a claim of confidentiality will be safeguarded according to policies set forth in Title 40, Chapter 1, Part 2, Subpart B. The public reporting and recordkeeping burden for this collection of information is estimated to average 30 minutes per response. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. 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. 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 (2822), 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.

EPA Form 3520-1 (Rev. 4-10) Previous editions are obsolete Pg 2 of 2