EPA Form 3520

- 29 OMB Control No. 2060

- 0545

U.S. Environmental Protection Agency

Motor Vehicle and Engine Compliance Program

C orrection F orm

Date:

Manufacturer Name:

Family Na me:

Original Payment Date:

Original Amo unt Paid: $

Revised Family Name:

Company Representative:

Name: Phone:

Email Address: Fax: (optional)

Reason for Correction:

Typographical error in original family or test group n ame.

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

overpayment amount in the comments box

.

Other (explain in comments box):

Comments:

Submission:

(1 ) Forms may be filled out and submitted online at www.Pay.gov

. (2) Forms may be submitted as email attachments to Fees@epa.gov

(3) Forms may be submitt ed by surface mail to:

Environmental Protection Agency

- NVFEL

Fees Team

Compliance Division

2000 Traverwood

Ann Arbor, Michigan 48105



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Instructions

The public reporting and recordkeeping burden for this collection of information is estimated to average 18 minutes per response. Send

comments on EPA' s need for this information, the accuracy of the provided burden estimate, and any suggested methods for minimizing

respondent burden, includi ng through the use of automated collection techniques, to the Director, Collection Strategies Division, U.S.

Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., N.W., Washington, D.C. 20460. Include the OMB control number in any

correspondence . Do not send the completed Form 3520

- 29 to this address.EPA Form 3520

- 29 OMB Control No. 2060

- 0545

This form is used to make typographical and other corrections to a family or test group nam e, to apply an overpayment on one family

to certification fee payment for a different family

, and to make other changes to previously submitted fee filing forms. For corrections

requiring a dditional payment, use the MVECP Miscellaneous Payments Due Form , t o both make the change and submit the payment.

For corrections that result in a reduction in the amount owed, the correction can be treated as an overpayment on the new family using

this form, and a Refund Request Form can be used to be refunded the overpa yment if desired . All corrections are subject to EPA

approval. All forms can be found and submitted at www.Pay.gov or downloaded at www.epa.gov/otaq/fees.htm

.

Manufact urer Name:

Please enter the name of the company or manufacturer.

Family Name:

Enter the original test group or family name. If you are using the form to apply overpayments (credit balance) on more than one

family to the "revised" family name below, list the additional 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 origi nal test

group or family. Use the best information available.

Original Amount Paid:

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

Revised Family Name:

Indicate the revised or new family or test group name. If you are using the form to correct a t ypographical or other mistake in the

name, enter the correct ed 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 family, put down the new fam ily to which the overpayment should be

applied. Use one correction form for each new family to which overpayments are being assigned.

Company Representative:

Enter the authorized company representative information

, including a contact name, email address, telephone number, and fax

number. The contact should be a person familiar with the correction who can be reached for clarification of any issues. Forei gn

manufacturers may find that having a contact person in the U.S. will expedite resolution of fee payme nt issues. This contact person

will be notified if the correction is not approved or there is a problem.

Reason for Correction:

Select the reason for correction:

-- Typographical error in original family or test group name.

-- Overpayment for original family name, please apply the amount to the revised family name.

Select this option to transfer an overpayment on the original family or test group to the "revised" family or test

group. E nter information about the original payment(s) in the Comments box. This will help EPA confirm the

overpayment.

-- 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.

Submission:

(1 ) Forms may be filled out and submitted online at www.Pay.gov

. (2) Forms may be submitted as email attachments to Fees@epa.gov

(3) Forms may be submitted by surface mail to:

Environ mental Protection Agency

- NVFEL

Fees Team

Compliance Division

2 000 Traverwood

Ann Arbor, Michigan 48105