EPA Form 3520

- 29 OMB Control NO.2060

- 0545

U.S. E nvironmental P rotection A gency M otor V ehicle and E ngine C ompliance P rogram N onroad F ee F iling F orm F or C ertification A pplications R eceived In C alendar Year 20 13

Manufact u rer Name

Address

City/State/Zip Code/Country

Nonroad Certification Request Type (check one)

**NR CI #**  **($2,239) Locomotives ($563)** 

**NR SI ($563) Recreational (except marine) ($563)** 

**Equipment and Fuel System Components ($241) All Marine ($563)** 

# Excludes Locomotives, Marine and Recreational Vehicles

EPA family name:

For dual U.S./IMO Marine only, also give IMO name:

Amount paid (U.S. Funds Only): 

### $

Enter the check number, or the statement "WIRE" or "ACH":

**Reduced Fee Section** (40 CFR §1027.120 )

**Reduced fee calculation (minimum initial payment $750): Total number of vehicles/units covered:**

**Aggregate retail sales price of the vehicles/units: $ x 1% = $** 

Company Representative: Signature:

Title: Phone/Fax: / Date: / /

**E-mail Address: Submission of payments and forms:** 
(1) Online: **Forms** may be found and submitted with or without **payments** on-line at www.Pay.gov

. (2) By mail: For check payments only, send **checks** and this **form** to:

**Environmental Protection Agency Motor Vehicle and Engine Compliance Program** 

**P.O. Box 979032 St. Louis, MO 63197-9000** 

(3) Transmit offline Wire **payments** to the New York Federal Reserve Bank . (See Instructions, p.2)
(4) Transmit offline ACH **payments** to the Federal Reserve Bank of Cleveland . (Instructions, p.2)
(5) **Forms** not submitted under (1) and (2) above can be sent as email attachments to Fees@epa.gov. Forms and payments sent in ways other than the above may be delayed or ineffective. See the Instructions for sending checks and forms by private mail service (e.g., Federal Express)

**.**

This form expires 1/1/ 2014 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 method s for minimizing respondent burden, including through the use of automated collection techniques, to the Director, Collection Strategies Division, U.S. Environme ntal Protection Agency (2822T), 1200 Pennsylvania Ave., N.W., Washington, D.C. 20460. Include t he 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

Page 2 

### Instructions

NOTE: This form applies to complete certification applications that are received in Calendar Year (C Y) 20 13

. Fee amounts due are subject to change every year. Use of the form for the wrong calendar year can cause incorrect payments and delays. Get the form for the calendar year of your application submission at www.epa.gov/otaq/fees.htm

or www.Pay.gov . Forms and payments may be submitted online at www.Pay.gov

.

Manufacturer Name and Address List the applicant ' s corporate name and corporate address as it w ill appear on the Certificate of Conformity.

Certification Request Type Check the box that specifies the certification request type. All nonroad certification request types and fees also apply to
ICIs. Off

- road recreational vehicles with SI engines should check Recreational. If you are paying a reduced fe e, s till mark the appropriate certification request type.

EPA Family Name Enter the appropriate EPA standardized family

, test group , evaporative or equipment/component name that will appear on the Certificate of Conformity. For marine compression

- ignition engines, if you are applying for a federal certificate and an Annex VI certificate for the same family, enter both family names in the spaces provided and submit a single fee for the amount indicated next to the certification type box.

Amount Paid Enter the appropriate fee amount for the designated certification request type. The full fee, payable in U.S. dollars, along with a properly completed fee filing form, must be received before certification review can begin. All banking fees are the responsibility of the manufacturer . The reduced fee amount (if applicable) is also entered in this box.

Check Number, ACH, or WIRE (for off

- line payments) The check number is mandatory for c heck, money order, bank draft, or certified check; or enter the letters "WIRE" or "ACH" if sending an electronic funds transfer. Indicate the standard family or test group name on the check. Make checks payable to “U.S. Environmental Protection Agency”.

Indicate in the message field the information : For Wire : Receiver FI: TREAS NYC (this is the short name for the US Treasury's routing number). Routing Number (ABA number or Swift Code for participating banks. For further information, email Fees@EPA.gov ): 021030004

. Beneficiary (Agency Location Code [ALC] or EPA Account Number): 86 8 01009900 0

. Beneficiary Name: US Environmental Protection Agency. Originator Information: MVECP Fees, manufacturer name, family name(s). If spa ce is limited, list one family and the number of families.

For ACH : Standard Entry Class: CCD; Transaction Code: 22; Receiving DFI ID (ABA number): 051036706; Account

Number: 868010099000 ; Receiving Company Name: US Environmental Protection Agency. Payment Related Information: family name(s).

Reduced Fee Section (if applicable) Reduced fee submissions must be supported by the reduced fee calculation on Page 1 and any relevant supporting

information requested by EPA at the time of application review. Ent er the number of vehicles/ units projected for sale under the family/test group. Enter the aggregate projected retail sales price of the vehicles or units and multiply that value by 1% (.01). Enter and pay the reduce fee amount (minimum $750).

Company Representative Enter the representative ' s name, signature, title, phone/fax, date, and an e

- mail address. The person named should be someone familiar with the payment who can be contacted for clarification of any issues. Note: A n acknowledgment o f

fees received will be sent to this e

- mail address. No other receipts will be sent.

Bank Address for Private Mail Shipment (other than U.S. Postal Service) If using a private shipping service such as Federal Express (or other service), send checks with f ee filing forms to:

U.S. Bank

Government Lockbox 979032

1005 Convention Plaza

SL

- MO

- C2

- GL St. Louis, MO 631 01