Form Approved OMB 2060-0095 2060-0294 Approval Expires 8/31/03

 United States Environmental Protection Agency

Application for Final Admission of Nonconforming Imported Vehicle or Engine

Warning: 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 United States Code 1001). This form is required to be submitted to EPA under 40 CFR 85.1505, 85.1509, 89.605, 89.609.

1. Port of entry 2. Entry date

(mo/dy/yr)

3. Customs entry number: 4. Vehicle Identification Number (VIN), or engine serial number

5. Date of original manufacture

(mo/yr) 

6. Original manufacturer 7. Model

8. Declaration code (letter or box number from EPA form 3520-1 or 3520-21) 9. EPA certificate no. and model year and expiration date of certificate applicable

to this importation

Names, Addresses, and Telephone Numbers of Relevant Parties

10. Importer (ICI) 11. Owner 12. Vehicle/engine storage location (no P.O. boxes)

Telephone number Taxpayer ID # Telephone number

13. Person to receive oral or written notification that EPA has not approved

final admission

14. Telephone number 15. Modification date

16. Designate the provisions

under which the vehicle/engine

was modified and tested.

 For vehicle or engine modified under a certificate, write sequence number in 

this box beginning with the first one imported under the certificate, which is the certified

prototype. Ordinarily, every 3rd one is tested (1st, 4th, 7th, 10th, etc.)

For modification/test

vehicle or engine,

mark ìXî in this box.

Name of test laboratory _______________________________________________________

Initial test results: (indicate applicable units and pollutants)

Specify mileage used for

full useful life

______ K mi

 Deterioration factors

(as applicable)

Test results adjusted

by the deterioration

factor and rounded to

two significant figures

using ASTM E 29-67

rounding procedures: Emission standards

 Date of test 50K 

full 

useful life 50K

full 

useful life 50K

full 

useful life

HC, NMHC or 

NOx+HC

g/mi or g/kW-hr

g/mi 

or g/kW-hr

CO

g/mi or g/kW-hr

g/mi 

or g/kW-hr

NOx

g/mi or g/kW-hr

g/mi 

or g/kW-hr

Evap.

g/test g/test

Particulate 

g/mi or g/kW-hr

g/mi 

or g/kW-hr

18. Combined Fuel Economy. For vehicles only - report the combined fuel economy value (harmonic average calculated per 40 CFR 600.513-91(a)(2)) from the 

 last city and highway test for each modification/test vehicle.

19. For EPA use only

 Date final admission form received

EPA Form 3520-8 (Rev. 1-02) Previous versions are obsolete Pg 1 of 2
20. Place an ìXî in only one box

G I certify that the vehicle or engine has been modified in accordance with the provisions of a currently valid certificate of conformity. If applicable, a Federal

Test Procedure was performed on the vehicle or engine in accordance with procedures in 40 CFR Part 86 or Part 89 as applicable at a laboratory in the

U.S. (40 CFR 85.1505(a)(2)(ii), 89.605(a)(2)(ii)).

G I certify that the vehicle or engine has been modified and the Federal Test Procedure was performed on the vehicle or engine in accordance with

procedures in 40 CFR Part 86 or 89 at a laboratory in the U.S. For a vehicle, the emission testing and development of Fuel Economy data were performed

after modification to Department of Transportation safety standards. (40 CFR 85.1509(g)(2), 89.609(b)(2)).

G I certify that the vehicle or engine has been modified in accordance with the provisions of a currently valid certificate of conformity. EPA has approved the

plan for me to receive information concerning OEM running changes that affect emissions and therefore testing was not required. (40 CFR

85.1505(a)(2)(i), 89.605(a)(2(i)).

21. I certify that as the certificate holder I have provided or will provide to the purchaser or owner of the vehicle or engine, as applicable: 

 (1) written instructions for maintenance and use as required by 40 CFR 85.1510(a), 89.610(a); 

 (2) an emissions warranty as described in 40 CFR 85.1510(b), 89.610(b), Part 85 Subpart V and Clean Air Act sections 207(a) and (b); 

 (3) an emission label as required by 40 CFR 85.1510(c), 89.610(c) and Part 600 Subpart D; 

 (4) a fuel economy label as required by 40 CFR 85.1510(d) and Part 600 Subpart D. 

I certify that as the certificate holder I have complied with the applicable provisions of the Energy Act of 1978, 26 USC 4064 (gas guzzler tax) and for vehicles not 

 owned by me I have provided the applicable tax forms to the owner;

I have complied with the requirements of 40 CFR 80.24 as applicable to affix applicable unleaded fuel labels; 

I am responsible for the vehicle or engine compliance with Federal emission requirements regardless of whether I own the vehicle or engine. 

I certify that I have read and understand the warning above regarding the submission of false or fraudulent statements or concealing a material fact, and the 

 prohibited acts in 40 CFR 85.1513, 89.612 as applicable, and that the information I have provided is correct.

I understand that EPA Enforcement Officers are authorized to conduct inspections or testing otherwise permitted by 40 CFR Parts 85 or 89 or other applicable 

 provisions of the law. 

I will hold this vehicle or engine at least 15 working days from the date of EPAís receipt of the final admission information unless otherwise notified by EPA.

I have paid the applicable Motor Vehicle and Engine Compliance Program fee for this vehicle and submitted the Fee Filing Form (OMB No. 2060-0104) with the 

 payment, (ref: EPA guidance letter CD-92-07, July 7, 1992).

 Specify check number of fee payment _____________________ Date of check _________________ 

Signature of ICI corporate officer Print or type name Date signed

Fax or mail this form to the following addresses

(one form to each address). For delivery of

copy #1 by certified U.S. Express Mail use the

following address:

Attn: FINAL ADMISSION

U.S. Environmental Protection Agency

Certification and Compliance Division (6405-J)

1200 Pennsylvania Avenue, N.W.

Washington, D.C. 20460 (202) 564-9240

 (202) 565-2057 (fax)

Mailing Instructions

For delivery of copy #1 by a courier service 

(e.g., Federal Express, DHL, etc.) only

use the following address:

Attn: FINAL ADMISSION

U.S. Environmental Protection Agency

Certification and Compliance Division (6405-J)

501 3rd Street N.W.

Washington, D.C. 20001 (202) 564-9240

For delivery of copy #2, use the following address:

Attn: FEES COORDINATOR

U.S. Environmental Protection Agency

Certification and Compliance Division

2000 Traverwood Drive

Ann Arbor, MI 48105 (734) 214-4888

 (734) 214-4869 (fax)

Privacy Act Statement

Collection of the information on this form is authorized by the Clean Air Act, 42 USC 7401 et seq. (see 40 CFR 85.1501 et. seq. and 89.601 et. seq.) The

Environmental Protection Agency (EPA) uses this information to determine compliance of noncomplying imported vehicles with U.S. emission requirements and for

investigations with respect to EPAís import regulations. The information will be supplied to the internal Revenue Service for the purpose of collecting the gas guzzler

tax where applicable. Disclosure of this information may also be made to other Federal, State, or local law enforcement agencies when there is a violation of civil or

criminal law. Furnishing the information on this form, including your Social Security Number, is voluntary but failure to do so may result in disapproval of the importation

of the vehicle identified on this form. 

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 3520-8 (Rev. 1-02) Previous versions are obsolete Pg 2 of 2