EPA Form 3520-29 OMB Control No. 2060-0545; approval expiration date: 7/31/2010



### U.S. ENVIRONMENTAL PROTECTION AGENCY

**MOTOR VEHICLE AND ENGINE COMPLIANCE PROGRAM**

**ON-HIGHWAY FEE FILING FORM** 

**FOR CERTIFICATION APPLICATIONS RECEIVED IN CALENDAR YEAR 2010** 

Manufacturer Name

Address

City/State/Zip Code/Country

On-Highway Certification Request Type (check one)

**LDV/LDT/MDPV/HDV (Chassis cert) FEDERAL ($34,849) HDV EVAP-ONLY ($511)** 

**LDV/LDT/MDPV/HDV (Chassis cert) CAL-ONLY ($17,591) HDE CALIF-ONLY ($511)** 

**HDE (Engine Dyno cert) FEDERAL ($35,967) MOTORCYCLE ($1,210)** 

**LD/MDPV/HDV ICI**  **($47,928)**

EPA standard engine family or test group or
HDV Evaporative family name:

Amount paid (U.S. Funds Only): 

## $

Enter the check number, or the statement A EFT/WIRE @ or A EFT/ACH @ :

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

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

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

**Check box if an Independent Commercial Importer: List the VIN of imported vehicles/engines below:** 

Company Representative: Signature:

Title: Phone/Fax: / Date: / /

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

. (2) 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 EFT/Wire **payments** to the New York Federal Reserve Bank . (See Instructions, p.2)
(4) Transmit offline EFT/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: 1/1/2011 The public reporting and recordkeeping burden for this co llection of information is estimated to average 18 minutes per respons e. Send comments on EPA’s need for this information, the accuracy of the provide d burden estimate, and any suggested methods for minimizing resp ondent burden, including through the use of automated collection techniques, to th e Director, Collection Strategies Division, U.S. Environment al Protection Agency (2822T), 1200 Pennsylvania Ave., N.W., Washi ngton, D.C. 20460. Include the OMB control number in any correspondence. Do not sen d the

com p leted Form 3520-29 to this address.EPA Form 3520-29 OMB Control No. 2060-0545; approval expiration date: 7/31/2010



### Page 2

Instructions

NOTE: This form applies to complete certification applic ations that are received in Calendar Year (CY) 2010. 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 cale ndar 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 will appear on the Certificate of Conformity

.
Certification Request Type Check the box that specifies the certification request type. If you are paying a reduced fee, still mark the appropriate certification request type

.
EPA Standard Engine Family or Test Group or HDV Evaporative Family Name Enter the appropriate EPA standardized engine family or test group name as it will appear on the Certificate of Conformity. Forms and payments for Modification and Test vehicles under 40 CFR 85.1509 must list the engine family for the currently valid Certificate of Conf ormity under which the vehicles are being imported.

Amount Paid Enter the appropriate fee amount for the designated certificati on 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, EFT/ACH, or EFT/WIRE (for offline payments) The check number is mandatory for check, money order, bank draft, or certified check; or enter the letters "EFT/WIRE" or "EFT/ACH" if sending an electronic funds transf er. Indicate the standard engine family or test group

name on the check. Make checks payable to “U.S. Environmental Protection Agency”.

Indicate in the EFT message field the information : For Wire : RDFI: Federal Reserve Bank; Locati on Code (Same as EPA Account Number): 68-01-0099 ; "EPA

MVECP Fee" ; ABA number: 021030004. (ABA number is same as Swift Code or Routing Number for participating banks. For further information, email Fees@epa.gov) . Note: the wire detail corresponding to ABA 021030004 is “TREAS NYC”; this is the same as the Federal Reserve Bank.

For ACH : RDFI: Federal Reserve Bank, Routing Tran sit number: 051036706, Account number: 540006, Account Name: U.S. Environmental Protection Agency (EPA). Note: the 051036706 company name appears as “U.S. EPA”; the receiving bank is still the Federal Reserve Bank of Cleveland.

Please include in wire or ACH message fields the follo wing: the words “MVECP Fees”, manufacturer name, and engine family/test group/HDV evaporative group name(s). If space is limited, list one name and the number of

families.

Reduced Fee Section (if applicable) Reduced fee submissions must be supported by the reduced fee calculation on Page 1 of this form and any relevant supporting information requested by EPA at the time of a pplication review. Enter the number of vehicles/engines projected for sale under the engine family/test group. Enter the aggregate projected retail sales price of the vehicles or engines and multiply that value by 1% (.01). Enter a nd pay the reduce fee amount (minimum $750). If you are an ICI, please enter the VIN for any vehicles/engines already (or soon to be) in your possession. For any additional VINs, please use a separate page. For further inform ation see the reduced fee provisions under 40 CFR §1027.120

.

Company Representative Enter the representative's name, signature, title, phone/fax, date, and an e-mail address. Note: an acknowledgment of 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 fee filing forms to:

U.S. Bank

Government Lockbox 979032

1005 Convention Plaza

SL-MO-C2-GL St. Louis, MO 63101