Document ID: EPA-HQ-OAR-2010-0690-0034
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2020-10-09T04:00Z

REPLY FORM
      
      
      1 .       Owner's Name                                                           2. Control No.                                                 

            THIS INFORMATION  REQUEST  IS AUTHORIZED BY LAW. WHILE YOU ARE NOT REQUIRED TO RESPOND, YOUR COOPERATION IS NEEDED TO MAKE THE RESULTS OF THIS INVESTIGATION VALID
      
      3.        Do you own/lease a                   vehicle with the vehicle identification number

(VIN)	___	___	___	___	___	___	___	___	___	___	___	___	___	___	___	___	___?     _____yes      _____no
4.       If so, list the Make                                                      Model                                                               
5.        Current odometer reading                                      miles.
6.        Are you the original owner/lessee?         yes 	    _____no
7.        Is your  vehicle ______ automatic    ______ manual
   8. 	 Are you interested in participating in this program?
        	 yes	  _____ no 	             _______ need more information.

  9. 	May we contact you at your convenience:

        Home Phone: (_____) - _____________________	Best time to call:            a.m. ______p.m. 
        Work Phone:  (_____) - _____________________	Best time to call:            a.m. ______p.m. 
        Cell Phone:      (        ) - _____________________	 Best time to call: _______ a.m.             p.m.
           IF YOU HAVE ANY QUESTIONS, PLEASE CALL US TOLL FREE AT (855)665-1228.
                                             
      WHETHER OR NOT YOU PLAN TO PARTICIPATE, PLEASE RETURN THIS FORM IN THE POSTAGE PAID ENVELOPE.                                                                                                                      
                                                       
                            Privacy Act Statement	
Title 42, United States Code, Section 7451, Compliance by vehicles and engines in actual use, authorizes the collection of this information.  The primary use is to provide an instrument by which individuals may indicate interest in and eligibility for participating in EPA's Light-Duty In-Use Testing Program.  Additional disclosures of this information may be made pursuant to published routine uses, including to appropriate agencies for law enforcement purposes and to contractors working for EPA who have a need to know in the course of that work.
Providing the requested information is voluntary, but failing to do so will result in EPA's inability to approve your participation in the Light-Duty In-Use Testing Program.

                                       
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0086). Responses to this collection of information are voluntary (42 USC 7541.) 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. The public reporting and recordkeeping burden for this collection of information is estimated to range from 1 to 60 minutes per response, with an average of 30 minutes per response. 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 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.