Epa Form 3520-21 - United States Environmental Protection Agency Engine Declaration Form Page 2

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Importation of Engines Excluded from U.S. EPA Emission Standards

19. Competition engine. The engine must be used solely for competition, subject to the provisions of 40 CFR 1068.310(a), 85.1511(e), 89.611(e),

90.612(e), 91.704(e), or 94.804(c)(2). An EPA letter of approval must be attached to this form.

20. Stationary engine. The engine must be used for a stationary purpose and remain at a single site at a building, structure, facility or installation for

more than 12 consecutive months throughout its lifetime, or remain at a seasonal source during its full annual operating period (see the definition of

“nonroad engine” in 40 CFR 1068.30, 89.2, or 90.3). Starting January 1, 2004 for spark-ignition engines above 19 kW and January 1, 2006 for all

compression-ignition engines, the engine must be labeled (see 40 CFR 1039.20 or 1048.20). Penalties: Any person who circumvents or attempts to

circumvent residence-time requirements for stationary engines may be fined up to $32,500 per day of violation (40 CFR 1068.101(b)(3), 89.1006(a)(5),

90.1006(a)(5)). NOTE: Stationary engines may be subject to state or local regulations.

21. Underground mining. Engine must be used in underground mining and regulated by the Mining Safety and Health Administration (MSHA). See

40 CFR 89.1 and 1039.5; see also 30 CFR 7, 31, 32, 36, 56, 57, 70, 75. For compression-ignition engines only.

22. Spark-ignition hobby engine. For a spark-ignition engine powering a reduced-scale model of a vehicle not capable of transporting a person.

See 40 CFR 90.1(d)(6).

23. Compression-ignition hobby engine. For a compression-ignition engine with displacement below 50 cc per cylinder. See 40 CFR 89.1(b)(5).

Exemptions for Specific Engine Categories or Other Special Cases

24. Transition Program for Equipment Manufacturers. Importing a piece of equipment, subject to the provisions of 40 CFR 89.102 or

40 CFR 1039.625 and 1039.626 (Category D only). Maximum engine power: ____________

HP (or identify the regulatory power category).

25. Personal-use exemption for small spark-ignition engines. Importing three or fewer nonroad spark-ignition engines at or below 19 kW for

purposes other than resale, where the importer has never previously used this exemption, subject to the provisions of 40 CFR 90.611.

26. Engine imported by an Independent Commercial Importer recognized by EPA. Only for Categories A and D above.

26a. For modification under a valid EPA certificate issued for the specific make, model, and model year according to 40 CFR 85.1505, 89.605 or

1039.660.

26b. For modification and testing according to 40 CFR 85.1509, 89.609, or 1039.660. NOTE: The imported engine must be at least 6 years old.

26c. For precertification testing to obtain an EPA certificate under 40 CFR 85.1511(b)(3), 89.611(b)(3), or 1039.660. NOTE: Customs bond is

required. Specify location of storage (required):

NOTE: Under 26a and 26b, you may import up to five highway engines and five nonroad engines in a given model year that are certified to standards

based on an engine’s original production year. You may import any number of engines certified to standards that apply based on the year the engine is

modified. See 40 CFR 85.1503 and 89.603.

27. Other exemption. Describe the exemption, attach EPA approval (if applicable), and identify the regulatory cite:_________________________

Declaration of Nonroad or Heavy-duty Highway Engine, or Nonroad Vehicle or Equipment

Port code:

Customs entry no:

Entry date:

Engine manufacturer; model and serial number of each engine; for certified engines or

vehicles, identify the engine family name:

For uncertified engines (or vehicles), identify the engine (or

Vehicle or equipment manufacturer; model, serial number, and type of equipment (if

vehicle) build date:

applicable):

month

year

on engine

other (explain)

Names, Addresses, and Telephone Numbers of Relevant Parties

Certification: I certify that I have read and understand the purpose of this form, the penalties for falsely declaring information, for providing misleading

information, or for concealing a material fact. The information I have provided is correct, and all required attachments are appended to this form. I

authorize EPA Enforcement Officers to conduct inspections or testing permitted by the Clean Air Act. I am the owner, the importer, or an agent of the

owner or importer.

Signature:

Printed name:

Date:

Identify the name, address, phone number, and e-mail address for the importer, broker, and owner as applicable:

Importer (required):

Broker (optional):

Owner (optional):

Penalties: (1) Anyone who knowingly makes any false or fraudulent statement, or omits or conceals a material fact can be fined up to $270,000 or imprisoned for up to 5

years, or both (18 U.S.C. 1001). Anyone who illegally imports an engine may be fined up to $32,500 per engine (42 U.S.C. 7524), and may be subject to forfeiture of the

entire importation bond, if applicable (40 CFR 1068.335, 89.612, 90.613, 91.705, 92.805, 94.805), and the engine is subject to seizure by Customs (19 CFR 162.21). (2)

Anyone who distributes in commerce, sells, offers for sale, or introduces into commerce an engine subject to EPA certification requirements but not covered by a

certificate of conformity, may be fined up to $32,500 per violation (40 CFR 1068.101(a), 89.1006, 90.1006, 91.1106, 92.1106, 94.1106).

Information collection: This information is collected to ensure that engines imported into the U.S. conform with applicable emission requirements. Responses to this

collection are mandatory (Clean Air Act sections 202, 203, and 208). Information submitted to the Agency under a claim of confidentiality will be safeguarded as

described in 40 CFR part 2. The public reporting and recordkeeping burden for this collection of information is estimated to average 30 minutes per response. 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, DC 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

EPA Form 3520-21 (Rev. 04-06).

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This form is approved under OMB control number 2060-0320.