Epa Form 3520-1 - Declaration Form printable pdf download

Form Approved O M B 2060-0095

United States Environmental Protection Agency

Declaration Form

Importation of Motor Vehicles and Motor Vehicle Engines Subject to Federal Air Pollution Regulations

U .S . E.P .A ., C om pliance & Innovative S trategies D ivision, 2000 T raverwood D rive, Ann A rbor, MI 48105

.epa.gov/otaq/im ports

Phone (734) 214-4100; Fax (734) 214-4676.

This form must be submitted to the U.S. Customs and Border Protection (Customs)

(42 USC

7522, 7601:

19 CFR

12.73) for each motor vehicle

(including motorcycles, disassembled vehicles, kit cars, light-duty vehicle/motorcycle engines) imported into the U.S., except that this form is not

required for motor vehicles that are imported by their original manufacturer and are new and are covered by an EPA certificate of conformity and

bear an EPA emission control label. One form per shipment may be used, with attachments including all information required to fully describe

each vehicle or engine as below. Check the box below indicating the provisions under which you are importing this vehicle or engine. Offroad

vehicles/engines and heavy-duty engines must use form 3520-21. Note: Although only imports using codes G, I, K, L, M-3, and O require specific

written authorization from EPA, Customs may request EPA review of importer documentation and eligibility for any import using this form. A

nonconforming vehicle that is ineligible for the exemptions or exclusions listed below, must be imported through an independent commercial

importer (ICI) under codes A, C, J, or Z. For codes A, C, J, and Z, EPA does not authorize the release to the vehicle owner.

Penalties: 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 USC 1001). Any person who improperly imports a motor vehicle (including a motorcycle) or engine may be fined up

to $32,500 per vehicle or engine

(42 USC

7524), and may be subject to forfeiture of the entire importation bond, if applicable

(40 CFR

85.1513), and the U.S.

Customs Service may seize the vehicle or engine

(19 CFR

162.21).

Description and Declaration of Motor Vehicle or Motor Vehicle Engine (Note: Heavy-duty Engines must use form 3520-21)

1. Port code:

2. Entry date:

3. Customs entry number:

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

(mm/dd/yyyy)

5. Manufacture date (mm/yyyy):

6. Manufacturer (make):

7. Model:

8. ICI imports only, codes A, C, J, Z - EPA certificate no.,

model year and expiration date of applicable certificate:

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, or 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, importer, or agent for the owner or importer.

9. Importer (code B: must be

10. Owner:

11. Storage location:

12. Signature:

certificate holder or their agent

for shipments of new vehicles

prior to introduction into

commerce; codes A, C, J, Z:

13. Date:

must be ICI):

14. Name, company and phone (type or print):

U.S. conforming and “identical” vehicles

code B - U.S. certified - unmodified vehicle bearing a U.S. EPA emission control label in engine compartment (or on motorcycle frame) in English.

code F - U.S. certified, catalyst restoration - U.S. certified vehicle as described above, except that the catalyst, oxygen sensors or fuel filler neck

restrictor were removed or damaged. The importer attests that the catalyst and oxygen sensors and fuel filler neck restrictor, as applicable, will be re-installed

or replaced after importation. If leaded gasoline was used, the importer attests that after importation (1) the fuel tank will be drained and refilled with unleaded

gasoline, (2) the catalyst and oxygen sensors, if they were left on the vehicle during use of the leaded gasoline, will be replaced, and (3) the fuel filler neck

restrictor will be checked and replaced as necessary. No bond or EPA approval is required.

code EE - identical in all material respects to a U.S. certified version - either 1) Canadian vehicle (proof required e.g. Canadian emission control label,

registration or title, or letter from the U.S. or Canadian manufacturer representative on letterhead verifying manufacture for sale in Canada) on EPA list of

Canadian "identical" models, or 2) vehicle from any country with letter attached to this form from the manufacturer’s U.S. representative on letterhead (not a

dealer or mechanic) stating that the vehicle is identical to a U.S. EPA certified version with respect to emissions. The importer attests that vehicle is being

imported for purposes other than resale or lease. For import of “identical” Canadian vehicles for resale, use code FF.

code FF - Canadian “identical” models imported for resale or lease

Canadian vehicle as described above appearing on

EPA list of Canadian

“identical”

models, imported for resale or lease. The importer attests that the importer will satisfy applicable labeling, warranty and CAFÉ requirements as

specified by EPA.

EPA exempted vehicles

code M - miscellaneous exemption, either 1) Canadian vehicle as described above (proof required) and the importer is either permanently emigrating to

the U.S. or will reside in the U.S. for greater than one year under a worker or student visa, or 2) Canadian vehicle received by U.S. resident through

inheritance, or 3) EPA hardship letter based on unforseen and extraordinary circumstances is attached to this form.

code E -

vehicle at least 21 years old

(calendar year of manufacture subtracted from year of importation) and in original unmodified configuration is either

exempted or excluded from EPA emission requirements, depending on age. Vehicles at least 21 years old with replacement engines are not eligible for this

exemption unless they contain equivalent or newer EPA certified engines. Customs may require proof of vehicle age.

EPA Form 3520-1 (Rev. 10-10) Previous editions are obsolete

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