5900-241 TPEM Engine Mfg Report v1.1

United States
US Environmental Protection Agency
Office of Air and Radiation, Office of Transportation and Air Quality
Transition Program for Equipment Manufacturers
Engine Manufacturer Report
Last Revision: December 2013 Version Number: 1.1
Please submit forms to: TPEM-CI@epa.gov DO NOT MAIL HARD COPIES. DO NOT SUBMIT THROUGH VERIFY. Please use this form to submit your TPEM engine manufacturer report within 45 days after the end of the model year (§1039.250(a)(2)).
Engine Manufacturer Information					Submission Date:
	Manufacturer Name:				OMB No. 2060-0369
	Contact Name:				Approval Expires on
	Email Address:				August 31, 2014
	Phone #:				EPA Form 5900-241
	Manufacturer Address
	Address 1:
	Address 2:
	City:
	State:
	ZIP:
	Country:				Notification contains Confidential Business Information (CBI)?
	40 CFR Part:	Part 89
	Model Year:
	Comments:
Engine Manufacturer TPEM Report Data
	Engine Family	Engine Model	Power Category	Buyer or Shipping Destination	Buyer's Address or Contact Information (Optional)	Exempt Engines Production Volume
				Paperwork Reduction Act Notice
				The public reporting and recordkeeping burden for this collection of information is estimated to average 11 hours 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, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB Number 2060-0369 in any correspondence. Do not send the completed Form 5900-241 to this address.