5900-430 TPEM Importers Notification

					United States
					US Environmental Protection Agency
					Office of Air and Radiation, Office of Transportation and Air Quality
					Transition Program for Equipment Manufacturers (TPEM)
					Equipment Importer Notification (Non-Manufacturer) - §1039.626(b)(1)
					Last Revision: August 2018 Version Number: 1.1
This form is for IMPORTERS ONLY. Please submit forms to: TPEM-CI@epa.gov DO NOT MAIL HARD COPIES. NOTE: In addition to this Notification, you must also submit an annual report for each year you import equipment with engines exempted under §1039.625. The annual report is due by March 31 of the year after you import the equipment. (See: §1039.626(b)(2)) Submit your reports using the electronic template found at: [INSERT WEB ADDRESS].
Importer Basic Information					Submission Date:
	Importer (Company) Name:					If Notification submitted by 3rd Party, provide the following information:
	Importer Contact Name:					3rd Party Contact Name:
	Importer Email Address:					3rd Party Email Address:
	Importer Phone #:					3rd Party Phone #:
	Importer Address:					3rd Party Address:
		Address 1:					Address 1:
		Address 2:					Address 2:
		City:					City:
		State:					State:
		ZIP:					ZIP:
		Country:					Country:
	If the importer company is part of another (Parent Company), provide the following information:
	Parent Company Name:
	Parent Company Address:
		Address 1:
		Address 2:
		City:
		State:
		ZIP:
		Country:
	Other Companies Operating under Parent Company:
	Other Information:
	Does this Notification contain Confidential Business Information (CBI)?
	Comments:
TPEM Notification Data for Importers
						UPCOMING CALENDAR YEAR:
	For all importers:					For the upcoming calendar year, please provide your best estimate of the number of units by power category and by manufacturer that you will import [See: 40 CFR §1039.626(b)].
	Please provide the manufacturer name and address associated with the imported equipment under the TPEM provisions of Part 1039.
	Engine/Equipment Manufacturer(s)					Expected TPEM Equipment Imports
	Manufacturer Name	Manufacturer Type	Contact Name	Corporate Address		YEAR	Equipment Manufacturer	Power Category	Volume (# units)
						PREVIOUS CALENDAR YEARS:
						For previous calendar years, enter the number of units by power category and by manufacturer that you have imported under 40 CFR §89.102(d).
						Historical TPEM Equipment Volume
						YEAR	Equipment Manufacturer	Power Category	Volume (# units)
	Paperwork Reduction Act Notice
	The public reporting and recordkeeping burden for this collection of information is estimated to average XX 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 5900-242 to this address.