5900-309 Cash Incentive

EPA's Light-Duty In-Use Vehicle Testing Program (Renewal)

Form 5900-309 cash incentive

EPA's In-Use Vehicle and Engine Testing Programs

OMB: 2060-0086

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OMB Control No. 2060-0086

Expires: MM/DD/YYYY


CASH INCENTIVE AGREEMENT


I, _____________________________, the owner ( ) and/or joint owner ( ), and/or principal driver ( )


being fully advised agree to the following:


( ) To accept a total of $20.00 per day, in addition to the use of a loaner

vehicle.


( ) To accept a total of $50.00 per day, in lieu of a loaner vehicle.


while the vehicle described herein, MAKE_______________________


MODEL_________________YEAR_______VIN_________________________

is in possession of Jacobs, a contractor to the U.S. Environmental Protection Agency.

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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.

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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, DC 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.”














PARTICIPANT:

_________________________________________ ___________________ SIGNATURE DATE

JACOBS REPRESENTATIVE:

________________________________________ ___________________ SIGNATURE DATE


EPA Form 5900-309

Revision Date 3/18/2021


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Titlecash incentive mpf
AuthorDorothy Day
File Modified0000-00-00
File Created2021-05-01

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