EPA's In-Use Vehicle and Engine Testing Programs

2. Control No.

1. Owner's Name

THIS INFORMATIONREQUEST IS AUTHORIZEDBY LAW. WHILEYOU ARE NOT REQUIREDTO
RESPOND, YOUR COOPERATION IS NEEDED TO MAKETHE RESULTS OF THIS INVESTIGATION
VALID.
3.

Do you own/lease a

vehicle with the vehicle identification number

?

(VIN)

4.

If so, list the Make

5.

Current odometer reading

6.

Are you the original owner/lessee?

'1.

Is your vehicle -

8.

Are you interested in participating in this program?
_yes

9.

_yes

_no

, Model-

automatic -

miles.

-

yes -

no

manual

_no

-

need more information.

May we contact you at your convenience:
Home Phone: (
Work Phone: (

-

Best time to call:

a.m.

p.m.

)-

Best time to call:

a.m.

p.m.

)

IF YOU HAVE ANY QUESTIONS. PLEASE CALL US TOLL FREE AT (866)665-1228.
WHETHER OR NOT YOU PLAN TO PARTICIPATE, PLEASE RETURN THIS CARD IN THE
POSTAGE PAID ENVELOPE.

OMB No. 2060-0086
Form Approved OMS No. 158-R0146

'