Form 5900-300 Voluntary Emissions Recall Report

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
Voluntary Emissions Recall Report (VERR)

* = required field

Validate Form

Report / Manufacturer Information
New VERR

Correct / Update VERR *

Manufacturers are required to submit six Quarterly
Reports following a new VERR submission.

EPA VERR Number *
Manufacturer VERR Number *
Form Version Number *

Additional email address

Voluntary Emission Recall Information
Owner notification start date *
Problem category *

Owner notification final date
Air Inlet/Intake System
Catalyst/Aftertreatment Component/System (non-diesel engine)
Computer Related (Other than OBD)
Crankcase Ventilation Component/System
Diesel Particulate Filter System
Electrical, Mechanical and Cooling Systems

Defect description *

Related emissions defect
information report (EDIR)
number(s) *
Add EDIR #

Remove Last #

Describe the specific
modifications. *

Describe the method used to
determine the names and
addresses of the vehicle or engine
owners *
EPA Form 5900-XXX (Rev 09/2013)

Page 1 of 8

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
* = required field

Voluntary Emissions Recall Report (VERR)

Validate Form

Describe the conditions, proper
maintenance, or use upon which
the manufacturer determines
eligibility for repair *
Describe the procedure for the
vehicle or engine owners to correct
the nonconformity *

Describe any authorized warranty
agents or persons other than
dealers who will remedy the
defect *

Describe the system used to assure
an adequate supply of parts will be
available to perform the repair *

Describe the impact of the
proposed changes on fuel
economy *

Describe the impact of the
proposed changes on drivability *

Describe the impact of the
proposed changes on safety *

Type of related documents to be submitted to the Verify Document Module *
(CTRL + Click to select multiple value(s))

No Related Documents to Submit
Owner Notification
Dealer Notification/Bulletin
Repair Instructions
Technical Service Bulletin
Sample Repair Label
Other (Specify in 'Notes' field)

Number of related documents to be submitted to Verify Document Module *
EPA Form 5900-XXX (Rev 09/2013)

Page 2 of 8

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
* = required field

Voluntary Emissions Recall Report (VERR)

Validate Form

Notes

EPA Form 5900-XXX (Rev 09/2013)

Page 3 of 8

EPA Form 5900-XXX (Rev 09/2013)

Model / Calibration *

Model Year *

Vehicle / Engine Information

Add Vehicle / Engine

Make *

Certified Sales Area *

Test Group / Engine Family Information

Voluntary Emissions Recall Report (VERR)
Affected Vehicles / Engines Description

Test Group /
Engine Family *

Add Test Group / Engine Family

* = required field

2000 Traverwood Drive, Ann Arbor, MI, 48105

Validate Form

Page 4 of 8

Delete This Vehicle / Engine

Number Covered by Recall *

Delete Test Group / Engine Family

Displacement
(Liters) *

ENVIRONMENTAL PROTECTION AGENCY

United States

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
Voluntary Emissions Recall Report (VERR)
Help Section
General
Validate Form Button
Clicking this button will check to see if the form is valid and identify any form errors for correction.
Failure to submit a valid form means you have not met reporting requirements and the system will reject
the form.

Report Information
New VERR or Correct / Update VERR
If you are submitting this VERR for the first time, you should select "New VERR." If you are updating or
correcting a previously submitted VERR, you should select "Correct / Update VERR." If you select
"Correct / Update VERR", you must enter the number of the original VERR that you are updating /
correcting and the reason that you are correcting or updating the VERR.
EPA VERR Number
You must enter a number for the VERR. If you are submitting a new VERR, the number should be exactly
four digits and must contain zeroes for numbers with fewer than four significant digits (e.g., "0007").
Manufacturer VERR Number
You may enter anything, up to 20 characters into this field, it is designed to allow manufacturers to
internally track their defect reports. If you are using your own internal number for VERR tracking
purposes, you may enter it here. Otherwise, enter the EPA VERR number here.
Form version number
You must enter a two digit form version number. If you are submitting a corrected or updated VERR,
increment the number of the previous submitted VERR. The number should be exactly 2 digits
and must contain zeroes for numbers with fewer than two significant digits (e.g., "01").
Reason for correction / update
If you selected "Correct / Update VERR", you must enter the reason that you are correcting or updating
the VERR. If you are submitting the VERR for the first time, you should select "New VERR." (4000
Character Limit)
Additional email address
You may enter an additional group e-mail that can be used in notifications or communications concerning
this report. The primary e-mail used for notifications or communications will be the one provided during
the Verify registration process.
Owner notification start date
Enter the first date that you notified owners about the voluntary emissions recall campaign described in
this report.
Owner notification final date
Enter the final date that you notified owners about the voluntary emissions recall campaign described in
this report.

EPA Form 5900-XXX (Rev 09/2013)

Page 5 of 8

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
Voluntary Emissions Recall Report (VERR)
Help Section
Problem category
This list is used to categorize the problem identified in the EDIR. You must only select one category and
it should be for the primary problem, if there are multiple problems identified in the EDIR. For example,
if an EGR valve problem is defective and, subsequently, an On-board Diagnostic (OBD) malfunction
indicator lamp (MIL) is illuminated for an EGR fault, the problem category should identify the EGR
components as defective, not the OBD system. In contrast, if an OBD MIL is being erroneously
illuminated for EGR valves that are not defective and the OBD programming is being corrected, then the
problem category should identify the OBD system as defective.
Defect description
Clearly identify the device, system, assembly or software that has the defect, what the defect is, and
to the extent known at the time, the cause of the defect. (4000 Character Limit)
Related Emissions Defect Information Report
Enter the number(s) for the related EDIR(s) for this VERR. If you are entering multiple EDIR numbers
use the "Add EDIR #" button. You may add up to twelve related EDIR Numbers.
Describe the specific modifications.
Include alterations, repairs, corrections, adjustments and other changes that will be performed to
address the emission-related defect. (4000 Character Limit)
Describe the method used to determine the names and addresses of the vehicle or engine
owners
Describes the method used to determine the names and addresses of the vehicle or engine owners. (4000
Character Limit)
Describe the proper maintenance or use upon which the manufacturer determines eligibility
for repair
Describes the requirements (e.g., mileage) to meet in order to be eligible for manufacturer repair. (4000
Character Limit)
Describe the procedure for the vehicle or engine owners to correct the nonconformity
Describes the procedure that the vehicle or engine owner should follow in order to correct the defect.
(4000 Character Limit)
Describe any authorized warranty agents or persons other than dealers who will remedy the
defect
Describes any authorized warranty agents or persons other than dealers who will remedy the defect.
(4000 Character Limit)
Describe the system used to assure an adequate supply of parts will be available to perform
the repair
Describes the system used to assure an adequate supply of parts for performing the repair. (4000
Character Limit)
Describe the impact of the proposed changes on fuel economy
Describes the impact of the proposed changes the on fuel economy of the vehicles or engines. (4000
Character Limit)

EPA Form 5900-XXX (Rev 09/2013)

Page 6 of 8

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
Voluntary Emissions Recall Report (VERR)
Help Section
Describe the impact of the proposed changes on drivability
Describes the impact of the proposed changes on the drivability of the vehicles or engines. (4000
Character Limit)
Describe the impact of the proposed changes on safety
Describes the impact of the proposed changes on the safety of the vehicles or engines. (4000 Character
Limit)
Type of related documents to be submitted to the Verify Document Module
If you are submitting documents related or supporting the VERR to the Verify Document Module, you can
use this list to identify one or more of these documents that you are submitting. If you are submitting
documents containing confidential business information (CBI) you should select "Other (Specify in 'Notes'
field" and indicate in the "Notes" field that a CBI document is being submitted separately (e.g., "CBI
attached in separate document.")".
Number of related documents to be submitted to Verify Document Module
Enter the number of documents you will be submitting to the Verify Document Module. Since some
documents may be combined, it is helpful to know how many related documents that accompany an EDIR
should be retrieved from the Verify Document Module.
Notes
Use this field to enter any notes and/or comments. In addition, there are particular fields that require
you to enter notes when certain options are selected and this field should be used for this that purpose.
(4000 Character Limit)

Affected Vehicles / Engines Description
Test Group / Engine Family
Enter the test group or engine family of the affected vehicle(s) or engine(s). [Example: 9EPAX04.23A1]
Certified Sales Area
Select the appropriate certified sales area for the applicable test group or engine family. For vehicles that
were certified to exhaust emission standards for California and Section 177 states, select the "CA+177
States" option. For vehicles that were certified to exhaust emission standards for states outside other
than California and Section 177 states, select the "FED" option. For vehicles that were certified to
exhaust emission standards for California and Section 177 states and states other than California and
Section 177 states, select the "50-State" option.
Number Covered by Recall
Enter the number of vehicles from each test group that will be remedied by the actions described in the
VERR. The number of vehicles recalled for each test group will be totaled and displayed in the "Total
Covered by the Recall" box at the top right of the form for comparison purposes. Please enter the
accurate number of vehicles for each test group to ensure that the total number covered by the recall is
accurate.
Make
Enter the specific make (i.e., name plate) for the affected vehicle(s) or engine(s). [Example: Buick,
Lexus, Mercury]

EPA Form 5900-XXX (Rev 09/2013)

Page 7 of 8

OMB Control No. 2060-0048 Approval Expires on 10/31/2013
OMB Control No. 2060-0140 Approval Expires on 5/31/2014

United States

ENVIRONMENTAL PROTECTION AGENCY
2000 Traverwood Drive, Ann Arbor, MI, 48105
Voluntary Emissions Recall Report (VERR)
Help Section
Model / Calibration
Enter the model or calibration name that the manufacturer has designated for the vehicle or the calibration for the engine
that is affected in the defect recall report
Model Year
Enter the model year of the affected vehicle(s) or engine(s). [Example: 2001]
Displacement (liters)
Enter the engine displacement for the affected vehicle(s) or engine(s) in liters. [Example: 4.23]
Vehicle Information Page Buttons
Add Test Group / Engine Family - This button is used if a report covers multiple Test Groups / Engine
Families. Clicking this button creates additional Test Group / Engine Family tables at the end of the
"Affected Vehicles / Engines Description" section. Each additional Test Group / Engine Family table will
have a row to add Vehicle / Engine Information. Additional rows can be added if this Test Group / Engine
Family covers multiple Vehicles / Engines (see instructions below for adding rows to the Vehicle / Engine
Information section).
Delete Test Group / Engine Family - This button is used for deleting a Test Group / Engine Family Table.
Clicking this button in a Test Group / Engine Family table will delete that Test Group / Engine Family
table, and all associated Vehicle/Engine Information, only.
Add Vehicle / Engine - This button is used if a Test Group / Engine Family covers multiple Vehicles /
Engines. Clicking this button in a Test Group / Engine Family table will add a new row to the bottom of
the Vehicle / Engine Information section in that Test Group / Engine Family table only.
Delete Vehicle / Engine - This button is used for deleting a specific row of Vehicle / Engine Information in
a Test Group / Engine Family table. Clicking the button at the end of a row will delete the a Vehicle /
Engine information for just that row.

Paperwork Reduction Act Notice
The public reporting and record keeping burden for this collection of information is estimated to average 0.5 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 control number in any
correspondence. Do not send the completed Form 5900-91 to this address.
EPA Form 5900-XXX (Rev 09/2013)

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