Fillable Application for Permission to Import a Motor Vehicle (National Highway Traffic Safety Administration)

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Application for Permission to Import a Motor Vehicle (National Highway Traffic Safety Administration)

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The Application for Permission to Import a Motor Vehicle (National Highway Traffic Safety Administration) form is 3 pages long and contains:

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  • 7 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for National Highway Traffic Safety Administration

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1. APPLICANT (Owner):
Name: ____________________________ E-Mail Address: _______________________
Street Address: ___________________________________________________________
City: ________________________ State: ___________ ZIP: ______________________
Tel: (________) _____________________ Fax: (________) _______________________
2. VEHICLE IDENTIFICATION:
Year: _______ Make: _______________________ Model: _______________________
VIN (or chassis number): _________________________ Engine: _________________
Date of Manufacture: ________________ Current Odometer Reading: _____________
3. WHERE VEHICLE WILL BE STORED IN THE UNITED STATES:
Street Address: ___________________________________________________________
City: ________________________ State: ___________ ZIP: ______________________
4. ON-ROAD USE:
No: _____ If no, EPA waiver required Yes: _____ If yes, complete the following:
Name of Independent Commercial Importer (ICI) ______________________________
5. BASIS FOR APPLICATION:
The vehicle is of technological significance.
The vehicle is of historical significance.
The vehicle is of exceptional significance (if total production exceeded 500 units).
6. DOCUMENTS ATTACHED
Photographs (front, both sides, rear, interior, and odometer).
Production Verification.
Insurance policy limiting vehicle to 2,500 miles annually.
Documentation to support historical or technological significance (if the vehicle has
not previously been approved by NHTSA for Show or Display).
Application for Permission to Import a Motor
Vehicle for Show and Display
I the undersigned understand that 49 U.S.C. 30114 and appropriate delegations
authorize the National Highway Traffic Safety Administration (NHTSA) to
establish terms that NHTSA decides are necessary for importations for show or display.
If NHTSA agrees to permit my importation for show or display of the vehicle described
above, in consideration of such agreement I agree to abide by each of the following terms
that NHTSA has established, until the vehicle is 25 years old, specifically to:
A. Create, maintain, and make available at reasonable times for review or
copying by NHTSA the following records for the vehicle:
i. Title to the vehicle.
ii. A copy of the HS-7 Form and all other relevant importation documents.
iii. A log indicating all locations where the vehicle is shown or displayed,
including
a description of any event, event sponsor, and method used to
transport the vehicle to and from the event.
I agree that the log will
account for the entire exemption period and give the mileage
of the vehicle
for each event.
iv. Current insurance policy.
v. Documents relating
to the final disposition of the vehicle.
B. Provide reasonable access and entry for NHTSA employees to inspect any facility
where I am displaying or storing the vehicle and to any facility where any
record or other document relating to the vehicle is located.
C. Not
sell, lease, or transfer custody of the vehicle unless I have received
written permission from NHTSA. If I wish to sell or transfer permanent custody of
the vehicle to another person, I understand that I cannot sell or transfer the vehicle
unless and until that person has applied for and obtained a new show/display
exemption from NHTSA.
D. Not register the vehicle for use on the public roads.
OR
If the vehicle is registered for use on the public roads, not accumulate more than
2,500 miles on the vehicle in any 12-month period after it has been brought into
compliance with the regulations of the Environmental Protection Agency (EPA).
E. Not to transfer temporary custody of the vehicle (other than for repair) to another
person, unless the transferee agrees in writing to the terms that I have
agreed to in this application. The written agreement will contain these terms
and identify the vehicle by make, model, model year, and vehicle identification
number (or chassis number).
F. Export or destroy the vehicle if I no longer wish to use it for the purpose of
show or
display (and have not sold or transferred it under the terms stated above).
7. TERMS OF IMPORTATION
G. I will not drive the vehicle on public roads until it is
in compliance with the
requirements of the Environmental Protection Agency (EPA).
I understand that I must fully comply with the terms I have agreed to above. I further
understand that if I fail to comply with any of such term, I may be liable for a civil penalty, or
injunctive relief, or both. I also understand that under 49 CFR Part 578 Civil Penalties, I may be
subject to a civil penalty of up to $21,780 per violation. Finally, I understand that if I fail
to comply with regulations of the EPA (40 CFR 85.1511) or of U.S. Customs and Border
Protection (CBP), the vehicle may be seized by CBP.
__________________________________________ _________________
Prospective Purchaser Date
PAPERWORK REDUCTION ACT STATEMENT: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0002. The information collected on this
form is necessary to obtain from NHTSA a letter authorizing a motor vehicle that does not conform to all applicable Federal motor vehicle safety standards to be
imported for purposes of show or display. The information is used to verify that the vehicle is eligible to be imported for purposes of show or display and that the
importer has satisfied the conditions for importing a vehicle for those purposes. We estimate that it will take approximately 60 minutes to complete the form. The
information collected is necessary to obtain a benefit under 49 U.S.C. 30114 and 49 CFR 591.5(j)(1)(iii), 591.6(f)(2) and 591.7(d). Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer,
National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Room W45-205, Washington, DC, 20590.
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Application for Permission to Import a Motor Vehicle (National Highway Traffic Safety Administration)

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Completed 10 August 2020

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