STATE OF CALIFORNIA
CALIFORNIA ENVIRONMENTAL PROTECTION AGENCY
CALIFORNIA AIR RESOURCES BOARD
REGULATION FOR IN-USE OFF-ROAD DIESEL-FUELED FLEETS
RESPONSIBLE OFFICIAL AFFIRMATION OF REPORTING (ROAR) FOR ANNUAL REPORTING
MSCD/HDORSB-143 (REV. 05/2020) P AGE 1 OF 3
This form is required for the annual Responsible Official Affirmation of Reporting (ROAR) for fleets subject
to the Regulation for In-Use Off-Road Diesel-Fueled Fleets. Instructions on how to submit this form and
definitions are provided on pages 2-3.
PART I: FLEET INFORMATION
Check the box to confirm if you are authorized to submit this form then complete your information
below. I am the:
OR Responsible Official Designated Official
Annual Reporting Year:
DOORS Fleet ID Number: Company/Agency Name:
Name: Job Title:
Telephone Number: Email Address:
PART II: FOR CAPTIVE ATTAINMENT AREA FLEETS ONLY
Check Yes to affirm if you have designated this fleets as a Captive Attainment Fleet and that the
vehicles in this fleet did not operate outside of the Captive Attainment area, as defined by Cal. Code
Regs., Title 13, § 2449 subd. (c)(6) and the instructions. If you check YES and are not a Captive
Attainment fleet, your ROAR will not be processed. Check No or disregard if you are not a Captive
Attainment fleet.
Yes No
PART III: SIGNATURE
By signing below, I, the Responsible Official, affirm and certify under penalty of perjury, under the laws
of the State of California, that I have used all reasonable diligence in preparing this report, and that I
have reviewed this report and the information reported on this form for the off-road fleet indicated above
is true, accurate, and complete to the best of my knowledge, and that the fleet is in compliance with the
In-Use Off-Road Diesel-Fueled Fleets Regulation. By signing below, I agree that I understand that the
requirements that must be met in order for this affirmation to be valid are described in California Code of
Regulations, title 13, section 2449, subdivisions (g)(1) and (2), and that these requirements are met. By
signing below, I further certify that I have the authority to make this affirmation and certification on behalf
of the off-road fleet indicated above.
Signature of Responsible Official or Designated Official: Date:
FOR INTERNAL USE ONLY
Hours Submitted
Low
-Use
Outside
Agriculture
Missing Information
Fleet Data
Contact Data
Funding Data
Funding Data
Emi
ssion Com
pliance
Ye
s
No
Fleet Size:
Low-Use
Outside
Agriculture
Fleet Data
Contact Data
Yes
No
Funding Data
Hours Submitted Missing Information
Emission Compliance
STATE OF CALIFORNIA
CALIFORNIA ENVIRONMENTAL PROTECTION AGENCY
CALIFORNIA AIR RESOURCES BOARD
REGULATION FOR IN-USE OFF-ROAD DIESEL-FUELED FLEETS
RESPONSIBLE OFFICIAL AFFIRMATION OF REPORTING (ROAR) FOR ANNUAL REPORTING
MSCD/HDORSB-143 (REV. 05/2020) PAGE 2 OF 3
INSTRUCTIONS AND DEFINITIONS
Submit the completed form to DOORS@arb.ca.gov, fax to (916) 322-3923, or mail to: California Air
Resources Board, Attention: Off-Road Diesel Reporting, MSCD, Mail Stop 5B, PO Box 2815,
Sacramento, CA 95812.
With the submittal of this form, you are affirming that the information you have reported to the California
Air Resources Board (CARB) is complete, accurate, and true, and that your fleet is in compliance with all
aspects of the regulation, codified at California Code of Regulations, title 13, section 2449. This includes
reporting low-use, agriculture, and outside hour meter readings for the previous year, if applicable.
For questions regarding this form, contact the DOORS Hotline at: (877) 59DOORS (877-593-6677).
Responsible Official: One of the following: (A) For a corporation: A president, secretary, treasurer,
or vice president of the corporation in charge of a principal business function, or any other person
who performs similar policy or decision-making functions for the corporation. (B) For a partnership or
sole proprietorship: a general partner or the proprietor, respectively. (C) For a municipality, state,
federal, or other public agency: either a principal executive officer or ranking elected official. For the
purposes of this part, a principal executive officer of a federal agency includes the chief executive
officer having responsibility for the overall operations of a principal geographic unit of the agency
(e.g., a Regional Administrator of the U.S. EPA). [Cal. Code regs., Title 13 § 2449, subd. (c) (44)].
Designated Official: This is someone that the Responsible Official has designated as the person
responsible for signing official forms by submitting the Designated Official form MSCD/HDORSB-178
to CARB. Once on file, the form does not need to be re-submitted except to designate a new person
other than the Responsible Official as the person allowed to sign official forms for the fleet.
Annual Reporting Year: A signed MSCD/HDORSB-143 is due from each fleet by March 1st of each
year as a part of a fleet’s annual reporting requirements. This affirmation is for each vehicle in the fleet as
it was on December 31st of the previous year. For example, you would submit the
MSCD/HDORSB-143
for “Annual Reporting Year” by March 1, 2019 which affirms that all the information about your fleet as it
was on December 31, 2018, was reported correctly and is true and accurate. [Cal. Code Regs., Title 13,
§ 2449, subd. (g)(2)(A).]
Captive Attainment: Captive Attainment area fleet is a fleet or fleet portion in which all of the vehicles in
the fleet or fleet portion operate exclusively within the following counties: Alpine, Colusa, Del Norte,
Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Monterey, Plumas, San Benito, San Luis Obispo,
Santa Barbara, Santa Cruz, Shasta, Sierra, Siskiyou, Tehama, Trinity, Yuba, and the portion of Sonoma
County that lies within the boundaries of the North Coast Air Basin. State and federal fleets are
considered large fleets, regardless of their total horsepower, and therefore cannot be Captive Attainment
area fleets. A fleet will have stated in its initial reporting to CARB that it is Captive Attainment, and that
must be reflected in DOORS. [Cal. Code Regs., Title 13, § 2449, subd. (c)(6).]
DOORS Fleet ID Number: This number is assigned by CARB when you initially created your fleet in
DOORS. If you do not have this number, contact the DOORS Hotline. If the Responsible Official is the
same person for multiple fleets, they may submit one Responsible Official Affirmation of Reporting
(ROAR) form MSCD/HDORSB-143 with the DOORS IDs of all those fleets listed on the form.
Company/Agency Name: The legal name of the entity, business, organization, agency, or individual that
owns and has possession of each vehicle in the fleet, not a third party (i.e., consultants, distributors, sales
representatives, etc.).
STATE OF CALIFORNIA
CALIFORNIA ENVIRONMENTAL PROTECTION AGENCY
CALIFORNIA AIR RESOURCES BOARD
REGULATION FOR IN-USE OFF-ROAD DIESEL-FUELED FLEETS
RESPONSIBLE OFFICIAL AFFIRMATION OF REPORTING (ROAR) FOR ANNUAL REPORTING
MSCD/HDORSB-143 (REV. 05/2020) PAGE 3 OF 3
Signature: The handwritten signature of the Responsible Official or Designated Official. Digital
signatures will not be accepted, but original signatures on a form scanned and sent via fax or email will be
accepted.
NOTE: These instructions are provided as a courtesy, and do not supersede or alter the regulation. It is
your responsibility to understand and comply with the regulation.