Appendix 16 - Exemptions Extensions and Reciprocity Forms.pdf

STATE OF ILLINOIS

SCOPE OF SERVICES APPENDICES

APPENDIX 16 –EXEMPTIONS, EXTENSIONS, AND RECIPROCITY FORMS

List of Example Exemptions, Extensions, Reciprocity Forms

Sporting Activity Vehicle Exemption

Parade or Ceremonial Vehicle Exemption Out of State Compliance (Reciprocity) or Out of Area Exemption

Economic Hardship Extension Repair Waiver Application

State of Illinois IFB Appendix 16

The undersigned hereby certifies that the statements contained herein are true and correct, and further that the vehicle identified above is used exclusively in organized amateur or professional sporting activities, as defined in Section 3.310 of the Environmental Protection Act (415 ILCS 5/3.310). By affixing his/her signature hereto, the undersigned certifies that he/she is authorized to execute this form.

I acknowledge that the Illinois EPA is authorized to require, and I will disclose, the information requested on this form pursuant to 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276. This information shall be provided using this form, or by alternative means, at your discretion. Failure to disclose the requisite information or comply with 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276 may result in the exemption being denied and/ or penalties being imposed, as provided for by applicable law. Any person who knowingly makes a false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Sporting Activity Vehicle Exemption This form can be submitted online at www.IllinoisAirTeam.com

This form may be used to apply for a sporting activity vehicle exemption from the vehicle emissions testing requirement.

Please type or print legibly and complete all fields on the application.

Vehicle Information

Illinois License Plate Number Vehicle Identification Number (VIN) Model Year Vehicle Make Current Vehicle Mileage

Vehicle Owner Information

Registered Owner 1 Registered Owner 2

Street Address Street Address

City State Zip Code City State Zip Code

Daytime Telephone Number

Daytime Telephone Number

Email Address Email Address

Preferred Method of Contact:

(Please select only one method.)

Phone

Email

U.S. Mail

You must include the following documentation with this application:

1. A current copy of the insurance policy which clearly indicates the vehicle is insured as a limited, restricted or exhibition use vehicle.

2. Documentation supporting that the vehicle is operated exclusively in organized amateur or professional sporting activities as defined in

Section 3.310 of the Environmental Protection Act (415 ILCS 5/3.310).

3. Current photographs of the front, both sides, and rear of the vehicle, including the license plate number.

IL 532-3021

VIM 165 Rev. 2/2022

Application Instructions

This form may be used to apply for a sporting activity vehicle exemption. Illinois State Law (Illinois Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-15(b)(8)(I)) provides an exemption from the vehicle emissions testing requirement if the vehicle is operated exclusively in organized amateur or professional sporting activities, as defined in Section 3.310 of the Environmental Protection Act. "Organized amateur or professional sporting activity" means an activity or event carried out at a facility by persons who engaged in that activity as a business or for education, charity or entertainment for the general public, including all necessary actions and activities associated with such an activity. This definition includes, but is not limited to, (i) rifle and pistol ranges, licensed shooting preserves, and skeet, trap or shooting sports clubs in existence prior to January 1, 1994, (ii) public hunting areas operated by a governmental entity, (iii) organized motor sports, and (iv) sporting events organized or controlled by school districts, units of local government, state agencies, colleges, universities, or professional sports clubs offering exhibitions to the public.

Please type or print and complete all fields on the application. Failure to complete all fields on the application may result in its denial.

Along with the completed application, you must include the following:

1. A current copy of the insurance policy which clearly indicates the vehicle is insured as a limited, restricted or exhibition use vehicle.

2. Documentation supporting that the vehicle is operated exclusively in organized amateur or professional sporting activities as defined in Section 3.310 of the Environmental Protection Act (415 ILCS 5/3.310).

Acceptable forms of proof may include but are not limited to:

Proof of admission to an organized amateur or professional sporting activity or event that took place no more than twelve

(12) months prior to submittal of the application.

A photograph of the vehicle in an exhibition that took place no more than twelve (12) months prior to submittal of the application.

Current membership to a sports club.

3. Current photographs of the front, both sides, and rear of the vehicle, including the license plate, taken no more than three (3) months prior to submittal of the application.

If you have any questions on acceptable documentation, please call the Illinois Air Team at: 844.258.9071.

The Illinois EPA reserves the right to require a visual inspection of the vehicle at an official inspection facility.

Please be advised that this information must be submitted every two years to retain the exemption.

Information submitted on this form must be legible and all fields completed. Please include the license plate number and your telephone number on all documentation.

Submit this form and all documents by one (1) of the following methods:

Email to: Waivers@IllinoisAirTeam.net Fax to:

Mail to: [Contractor Name] [Address]

I, the undersigned, hereby certify that the statements contained herein are true and correct; I further certify that the vehicle indicated above is used exclusively for parade or ceremonial purposes by a not-for-profit veteran, fraternal or civic organization. By affixing my signature hereto, I, the undersigned, further certify that I am authorized to execute this form.

I acknowledge that the Illinois EPA is authorized to require, and I will disclose, the information requested on this form pursuant to 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276. This information shall be provided using this form, or by alternative means, at my discretion. Failure to disclose the requisite information or comply with 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276 may result in the exemption being denied and/or penalties being imposed, as provided for by applicable law. Any person who knowingly makes a false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Signature Date

Parade or Ceremonial Vehicle Exemption

This form may be used to apply for a parade or ceremonial vehicle exemption from the vehicle emissions testing requirement.

Illinois License Plate Number Vehicle Identification Number (VIN) Model Year Vehicle Make

Vehicle Owner Information Registered Owner 1 Registered Owner 2

Street Address Street Address

City State Zip Code City State Zip Code

Daytime Telephone Number

Daytime Telephone Number

Email Address Email Address

The undersigned certifies by checking the box below that the vehicle indicated above is used exclusively for parade or ceremonial purposes by a not-for-profit veterans, fraternal or civic organization.

I hereby certify to the statement above:

Acceptable proof for each of the following includes, but is not limited to, articles of organization, by-laws, and federal or state tax reporting forms.

Please provide the method of proof you are using for each:

1) Proof of the Status as a Veterans, Fraternal or Civic Organization:

2) Proof of Status as a Not-for-Profit Organization:

IL 532-3022

VIM 166 Rev. 11/2017

This form may be used to apply for a parade or ceremonial vehicle exemption from the vehicle emissions testing requirement. Illinois State Law (Illinois Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-15(b)(8)(F)) provides an exemption from the vehicle emissions testing requirement for a vehicle that is operated exclusively for parade or ceremonial purposes by a not-for-profit veteran, fraternal or civic organization.

Please type or legibly print and fill out all fields. Failure to complete all fields may result in denial of your application.

Please submit proof of the status as a veteran, fraternal or civic organization, and as a not-for-profit organization.

Acceptable proof includes, but is not limited to, articles of organization, by-laws and federal or state tax reporting forms. Failure to submit documentation may result in denial of your application.

If you have any questions on acceptable documentation, please call the Illinois Air Team at: 844.258.9071.

Information submitted on this form must be legible. Please include the license plate number and your telephone number on all documentation.

Submit this form and all documents by one (1) of the following methods:

Web: www.IllinoisAirTeam.com

Email to: Waivers@IllinoisAirTeam.net Fax to 312.327.7640

Application for Out of State Compliance or Out of Area Exemption

This form may be used when a vehicle is outside the Illinois vehicle emissions testing area

Please type or print legibly and complete all fields on the application

For fastest service, submit your application online at www.IlinoisAirTeam.net

Street Address Street Address

City State Zip Code City State Zip Code

Daytime Telephone Number

Daytime Telephone Number

Email Address Email Address

How should we contact you:

(Please select only one method)

Email U.S. Mail

Location of Vehicle: The undersigned hereby certifies that the vehicle identified above is located at the following address:

Address

City County State Zip Code Country

Please read carefully and select correct application type (Only select one)

Out of State Compliance When a vehicle is located and primarily used outside of the Illinois vehicle emissions testing area and is located in a state/county where vehicle emissions testing is required. Proof of a passing emissions test from the state where the vehicle is located must be submitted with this application. See application instructions for details.

Out of Area Exemption When a vehicle is located and primarily used outside of the Illinois vehicle emissions testing area and is located in a state/county where vehicle emissions testing is not required. Proof of where the vehicle is located must be submitted with this application. See application instructions for details.

(See page 2 of application for further instructions and acceptable forms of proof)

The undersigned hereby certifies that the statements contained herein are true and correct and further certifies that the vehicle identified above is located at the address stated herein and primarily operated outside of the vehicle emissions testing area and in the area identified above. By affixing his/her signature hereto the undersigned further certifies that he/she is authorized to execute this form.

The Illinois EPA is authorized to require, and you shall disclose, the information requested on this form pursuant to 625 ILCS 5/13C and/or 35 Ill.

Adm. Code Part 276. This information shall be provided using this form or by alternative means at your discretion. Failure to disclose the requisite information or comply with 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276 may result in this application being denied and/or penalties being imposed as provided for by applicable law. Any person who knowingly makes false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Registered Owner’s Signature Date

IL 532-3040

VIM 171 Rev. 09/2019

Out of State Compliance - When a vehicle is located and primarily used outside of the Illinois vehicle emissions testing area and is located in a state/county where vehicle emissions testing is required.

This form may be used to provide proof of compliance with the Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C) for a vehicle that has been inspected and is in compliance with the vehicle emissions testing standards applicable in the state or county where the vehicle is currently located and operated. Out of state compliance is granted for a maximum of two (2) years.

Along with this completed application, you must include proof that the vehicle has passed an emissions test or received a waiver or exemption, or otherwise complied with the emissions testing requirement of the state or county where the vehicle is located and operated. A vehicle inspection report or other documentation dated more than four

(4) months prior to your Test by Date will NOT be accepted. Failure to submit the correct documentation may result in denial of your application.

For a list of states where vehicle emissions testing is required visit https://illinoisairteam.net/wp-content/uploads/2019/04/042919-Out-of-State-Links.pdf

Out of Area Exemption - When a vehicle is located and primarily used outside of the Illinois vehicle emissions testing area and is located in a state/county where vehicle emissions testing is not required.

This form may be used to apply for an out of area exemption from the vehicle emissions testing requirement in accordance with the Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-15(b)(9)) and 35 Ill. Adm. Code Section 276.405. This form is used to verify the current location of the vehicle outside the Illinois vehicle emissions testing area and where emissions testing is not required. Out of area exemptions are granted for a maximum of one (1) year.

Along with this completed application, you must include proof of where the vehicle is currently located. Documents submitted must display your preprinted name and address. Documentation submitted must be dated within three (3) months of submission. Documentation dated more than three (3) months prior to submittal of your application will NOT be accepted. Failure to submit the correct documentation may result in denial of your application.

Acceptable forms of proof include: Property Tax Bill, Utility Bill, Military Orders, Tuition Bill, Lease Signed by Both the Tenant and Landlord, Vehicle Storage Receipt, Bank Statement, Credit Card Bill Medical Bill, Driver’s License, National Student Clearinghouse Certificate, Letter from Employer on Company Letterhead telephone number on all documentation.

Submit this form and all documents by one (1) of the following methods:

Web: www.IllinoisAirTeam.net

Email to: Waivers@IllinoisAirTeam.net

Fax to: 312.327.7640

If you have any questions about acceptable documentation, please call the Illinois Air Team at: 844.258.9071

Economic Hardship Extension

This form may be used to apply for an economic hardship extension in accordance with the Illinois Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-30) and 35 Ill. Adm. Code Section 276.404.

Please type or print legibly and complete all fields on the application.

Street Address Street Address

City State Zip Code City State Zip Code

Daytime Telephone Number

Daytime Telephone Number

Email Address Email Address

Household(s) Income Eligibility Requirements Below

Household(s) Income Chart

For families/households with more than 8 people, add $7,080 for each additional person.

(In the case of multiple registered owners who are not part of the same household, both owners must provide income.)

Total number of people living in household(s): Total household(s) income:

Eligibility (Do I qualify?) (See reverse side for instructions)

If an economic hardship extension has been previously issued, the vehicle must have passed an emissions test prior to the issuance of another economic hardship extension. A waiver is not acceptable.

If you answer “NO” to any of the following questions, your application will be denied. YES NO

1) Do you meet the guidelines of the Household(s) Income chart above?

2) Did this vehicle fail an emissions test?

3) Did you attach an estimate or repair receipts related to the test failure(s) totaling at least $225?

The undersigned hereby certifies that the statements contained herein are true and correct and acknowledges that the Illinois EPA may revoke an economic hardship extension if it is determined that any such statement is false. By affixing his/her signature hereto the undersigned further certifies that he/she is authorized to execute this form.

By signing this form, the undersigned authorize(s) all relevant State agencies, including the Illinois Department of Revenue and the Illinois Department of Human Services, to release to the Illinois EPA or its contractor, information regarding his/her/their Illinois tax record(s) and/or other relevant information to verify household size and income information.

The Illinois EPA is authorized to require, and you shall disclose, the information requested on this form pursuant to 625 ILCS 5/13C and/or 35 Ill. Adm.

Code Part 276. This information shall be provided using this form or by alternative means, at your discretion. Failure to disclose the requisite information or comply with 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276 may result in the extension being denied and/or penalties being imposed, as provided for by applicable law. Any person who knowingly makes a false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Signature Registered Owner 1 Date Signature Registered Owner 2 Date

Total Number of People Living in Household(s)

Combined Income of Household(s) Members - Age 18 or Older During Preceding 12 Months

1 $20,385 2 $27,465 3 $34,545 4 $41,625 5 $48,705 6 $55,785 7 $62,865 8 $69,945

IL 532-2614

VIM 134 Rev. 1/2022

Application Instructions

Illinois State Law (625 ILCS 5/13C-30(c)) and regulations (35 Ill. Adm. Code 276.404) allow the Illinois Environmental Protection Agency (IEPA) to grant the registered owner(s) of a vehicle a one-year extension of time from the vehicle’s current registration expiration date to allow additional time to get the vehicle repaired and pass an emissions test.

This economic hardship extension can be granted only if all of the following eligibility criteria are met:

Household(s) Income Eligibility

The registered owner(s) of the vehicle must certify that the income during the preceding 12 months of all persons who were 18 years of age and older and residing in the household(s) was not more than the applicable amount stated below.

In the case of multiple registered owners, who are not part of the same household, both owners must certify that the sum of their household income was not more than the applicable amount stated below.

Household(s) Income Chart Total Number of People Living in Household(s) Combined Income of Household(s) Members - Age 18 or Older

During Preceding 12 Months 1 $20,385 2 $27,465 3 $34,545 4 $41,625 5 $48,705 6 $55,785 7 $62,865 8 $69,945

For families/households with more than 8 people, add $7,080 for each additional person.

Additional Eligibility Criteria

1) If the Household(s) Income does not exceed the applicable amount in the Household(s) Income chart above, check YES for Question 1 on the application. If not, check NO.

2) If the vehicle failed an emissions test, check YES for Question 2 on the application. If not, check NO. A reject is not a failure.

3) If estimates and/or receipts are attached, check YES for Question 3. If not, check NO. Estimates and/or receipts may not include any costs associated with any motor vehicle emissions-related recall that has been, or is to be, paid for by a manufacturer or dealer. All estimates and/or receipts must be prepared and dated on a company letterhead or invoice.

Handwritten estimates or receipts are not acceptable.

Attach one (1) of the following:

a) Receipts for emissions-related repairs performed no more than five (5) months prior to the expiration date of your vehicle’s Illinois registration. Receipts must be prepared on a work order dated by a recognized repair technician (someone that is: professionally engaged in vehicle repair, employed by a going concern whose purpose is vehicle repair or has nationally recognized certification for emissions-related diagnosis and repair) for emissions-related repairs, parts or services, including diagnostic fees, related to the test failure(s) in the amount of at least $225; or

b) If the registered owner(s) intend(s) to perform the repairs, the estimate must include only the cost for the parts related to the test failure(s). Brakes, exhaust systems, hoses, belts, etc., are not acceptable. The emissions-related estimate can be either a receipt from an auto parts store or an estimate for parts from a recognized repair facility on their business invoice.

4) The registered owner has not previously received an extension for economic hardship for the identified vehicle, or, if he/she has, the identified vehicle passed the vehicle emissions test prior to issuance of another extension for economic hardship.

Required Documentation If your income meets the above criteria, you may complete and submit this form and attach all supporting documentation. Supporting documentation includes copies of receipts or estimates for emissions-related repairs and/or parts.

If you have any questions on acceptable documentation, please call the Illinois Air Team at: 844.258.9071.

Information submitted on this form must be legible. Please include the license plate number and your telephone number on all documentation.

Submit this form and all documents by one (1) of the following methods:

Web: www.IllinoisAirTeam.com Email to: Waivers@IllinoisAirTeam.net

Fax to: 312.327.7640

The undersigned hereby certifies that the statements contained herein are true and correct. By affixing his/her signature hereto the undersigned further certifies that he/she is authorized to execute this form.

I hereby designate to request and/or receive a repair waiver on my behalf.

The Illinois EPA is authorized to require, and you shall disclose, the information requested on this form pursuant to 625 ILCS 5/13C-30 and 35 Ill. Adm.

Code Section 276.401. This information may be provided using this form or by alternative means at your discretion. Failure to disclose the requisite information or to comply with 625 ILCS 5/13C and 35 Ill. Adm. Code 276.401 may result in the denial of your application and/or penalties being imposed as provided for by applicable law. Any person who knowingly makes a false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Signature Date

Repair Waiver Application

This form may be used to apply for a repair waiver from the vehicle emissions testing requirement in accordance with the Illinois Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-30) and 35 Ill. Adm. Code Section 276.401.

Vehicle Owner Information Registered Owner 1 Registered Owner 2

Street Address Street Address

City State Zip Code City State Zip Code

Daytime Telephone Number

Daytime Telephone Number

Email Address Email Address

Email U.S. Mail

Waiver Requirements

IL 532-3027 VIM 170 Rev. 11/2017

Illinois law provides that a vehicle that has failed a vehicle emissions retest qualifies for a waiver of the emissions inspection standards if the following requirements are met:

1. The vehicle has received all repairs and adjustments for which it is eligible under any emissions performance warranty provisions pursuant to Section 207 of the Federal Clean Air Act.

2. The Illinois Environmental Protection Agency (IEPA) determines by normal inspection procedures that the vehicle's emissions control devices are present and appear to be properly connected and operating. Note: The Malfunction Indicator Lamp/Light (MIL) must be operative in order to qualify for a repair waiver.

3. Pursuant to 35 Ill. Adm. Code Section 276.401, a minimum expenditure of at least $450 in emissions-related repairs, exclusive of tampering-related repairs, have been made. Note: Repairs made must be consistent with the diagnostic trouble codes (DTCs) present at the time of the initial failure. Evidence of the repair(s) performed must be presented and consist of: signed receipts dated not more than 30 days prior to the test eligibility date that identify the vehicle by VIN, describe the diagnostic procedures utilized in determining the repairs, provide justification that repairs performed were appropriate and necessary for the failure and provide the amount charged for eligible emissions-related repairs.

4. Repairs for vehicles of model year 1996 and newer must have been conducted by a recognized repair technician.

If you have any questions on acceptable documentation, please call the Illinois Air Team at: 844.258.9071.

This form may be used to apply for a repair waiver from the vehicle emissions testing requirement in accordance with the Illinois Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-30) and 35 Ill. Adm. Code Section 276.401.

Please type or print legibly and complete all fields on the application. Failure to complete all fields may result in the denial of your waiver.

Along with this completed application, pursuant to 35 Ill. Adm. Code Section 276.401, you must submit proof that a minimum expenditure of at least $450 in emissions-related repairs, exclusive of tampering-related repairs, have been made. Repairs made must be consistent with the diagnostic trouble codes (DTCs) present at the time of the initial failure. Evidence of the repair(s) performed must be presented and consist of signed receipts dated not more than 30 days prior to the test eligibility date that identify the vehicle by VIN, describe the diagnostic procedures utilized in determining the repairs, provide justification that repairs performed were appropriate and necessary for the failure and provide the amount charged for eligible emissions-related repairs. The vehicle’s Malfunction Indicator Lamp/Light (MIL) must be operative in order to qualify for a repair waiver.

If you have any questions on acceptable documentation, please call the Illinois Air Team at: 844.258.9071.

telephone number on all documentation.

Submit this form and all documents by one (1) of the following methods:

Web: www.IllinoisAirTeam.com

Email to: Waivers@IllinoisAirTeam.net Fax to: 312.327.7640