CARB LDV E-Cert Form

Certification Summary Information (CSI) Requirements

Vehicle Fuel Category	Operating Fuel	CSI
Vehicle Fuel Category	Operating Fuel	1	2A	2B	3	4	5A	5B	6A	6B	6C	7	10A HEV, PHEV	10A Others	10B
Dedicated Single Fuel Vehicle	Gasoline, LPG	R	R	R	R	R	R	R	R	R	R	R	R	N/A	N/A	Select
	Diesel	R	R	N/A	R	R	R	R	N/A	N/A	N/A	R	R	N/A	N/A	Select
	CNG	R	R	N/A	R	R	R	R	N/A	N/A	N/A	R	R	N/A	N/A	Select
FFV	E85 + Gasoline	R	R	R	R	R	R	R	R	R	R	R	R	N/A	N/A	Select
Dual-Fuel Vehicle	(CNG, LPG) + Gasoline	R	R	R	R	R	R	R	R	R	R	R	R	N/A	N/A	Select
Bi-Fuel Vehicle	CNG + Diesel	R	R	N/A	R	R	R	R	N/A	N/A	N/A	R	R	N/A	N/A	Select
ZEV (Battery Electric, H2 Fuel Cell)	N/A	R	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	R	Select
R: Required, N/A: Not Applicable																Reset

File Naming Convention

When saving the InfoPath form, please follow the naming convention for all XML file submissions to the California Air Resources Board through the E-Cert Application Loader website.

The naming convention for the XML es consists of three parts as shown: CARBMFRCODE_LDV_TESTGROUP.xml

CARB MFR Code
- This is the manufacturer code that was assigned to each manufacturer by the California Air Resources Board.
LDV
- This will remain the same for each file.
Test Group
- This is the name of the test group for the particular application.

The only portions of the file name that change are the ones identified by red italics. An example file name would be MFR_LDV_123.CRB.45AB.xml.

Contact Information

CARB MFR Code:

First Name:

Last Name:

Phone Number:

Email Address:

General Info

CARB MFR Code:

Model Year:

Test Group Name:

Application Type:

CSI 1

Durability Group Name:

Running Change Reference Number/Name:

CARB TG Classification:

CARB TG Interim / In-Use FTP Standard:

CARB TG Interim / In-Use SFTP Standard:

Federally-Certified Vehicle (Cleaner Fedreal Vehicle):

CARB FTP Standard:

EPA FTP Standard:

SFTP Standard:

GHG Pooling Option:

NMOG + NOx Pooling Option:

Please select a vehicle class of a TG, or a vehicle class to which the most stringent standard is applied, if multiple vehicle classes are in the TG:

Does this TG meet optional LEV NOx exhaust emission standard certification for "Work Trucks"?:

TG Fuel Category:

Light-Duty Specially Constructed Vehicles (SPCNS):

Light-Duty Specially Constructed Vehicles Only
Weight of Worst Case Vehicle (lbs)	N/V Ratio of Worst Case Vehicle

OBD Approval Reference Number:

CSI 1 Manufacturer Notes:

CSI2A

Exhaust Emissions UL Years:

Miles:

Does this TG meet the Partial Soak STD?

Is any model in the TG granted DOR?

Does NMOG Cert include DOR NMOG Credit?

Is any model in the TG granted Non-PZEV Zero Evap?

Does NMOG Cert include Non-PZEV Zero-Evap NMOG Credit?

Direct measurement of NMOG?

NMOG+NOx fleet average credit for extended warranty?

FTP NMOG/NMHC ratio:

HCHO/NMHC ratio:

RAF for NMOG:

RAF for Methane:

FTP Exhaust Emissions:

FTP Exhaust Emissions Test Fuel:

If Other, Specify

Exhaust FTP xxHC Type:

If Other, Specify

Specify Modified Test Procedure for FTP Test? (If yes, describe moification & approval ref # in FTP Manufacturer Note)

Does this TG have a FFH?

Is the FFH operable above 40°F?

Does FTP CERT include FFH exhaust?

Units: (g/mi)
Air Pollutant	xxHC	NOx	NMOG + NOx	High Altitude NMOG + NOx	CO	HCHO (mg/mi)	PM	Highway NOx	Highway NMOG + NOx	Quick Drive-Away NMOG + NOx	Cold-CO
4K CERT (50°F)
4K STD (50°F)
50K CERT
50K STD
UL CERT
UL STD

CSI 2A Manufacturer Note for FTP Exhaust Emissions

SFTP Exhaust Emissions:

SFTP Exhaust Emissions Test Fuel:

If Other, Specify

Modified Test Procedure for SFTP Test? (If yes, describe modification & approval ref # in SFTP Manufacturer Note)

SFTP Test Cycle	US06			Cold Start US06 PHEV	SCO3		Composite
Air Pollutant	xxHC + NOx (g/mi)	CO (g/mi)	PM (mg/mi)	xxHC + NOx (g/mi)	xxHC + NOx (g/mi)	CO (g/mi)	xxHC + NOx (g/mi)	CO (g/mi)	PM (mg/mi)
4K CERT:
4K STD:
UL CERT:
UL BIN:
UL STD:

CSI 2A Manufacturer Note for SFTP Exhaust Emissions:

FFH Exhaust Emissions:

FFH Test Fuel:

If Other, Specify:

Modified Test Procedure for FFH Test? (If yes, describe modification & approval ref # in FFH Manufacturer Note)

Air Pollutant	NMOG	NOx	NMOG + NOx	CO	HCHO (mg/mi)	PM
50K CERT:
50K STD:
UL CERT:
UL STD:

CSI 2A Manufacturer Note for FFH Exhaust Emissions:

CSI2B

Evaporative/Refueling Emissions

Evap Data Set Number:

Evap Refuel Family:

Certification option for evaporative emissions:

Evap Emission STD Vehicle Class:

Cert Test Fuel for Evap:

If Other, Specify

Cert Test Fuel for ORVR:

If Other, Specify:

Modified Test Procedure for Evap Test? (If yes, describe modification & approval ref # in Manufacturer Note)

Evap Pollutant Type:

	Evaporative Emissions			Zero-Fuel Evaporative Emissions		Canister Bleed (g/test)	ORVR (g/gal)
	3-Days + Hot Soak (g/test)	2-Days + Hot Soak (g/test)	Running Loss (g/mi)	3-Days + Hot Soak (g/test)	2-Days + Hot Soak (g/test)	Canister Bleed (g/test)	ORVR (g/gal)
CERT:
FEL:
STD:

Evaporative Emissions:

Leak Family Identifier	CERT (inches)	Standard (inches)

Evap UL Years:

Evap UL Miles:

ORVR UL Years:

ORVR UL Miles:

NMOG credit (g/mi) used for zero evap cert (rig test only):

Evap emissions (g/test) offset by NMOG credit for zero evap test (rig test only):

CSI 2B Manufacturer Note:

CSI 3

Test Group Description:

Engine Set Number:

Engine Location (relation to the front of the vehicle):

TG Combustion Cycle:

If Other:

Cylinder/Block Arrangement:

If Other:

Number of Cylinders/Rotors:

Engine Cooling Medium:

If Other:

Engine Displacement (L):

Intake Valves per Cylinder	Exhaust Valves per Cylinder

Engine Valvetrain:

If Other:

Intake Variable Valve Timing (VVT):

Exhaust Variable Valve Timing (VVT):

Intake Valve Lift:

Exhaust Valve Lift:

Cylinder Deactivation:

Engine Special Features 1

Engine Special Features 2

TG Operating Fuel		TG Fuel Metering		TG Fuel Metering (If Other)	Rated Power (hp)	@RPM	Peak Torque (foot-pounds)	@RPM

CSI 3 Manufacturer Notes:

CSI 4 ( All fields in red are considered CBI)

Exhaust Emissions Control System (ECS) Information:

ECS Set Number:

Electronic Controls:

If Other:

ECS Configuration:

Exhaust Gas Recirculation (EGR):

Cooled EGR:

EGR Type:

If Other:

Air Aspiration Method in the TG:

If Other:

Number of Air Aspiration Devices:

Air Aspiration Configuration:

Charge Air Cooler Type:

Number of Charge Air Coolers:

Charge Air Cooler Configuration:

Air Injection:

If Other:

Direct Ozone Reduction (DOR) Device:

Total Number of Physical Container(s) of ATD(s):

This ECS Set is used for Production Vehicles:

This ECS Set is used for EDV:

This ECS Set is used for DDV:

CSI 4 Manufacturer Note:

After-Treatment Device (ATD) Information:

ATD Container Number:

After-Treatment Type:

200k Miles Extended Warranty for Particulate Filter:

Total Number of Physical Substrates (bricks) in this container:

ATD Note:

Brick (Substrate) Information

Size of Substrate (liters):

Substrate Precious Metals:

If Other:

Substrate Material:

If Other:

Substrate Construction:

If Other:

Cell Geometry:

If Other:

Substrate Cell Density (# of cells / in²):

Substrate Specific Active Surface Area (m²/liter):

Precious Metal Loading Rate (g/liter):

Precious Metal Composition:

Uniform Loading of Precious Metals?

Exhaust Feedback Sensor Information:

Sensor Type:

Other Sensor Information:

Sensor Type:

If Other, Specify:

Number of Sensors:

CSI 5A (All fields in red are considered CBI)

Exhaust Emission Data Vehicle Information

EDV Set Number:

Test Group Name:

EDV Division Name:

EDV Model Name:

EDV Test Vehicle ID:

EDV Test Data Type:

Original TG of EDV:

Original Evap Family of EDV:

EDV Engine Code:

EDV Displacement (liters):

EDV Cylinder (Block) Arrangement:

If Other, Specify:

EDV Number of Cylinders:

EDV Number of Intake Valves per Cylinder:

EDV Number of Exhaust Valves per Cylinder:

EDV Drive System:

EDV N/V Ratio:

EDV Curb Weight (lb):

EDV LVW (lb):

EDV ALVW (lb):

EDV ETW (lb):

EDV GVWR (lb):

EDV ECS Set Number:

EDV Rated Power (hp):

@ RPM:

EDV Transmission Type:

EDV Number of Transmission Gears:

Alternate Shift:

Shift Indicator Lamp (SIL):

Transmission Shift Mode for Exhaust Emission Test:

If Other:

ATD Grouping Statistic of EDV:

Tire Size:

Front:

Rear:

Raw Test Results without DF:

Test Type:

Tested By:

Test ID:

Test Date:

Alternative Test Procedure:

Exh Test Fuel:

If Other, Specify

Specify Tested For

Partial Soak Time (Minutes):

Target Coefficient A (lb.):

Target Coefficient B (lb/mph):

Target Coefficient C (lb/mph²):

Driver Selectable Mode:

PHEV Operating Mode:

Is this the official certification test?:

THC (g/mi)	NMHC (g/mi)	NMOG (g/mi)	NOx (g/mi)	CO (g/mi)	HCHO (mg/mi)	PM (g/mi)	CO2 (g/mi)	MPG	CH4 (g/mi)	N2O (g/mi)

CSI 5A Manufacturer Note:

CSI 5B(All fields in red are considered CBI)

Durability Data Vehicle (DDV) and Emission Test Data:

DDV Set Number:

MFR Vehicle ID:

Durability Group Method:

DDV ECS Set Number (From CSI 4):

ATD Grouping Statistic:

(ATD grouping statistic for this set of ATDs used for the DDV)

Max ATD Grouping Statistic:

(Maximum ATD grouping statistic for the durability group of the DDV)

Min ATD Grouping Statistic:

(Minimum ATD grouping statistic for the durability group of the DDV)

Durability Data Type:

Original Durability Group Name:

Aging Method:

Manufacturer ADP CARB Approval Ref # Durability Group Equivalency Factor:

ADP/Bench-aged Components

Durability Group Operating Fuel	Durability Group Fuel Metering	Durability Group Fuel Metering Other

Raw Exhaust Emission Test Results

Exhaust Test Date:

Test Point Mile:

MFR Test ID Number:

Exh Durability Test Fuel:

If Other, Specify

DF Emissions Test Type:

Driver Selectable Mode:

PHEV Operating Mode:

PHEV test only

THC (g/mi)	NMHC (g/mi)	NMOG (g/mi)	NOx (g/mi)	CO (g/mi)	HCHO (mg/mi)	PM (g/mi)	CO2 (g/mi)	CH4 (g/mi)	N2O (g/mi)

Deterioration Factors (DF):

DF Emissions Test Type:

DF Type:

	(Unites for Additive DF: mg/mi for HCHO, g/mi for all others)
	NMHC	NMOG	NOx	Highway NOx	CO	HCHO	PM	Cold-CO
50K DF
UL DF

Adjustment Factors for Regeneration:

Frequency of regeneration (F):

	NMHC or NMOG (g/mi)	NOx (g/mi)	Highway NOx (g/mi)	CO (g/mi)	COLD-CO (g/mi)	HCHO (mg/mi)	PM (g/mi)
EF_H
EF_L
EF_A
UAF
DAF

CSI 5B Manufacturer Notes:

CSI 6A

Evaporative Family Description

Evap Family Set Number:

Evap Family:

ORVR Type:

Fill Pipe Seal Mechanism:

If Other:

Fill Pipe Compliant:

Tank Material:

If Other, Specify:

Tank Temperature Profile Development:

Approval # (Environmental Chamber only)

Zero Evap Compliance

Is the vehicle a PZEV?:

HC Capture Method for Canister Bleed Test:

Evap Family Operating Fuel	Evap Family Operating Fuel Other

Canister Information

Canister Type:

Number of Canisters:

Canister Configuration:

Total Butane Working Capacity (g):

Canister Total Bed Volume (cc):

Canister Storage Medium:

Canister Notes:

Fuel Tank Information

Fuel Tank Set Number:

Used for Production Vehicle:

Used for Evap EDV:

Used for Evap DDV:

Number of Fuel Tanks:

40% Fill Total Fuel Tank(s) Capacity (Gallons):

100% Fill Total Fuel Tank(s) Capacity (Gallons):

Fuel Tank(s) Total Geometric Volume (Gallons):

Minimum Canister Working Capacity (g):

Fuel Tank Notes:

CSI 6A Manufacturer Note:

CSI 6B

Exhaust Emission Data Vehicle (EDV) Information:

Evap EDV Set Number:

Evap Family Name:

Evap Test Vehicle ID:

Evap Test Vehicle Model:

EDV Evap Type:

Original Evap Family of Evap EDV:

TG of Evap EDV:

Evap Test Vehicle Engine Code:

Displacement (liters):

Rated Power (hp):

@RPM

Cylinder (Block) Arrangement:

If Other

Specify number of Cylinders:

Transmission:

If Other, Specify:

Number of Transmission Gears:

Target Coefficient A (lb):

Target Coefficient B (lb/mph):

Target Coefficient C (lb/mph²):

Tire Size Front:

Tire Size Rear:

Curb Weight (lb):

LVW (lb):

ALVW (lb)

ETW (lb):

GVWR (lb):

Fuel Tank Set Number (From CS16A):

Raw Evaporative Refueling Test Results:

Evap Test Type:

Evap Test Date:

Alternative Test Procedure:

Evap Test ID Number:

Tested By:

Evap Test Fuel:

If Other, Specify

Official Cert Test:

Tested For:

R/L Test:

Test Procedure:

Evap Pollutant Type:

	1st Day	2nd Day	3rd Day	Hot Soak
Raw Evap Test for 3D+HS (g/test)
Raw Evap Test for 2D+HS (g/test)

Raw Evap Test for Running Loss (g/mi):

Raw Evap Test for ORVR (g/gallon):

Raw Evap Test for Canister Bleed (g/test):

Effective Leak Diameter Test Results:

Evap Test Type:

Test ID #	Test Date	Alternate TP?	V_gas (m³/s)	P_in (kPa)	P_atm (kPa)	T (K)	Leak Diameter (inches)

CSI 6B Manufacturer Note:

CSI 6C

Evaporative DDV Set Number:

Evaporative Family:

Evap DF Type:

DDV Evap Type:

Evap Family of Evap DDV:

TG of Evap DDV:

Evap DDV Test Vehicle Model:

Displacement (liters):

Fuel Tank Set Number (From CSI6A):

Evaporative DDV Note:

Durability Information:

Evaporative Durability Info Number:

Durability Information Type:

Manufacturer Durability Set (Bench/Vehicle/Rig Test) ID:

Vehicle Test ID:

(Vehicle Evap DF Test Only)

Evaporative Test Type:

Test ID Number:

Test Point (miles):

Test Date:

Alternative Test Procedure:

Evap Durability Test Fuel:

If other specify:

	1st Day	2nd Day	3rd Day	Hot Soak
Raw Evap Test for 3D+HS (g/test)
Raw Evap Test for 2D+HS (g/test)

Raw Evap Test for Running Loss (g/mi):

Raw Evap Test for ORVR (g/gallon):

Used For DF Calculation:

Deterioration Factors (DF):

	3-Days + Hot Soak (g/test)	2-Days + Hot Soak (g/test)	Running Loss (g/mi)	ORVR (g/gallon)
Overall Bench Evap DF:
Vehicle Evap DF:
Overall Certification Evap DF:

Bench DF Manufacturer Notes:

Vehicle DF Manufacturer Notes:

CSI 7 (All fields in red are considered CBI)

CSI 7 Vehicle Model Summary:

Model Number:

Vehicle Make:

Carline Name:

Badge Name:

Body Style:

MFR Model Code:

Trim Level (i.e., CE, LE, etc):

Vehicle Class:

ECS Set Number (From CSI 4):

Engine Code:

Engine Set Number (From CSI 3):

Evap Family:

Leak Family Identifier (From CSI 2B):

Min Curb Weight (lbs):

Max Curb Weight (lbs):

Min ETW (lbs):

Max ETW (lbs):

Min GVWR (lbs):

Max GVWR (lbs):

Min GCWR (lbs):

Max GCWR (lbs):

Drive System:

Electric Drive Motor Set # (From CSI 10A):

HEV Test Vehicle ID: (From CSI 10A)

Regenerative Braking:

Modified Test Procedure:

Shift Indicator Lamp (SIL):

Driver Selectable Modes:

If Yes, Describe the Modes:

Manufacturer Shift Schedule No. (City, Hwy, US06, SC03):

Label Type:

CA Projected Sales:

Section 177 States Projected Sales:

NMOG Credit Non PZEV Zero Evap:

NMOG Credit DOR Vehicle:

PZEV Allowances:

Baseline PZEV Allowance:

Zero Emissions VMT Allowance:

Advanced ZEV Componentry Allowance:

High Pressure Gaseous or Hydrogen Fuel Storage:

Qualifying HEV Electric Drive System:

Allowance for Qualifying HEV Electric Drive System:

Fuel Cycle Emissions:

Hydrogen Internal Combustion Engine:

Allowance for US06 Capability:

Model Type:

Transmission Set Number:

Transmission Type:

If Other, Specify

Transmission Gear #:

Model Type:

Axle Ratio

Evap Family Set Number (From CSI 6A)	Fuel Tank Set Number (From CSI 6A)

CSI 7 Manufacturer Note:

CSI 10A

HEV Set Number:

HEV Energy Storage Device Category:

If Other, Specify:

Does the Test Group include a BEVx?

If yes, select the type of BEVx:

Battery:

Battery Type:

If Other:

Specify Lithium-Ion Battery Cathode Type:

Lithium-Ion Battery Anode Type:

Number of Battery Cells:

Total Weight of Battery System (kg):

Total Battery System Voltage:

Total Battery System Specific Energy Density (Whr/Kg):

Battery Thermal Management:

If Other, Specify:

Electric Vehicle Charging Requirements (Sec. 1962.3):

Total Number of Capacitors:

Capacitor Rating (Farads)

Drive Motor:

Number of Drive Motors:

Electric Drive Motor Set Number:

(Select a sequential number, starting with 1 for each Set Number.)

Drive Motor Type:

If Other, Specify:

Drive Motor Mechanical Power (kW):

@RPM:

Drive Motor Peak Torque (Nm):

HEV Test Parameter Information Section:

HEV Test Vehicle ID:

HEV Electric Drive System Peak Power Output (kW):

HEV Traction Drive System Voltage (V):

HEV Traction Drive System Boost:

HEV Regenerative Braking:

If Other, Specify:

Alternative Test Procedure:

Off-Vehicle Charge Capable Hybrid Electric Vehicles:

Urban
Manufacturer Urban Test #:
Driver Selectable Mode:
Charge Depleting Cycle Range (R_cdcwu mi):
Charge Depleting Actual Range (R_cda mi):
Charge Depleting to Charge Sustaining Range (R_cdcsu mi):
All Electric Range (AER_u mi):
Equivalent All Electric Range (EAER_u mi):
Equivalent Electric Range Fraction (ERF_u %):
Equivalent All-Electric Range Energy Consumption (EAEREC_u, kWh/mi):
Highway
Manufacturer Highway Test #:
Driver Selectable Mode:
Charge Depleting Cycle Range (R_cdch mi):
Charge Depleting Actual Range (R_cdah mi):
Charge Depleting to Charge Sustaining Range (R_cdcsh mi):
All Electric Range (AER_h mi):
Equivalent All Electric Range (EAER_h mi):
Equivalent Electric Range Fraction (ERF_h %):
Equivalent All-Electric Range Energy Consumption (EAERECh_h, kWh/mi):
US06
Manufacturer US06 Test #:
Driver Selectable Mode:
All Electric Range (AER, mi):

Urban
Charge Depleting Net Energy Consumption (E_cd, kWh):
Net DC Energy from battery expended during test (kWh):
Net DC Charge from battery expended during test (Ah):
AC energy required to fully charge battery after CS or CD test (kWh):
Highway
Charge Depleting Net Energy Consumption (E_cd, kWh):
Net DC Energy from battery expended during test (kWh):
Net DC Charge from battery expended during test (Ah):
AC energy required to fully charge battery after CS or CD test (kWh):
Vehicle Value
Certification Range Value (mi):
PHEV Factor:
PHEV Vehicle Value:

CSI 10A Manufacturer Note:

CSI 10B (All fields in red are considered CBI)

ZEV Set Number:

ZEV Energy Storage Device Category:

If Other, Specify:

Battery:

Battery Type:

If Other, Specify:

Lithium-Ion Battery Cathode Type:

Lithium-Ion Battery Anode Type:

If Other, Specify Number of Battery Cells:

Total Weight of Battery System (kg):

Total Battery System Voltage:

Minimum Battery Voltage for Safe Operation:

Total Battery System Energy Capacity (Ah):

Total Battery System Specific Energy Density (Whr/Kg):

Battery Charger Type:

If Other, Specify:

Battery Thermal Management:

If Other, Specify:

Battery C/3 Information:

Battery Set Number:

C/3 Set Number:

C/3 Rate (A):

C/3 Temperature (Celsius):

Test 1	Test 2	Test 3

Electric Vehicle Charging Requirements (Sec. 1962.3)?:

Total Number of Capacitors:

Capacitor Rating (Farads)

Drive Motor:

Number of Drive Motors:

ZEV Electric Drive Motor Set Number:

Drive Motor Type:

If other, Specify:

Drive Motor Mechanical Power (kW):

@RPM:

Drive Motor Peak Torque (Nm):

Fuel Cell Only

Fuel Cell Vehicle Stack Technology:

Fuel Cell Vehicle: On-Board H2 Storage Method:

If other, Specify:

On-Board H2 Storage Capacity (kg):

Usable H2 Capacity as a Percentage of Maximum Capacity (%):

Range Test Procedure:

Hybrid Fuel Cell Vehicle (HFCV):

Fuel Economy (miles/kg H2) - City:

Fuel Economy (miles/kg H2) - Hwy:

Total # of Cells:

Fuel Cell Arrangement:

ZEV Test Parameter Information Section:

ZEV Test Vehicle ID:

ZEV Regenerative Braking:

If Other, Specify

ZEV Regenerative Braking Source:

Driver Controlled Regenerative Braking:

ZEV Vehicle Configuration:

Tire Size - Front:

Tire Size - Rear:

Curb Weight (lb):

LVW (lb):

GVWR (lb):

ALVW (lb):

ETW (lb):

Target Coefficient A (lb):

Target Coefficient B (lb/mph):

Target Coefficient C (lb/mph²):

Road Load Horsepower (RLHP):

Transmission Type:

If other specify:

# of Forward Transmission Gears

All Electric Range Test Information:

Parameter	Urban	Highway	Cold CO	SCO3	US06
ZEV Test Procedure:
ZEV Test ID (Urban):
ZEV Test ID (Highway):
ZEV Battery Thermal Conditioning Type:
Manufacturer Test Number:
All Electric Range (mi):
Net DC Energy Output during Test (kWh/mi):
Total AC Energy required to fully charge Batteries after Test (kWh/mi):
Total DC Energy required to fully charge Batteries after Test (kWh/mi):

Multi-Cycle Test Information:

	Urban				Highway
ZEV SMCT Discharge Rate (W):
ZEV MCT CSC Distance (mi):
ZEV MCT UBE (kWh):
	Phase 1	Phase 2	Phase 3	Phase 4	Phase 1	Phase 2
DC Energy Consumption (Wh/mi)

ZEV Model Information:

ZEV Model Number:

Zero Emission Vehicle Tier:

ZEV Electric Drive Motor Set Number for Model:

ZEV Battery Set Number for Model:

Fast Refueling UDDS ZEV Range Mileage:

Fast Refueling: Recharging/Refueling Time to replace (min):

CARB ZEV Multiplier:

CARB ZEV Credit (without multiplier):

CARB ZEV Vehicle Value:

ZEV Vehicle Make:

ZEV Model Name:

ZEV Category:

If Other, Specify:

Fuel Type:

Model Vehicle Class:

Model Specific Label Type:

NEV + Only

Time to accelerate from 0-20mph (s):

Top Speed (mph):

Equipped with sealed, maintenance-free batteries?

Meets Warranty Requirement?

Constant Speed Range (miles):

ZEV Projected Sales-CA Only:

ZEV Projected Sales-Section 177 States:

ZEV FFH Capability:

ZEV Cert Range Value:

CSI 10B Manufacturer Note: