Form for AFV Reporting in Compliance with E.O. 13031

(Dept or agency)_______________________________ AFV Acquisition Report for FY 19___

		Acquisitions
		Converted	Leased	Purchased	Total	Total Stock
1	Total # of vehicles acquired	xxxxxx
2	Exempt as law-enforcement or national-security vehicles	xxxxxx
3	Exempt due to geographic placement	xxxxxx
4	EPAct "covered fleet" vehicles (line 1 - (line 2 + line 3) (No double-counting of vehicles in lines 2 and 3.)	xxxxxx
5	E85 flex-fuel vehicles
6	Dedicated ethanol vehicles
7	M85 flex-fuel vehicles
8	Dedicated methanol vehicles
9	CNG dual-fuel vehicles
10	CNG dedicated vehicles
11	LNG dual-fuel vehicles
12	LNG dedicated vehicles
13	Propane/LPG dual-fuel vehicles
14	Propane/LPG dedicated vehicles
15	Dimethyl ether dedicated vehicles
16	Electric vehicles (dedicated) -- ZEV
17	Hydrogen dedicated vehicles -- ZEV
18	Credits claimed from medium-duty vehicle acquisitions (report separately)
19	Credits claimed from heavy-duty vehicle acquisitions (report separately)
20	Credits claimed from ZEV (hydrogen and electric) vehicle acquisitions
21	Total AFVs and credits (sum of lines 5-20)
22	AFV percentage of EPAct covered fleet acquisitions (line 21 ÷ line 4 × 100)	xxxxxx	%	%	%

Submitting official: ________________________________

Date: _________________

Address: ______________________________________

Phone: _______________________________ e-mail: __________________