7610-5 General Account Form

The Acid Rain Program and CAIR Trading Programs (CAIR NOX Annual, CAIR SO2, and CAIR NOX
Ozone Season) regulations require any person, company, or organization wishing to open a general
account for the purpose of holding and transferring allowances to submit a completed General Account
form. You also may use this form to change the information previously submitted for a general account,
such as the identity of the authorized account representative. In such cases, enter your allowance
account identification number in the space provided at the top of the form. Note: A compliance account
can only be established, and information concerning a compliance account can only be changed, by
submitting a Certificate of Representation form.
If you need assistance, call the Clean Air Markets Hotline at 202-343-9620.
STEP 2

The owners may choose an alternate to act on behalf of the Authorized Account
Representative.

STEP 3

Identify all parties with an ownership interest in the allowances held in this account. All of these
parties must be subject to a binding agreement authorizing the representation of the account by
the authorized account representative, and, if applicable, the alternate authorized account
representative, identified in Steps 1 and 2. If you (the authorized account representative) are
the only person with an ownership interest in the allowances held in the account, list your name
here. If additional space is needed, please attach a separate sheet of paper.

STEP 4

If you are establishing a general account, both the authorized account representative and the
alternate (if any) must sign and date the certifications. You are encouraged to use the CAMD
Business System (CBS) to submit general account information online. To register for CBS, go
to https://camd.epa.gov/loginrequest/index.cfm.

For more information see the applicable rule:
Acid Rain: 40 CFR 73.31
CAIR NOX Annual: 40 CFR 96.151 or 97.151 or the applicable State rule
CAIR SO2: 40 CFR 96.251 or 97.251 or the applicable State rule
CAIR NOX Ozone Season: 40 CFR 96.351 or 97.351 or the applicable State rule
Paperwork Burden Estimate
The public reporting and recordkeeping burden for this collection of information is estimated to average
10 hours per response. Burden means the total time, effort, or financial resources expended by persons
to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes
the time needed to review instructions; develop, acquire, install, and utilize technology and systems for
the purposes of collecting, validating, and verifying information, processing and maintaining information,
and disclosing and providing information; adjust the existing ways to comply with any previously
applicable instructions and requirements; train personnel to be able to respond to a collection of
information; search data sources; complete and review the collection of information; and transmit or
otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates,
and any suggested methods for minimizing respondent burden, including through the use of automated
collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection
Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control
number in any correspondence. Do not send the completed form to this address.

EPA Form 7610-5 (Revised 12-2008)

United States
Environmental Protection Agency

OMB Nos. 2060-0258, 2060-0570, and 2060-0584
Approval expires 7/31/2009

General Account Form
For more information, see instructions.
This submission is:

New (to open a new general account)
Revised (to revise information on an existing general account)

This account is authorized to hold allowances in these programs:
Acid Rain/CAIR SO2 Trading
CAIR NOX Ozone Season Trading
CAIR NOX Trading
If you are opening a new allowance account, complete all steps in this form. If this is a
revised submission, enter your account # and account name and complete Step 4 to
authorize the change of information. Only the authorized account representative or
alternate authorized account representative can authorize the change.

Account #

Account Name

STEP 1
Enter requested
information for the
authorized account
representative.

Name

Title

Company Name

Address

Phone Number

Fax Number

E-mail Address

STEP 2
Enter requested
information for the
alternate authorized
account representative
(required only if you
want the general account
to have an alternate
authorized account
representative).

Name

Title

Company Name

Address

Phone Number

Fax Number

E-mail Address

EPA Form 7610-5 (Revised 12-2008)

Page 1

STEP 3
Enter the names of all
parties (persons or
companies) subject to
the binding agreement
authorizing your
representation of the
account.

Name

Name

Name

Name

STEP 4
Read the certifications
and sign and date.

Acid Rain Program
I certify that I was selected under the terms of an agreement that is binding on all persons
who have an ownership interest with respect to allowances held in the Allowance Tracking
System account. I certify that I have all necessary authority to carry out my duties and
responsibilities on behalf of the persons with an ownership interest and that they shall be
fully bound by my actions, inactions, or submissions under 40 CFR Part 73. I am authorized
to make this submission on behalf of the persons with an ownership interest for whom this
submission is made.
I certify under penalty of law that I have personally examined, and am familiar with, the
statements and information submitted in this document and all its attachments. Based on
my inquiry of those individuals with primary responsibility for obtaining the information, I
certify that the statements and information are to the best of my knowledge and belief true,
accurate, and complete. I am aware that there are significant penalties for submitting false
statements and information or omitting material information, including the possibility of fine
or imprisonment for violations.
Clean Air Interstate Rule (CAIR) NOX Annual Trading Program
I certify that I was selected as the CAIR authorized account representative or the alternate
CAIR authorized account representative, as applicable, by an agreement that is binding on
all persons who have an ownership interest with respect to CAIR NOX allowances held in the
general account. I certify that I have all the necessary authority to carry out my duties and
responsibilities under the CAIR NOX Annual Trading Program on behalf of such persons and
that each such person shall be fully bound by my representations, actions, inactions, or
submissions and by any order or decision issued to me by the Administrator or a court
regarding the general account.
I am authorized to make this submission on behalf of the persons having an ownership
interest with respect to the CAIR NOX allowances held in the general account. I certify under
penalty of law that I have personally examined, and am familiar with, the statements and
information submitted in this document and all its attachments. Based on my inquiry of those
individuals with primary responsibility for obtaining the information, I certify that the
statements and information are to the best of my knowledge and belief true, accurate, and
complete. I am aware that there are significant penalties for submitting false statements and
information or omitting required statements and information, including the possibility of fine
or imprisonment.
Clean Air Interstate Rule (CAIR) SO2 Trading Program
I certify that I was selected as the CAIR authorized account representative or the alternate
CAIR authorized account representative, as applicable, by an agreement that is binding on
all persons who have an ownership interest with respect to CAIR SO2 allowances held in the
general account. I certify that I have all the necessary authority to carry out my duties and
responsibilities under the CAIR SO2 Trading Program on behalf of such persons and that
each such person shall be fully bound by my representations, actions, inactions, or submissions

EPA Form 7610-5 (Revised 12-2008)

Page 2

and by any order or decision issued to me by the Administrator or a court regarding the general
account.
I am authorized to make this submission on behalf of the persons having an ownership interest
with respect to the CAIR SO2 allowances held in the general account. I certify under penalty of
law that I have personally examined, and am familiar with, the statements and information
submitted in this document and all its attachments. Based on my inquiry of those individuals with
primary responsibility for obtaining the information, I certify that the statements and information
are to the best of my knowledge and belief true, accurate, and complete. I am aware that there
are significant penalties for submitting false statements and information or omitting required
statements and information, including the possibility of fine or imprisonment.
Clean Air Interstate Rule (CAIR) NOX Ozone Season Trading Program
I certify that I was selected as the CAIR authorized account representative or the alternate CAIR
authorized account representative, as applicable, by an agreement that is binding on all persons
who have an ownership interest with respect to CAIR NOX Ozone Season allowances held in the
general account. I certify that I have all the necessary authority to carry out my duties and
responsibilities under the CAIR NOX Ozone Season Trading Program on behalf of such persons
and that each such person shall be fully bound by my representations, actions, inactions, or
submissions and by any order or decision issued to me by the Administrator or a court regarding
the general account.
I am authorized to make this submission on behalf of the persons having an ownership interest
with respect to the CAIR NOX Ozone Season allowances held in the general account. I certify
under penalty of law that I have personally examined, and am familiar with, the statements and
information submitted in this document and all its attachments. Based on my inquiry of those
individuals with primary responsibility for obtaining the information, I certify that the statements
and information are to the best of my knowledge and belief true, accurate, and complete. I am
aware that there are significant penalties for submitting false statements and information or
omitting required statements and information, including the possibility of fine or imprisonment.

Signature (Authorized Account Representative)

Date

Signature (Alternate Authorized Account Representative, if any)

Date

EPA Form 7610-5 (Revised 12-2008)

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STEP 5 (Optional)
Respond to the
questions by marking all
appropriate boxes. (EPA
will use this information
for program evaluation
purposes only.)

Is the authorized account representative employed by an allowance brokerage firm?
No
Yes (if yes, please mark all boxes that apply)
This account will be used to transfer allowances between clients
This account will be used to hold allowances for investment purposes
This account will be used for other purposes
What types of business are represented by the owner(s) of allowances in this account (mark all boxes
that apply)?
Utility
Non-Utility Generators of Electricity
Industrial Boiler
Fuel Supplier
_______ Coal

_______ Oil

_______ Gas

_______ Other

Pollution Control Equipment Manufacturer or distributor
Public Interest Group
_______ Consumer

_______ Other

_______ Environmental

Other ───────────────────────────────▸

Submission
Information

Mail to the following address:
By regular/certified mail:

Or overnight mail:

U.S. Environmental Protection Agency
Clean Air Markets Division (6204J)
Attn: Allowance Tracking System
1200 Pennsylvania Avenue, NW
Washington, DC 20460

U.S. Environmental Protection Agency
Clean Air Markets Division (6204J)
Attn: Allowance Tracking System
1310 L Street, NW
Second Floor, Office 202B
Washington, DC 20005
(202) 343-9168

EPA Form 7610-5 (Revised 12-2008)

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