4620-15 General Account Information

United States
Environmental Protection Agency

OMB No. 2060-0445

General Account Information
This form is required to establish a general account in the NOx Allowance Tracking System (NATS) and should be submitted to EPA by
any person, company, or organization wishing to open such an account for the purpose of holding and transferring allowances under the
NOx BudgetTrading Program. To open a new general account, complete all steps in this form, leaving the NATS account number and
the Authorized Account Representative (AAR) ID blank for EPA to assign (unless you are an AAR for another account in NATS, in
which case you should write in your AAR ID number). Both the AAR and the alternate (if applicable) must sign and date the certification
statement in Step 6. To revise information associated with an existing general account, enter your NATS account number and AAR ID
number and complete only those steps covering the information you wish to change. You must complete Step 6 to authorize the change of
information. Only the AAR or alternate AAR can authorize the change, and only one signature is needed. The AAR should notify all
persons who have an ownership interest in the allowances held in an account every time he or she makes a
NOx Budget Trading Program submittal.
This submittal is:

NATS Account Number

~ New (to open a new general account)
~ Revised (to revise information on an existing general account)
AAR ID Number

Name of Account

STEP 1
Enter requested
information for the
Authorized Account
Representative.

Name

Firm (Optional)

Phone Number

Fax Number

E-mail Address

STEP 2 (Optional)
Enter requested
information for the
Alternate Authorized
Account Representative.

Name

Firm (Optional)

Phone Number

Fax Number

E-mail Address

STEP 3
Enter the mailing
address for the
account.

Address

STEP 4
Enter the names of all
parties (persons or
companies) subject
to the binding agreement
authorizing your
representation
of the account.*

Name

Name
Name

*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 AAR, and, if applicable, the alternate AAR, identified in Steps 1 and 2. If you (the AAR) are the
only person with an ownership interest in the allowances held in the account, list your name here.

General Account - Page 2
NATS Account Number (from page 1)

STEP 5 (Optional)
Respond to the
questions by marking
all appropriate boxes
(this information will
be used 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
will be used for
~ Thisotheraccount
purposes (please specify)
What types of business are represented by the owner(s) of allowances in this account? (Mark all boxes
that apply)

~ Utility
~ Non-Utility Generator of Electricity
~ Industrial Boiler
~ Fuel Supplier
______ Coal

______ Oil

______ Gas

______ Other

~ Pollution Control Equipment
~ Public Interest Group
______ Consumer

______ Other

______ Environmental

~ Other
STEP 6
Read the certification
and sign and date.
(Only one signature is
needed if the form is
being used to revise
account information.)
Leave the account
number blank if you
are opening a new
account.

Submission
Information

I certify that I was selected as the NOX authorized account representative or the NOX alternate
authorized account representative, as applicable, by an agreement that is binding on all persons who have
an ownership interest with respect to allowances held in the general account. I certify that I have all the
necessary authority to carry out my duties and responsibilities under the NOX Budget 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.

Signature (Authorized Account Representative)

Date

Signature (Alternate Authorized Account Representative, if any)

Date

U.S. Mail:
U.S. Environmental Protection Agency
NOx Budget Trading Program (6204J)
Attention: NOx Allowance Tracking System
1200 Pennsylvania Ave., NW
Washington, D.C. 20460

Overnight Mail:
U.S. Environmental Protection Agency
NOx Budget Trading Program (6204J)
Attention: NOx Allowance Tracking System
1310 L Street, N.W.
Washington, D.C. 20005

If you have any questions, please call the CAMD Hotline at 202-343-9620.

EPA Form 7620-15
Paperwork Burden Estimate
The public reporting and recordkeeping burden for this collection of information is estimated to average 30 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 (2822), 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.

United States
Environmental Protection Agency

OMB No. 2060-0445