Form 7610-5 General Account Form

&EPA

Instructions for General
Account Form

The Acid Rain Program and Cross-State Air Pollution Rule Programs (CSAPRNOx Annual, CSAPRNOx
Ozone Season, CSAPRSO2 Group 1, and CSAPRSO2 Group 2) 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

Cross-State Air Pollution Rule NOX Annual: 40 CFR 97.420

Cross-State Air Pollution Rule NOX Ozone Season: 40 CFR 97.520

Cross-State Air Pollution Rule SO2 Annual: 40 CFR 97.620 or 97.720

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.
1

United States
Environmental Protection Agency

OMB Nos. 2060-0258 and 2060-0667
Approval expires 12/31/2018

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 SO2 Trading
CSAPR NOx Annual Trading

CSAPR NOX Ozone Season Trading

CSAPR SO2 Group I Trading
CSAPR SO2 Group II 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

Mailing 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

Mailing Address

Phone Number

E-mail Address

EPA Form 7610-5 (Revised 06-2016)

Fax Number

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

Acid Rain Program
STEP 4
Read the certifications
and sign and date.

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.

EPA Form 7610-5 (Revised 06-2016)

Cross-State Air Pollution Rule (CSAPR) NOX Annual Trading Program
I certify that I was selected as the Cross-State Air Pollution Rule authorized account
representative or the alternate CSAPR authorized account representative, as
applicable, by an agreement that is binding on all persons who have an ownership
interest with respect to CSAPR 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 CSAPR 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 CSAPR 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.
Cross-State Air Pollution Rule (CSAPR) NOX Ozone Season Trading Program
I certify that I was selected as the Cross-State Air Pollution Rule authorized
account representative or the alternate CSAPR authorized account representative, as
applicable, by an agreement that is binding on all persons who have an ownership
interest with respect to CSAPR 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 CSAPR 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 CSAPR 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.

EPA Form 7610-5 (Revised 06-2016)

Cross-State Air Pollution Rule (CSAPR) SO2 Trading Program Group I
I certify that I was selected as the Cross-State Air Pollution Rule authorized account
representative or the alternate CSAPR authorized account representative, as
applicable, by an agreement that is binding on all persons who have an ownership
interest with respect to CSAPR Group I 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 CSAPRSO2 Group I SO2 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 CSAPRSO2 Group I 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

Cross-State Air Pollution Rule (CSAPR) SO2 Trading Program Group II
I certify that I was selected as the Cross-State Air Pollution Rule authorized account
representative or the alternate CSAPRSO2 authorized account representative,
as applicable, by an agreement that is binding on all persons who have an
ownership interest with respect to CSAPR 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 CSAPRSO2 Group II SO2 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 CSAPRSO2 Group II 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.

EPA Form 7610-5 (Revised 06-2016)

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

Signature (Authorized Account Representative)

Date

Signature (Alternate Authorized Account Representative, if any)

Date

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 ───────────────────────────────▸

EPA Form 7610-5 (Revised 06-2016)

Submission

Information

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

Or overnight mail:

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

U.S. Environmental Protection Agency
Clean Air Markets Division (6204M)
Attn: Allowance Tracking System
1201 Constitution Avenue, NW
7th Floor, Room #7421C
Washington, DC 20004
(202) 343-9168

EPA Form 7610-5 (Revised 06-2016)