5900-200 Class II Importer Quarterly Report

Production, Import, Export, Recycling, Destruction, Transhipment, and Feedstock Use of Ozone-Depleting Substances (Proposed Rule)

class_ii_importer_v3.0.xlsm

Production, Import, Export, Destruction, Transhipment, and Exempted Uses of Ozone-Depleting Substances (Renewal)

OMB: 2060-0170

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Section 1
Section 2
Section 3
Summary
Blend Breakout
Reference List


Sheet 1: Instructions





U.S. Environmental Protection Agency

Stratospheric Ozone Protection Program




Class II Importer Quarterly Report (Sec 82.24)

Version 3.0

Last Updated: March 2019




Instructions

Complete this form by filling in the data fields that are highlighted in blue. Guidance on how to complete individual data fields are provided in comment bubbles. Use the arrows to navigate between the tabs. Once completed, use the 'prepare submission' button on the Summary tab to generate your CSV file.

Copying and Pasting Data: If data are pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be

accepted into EPA’s ODS Tracking System. Refer to the Reference List to identify the valid naming scheme for specific data fields. Additionally, select "Paste As Values" when pasting data into the form.

Report Submission: This Excel file, the generated CSV file, and all supporting attachments should be submitted to EPA through the Central Data Exchange (CDX). Refer to EPA's website for additional information on form submission:

https://www.epa.gov/ods-phaseout/ods-recordkeeping-and-reporting




All information submitted to EPA will be treated as confidential in accordance with 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart.

The public reporting and recordkeeping burden for this collection of information is estimated to average 4 hours per response. 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 Avenue NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.




EPA Form #5900-200

OMB Control Number: 2010-0170

Expiration Date: 8/31/2021





Sheet 2: Section 1










U.S. Environmental Protection Agency






Class II Importer Quarterly Report












Date Prepared:













Section 1: Report Identification Information






Complete all fields below. No fields may be left blank.





The company name must match the organization name under which this report is submitted to EPA through CDX. Company Name:

1



Submission Type:

1



Reporting Year:

1



Reporting Quarter:

1



Per Customs and Border Patrol, this number could be the: - Internal Revenue Service (IRS) Employer Identification Number (EIN): NN-NNNNNNN; - IRS EIN with suffix: NN-NNNNNNNXX; - Social Security Number (SSN): NNN-NN-NNNN; or - CBP assigned number: YYDDPP-NNNNN. Importer Number:

1












Original Submission






Re-Submittal






Sheet 3: Section 2



























U.S. Environmental Protection Agency




















Class II Importer Quarterly Report









































Company Name:


















Reporting Period:







































Section 2: Import Transaction Data






















In the table below, enter data for each import transaction containing a class II controlled substance that took place during the reporting period. If no controlled substances were imported, the table may be left blank. For all controlled substances that are imported, all fields are required unless otherwise indicated. As a reminder, if material was imported for second party transformation or second party destruction, a copy of the transformation and/or destruction verification from each company for whom material was imported must be provided to EPA along with the submission of this report.





If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.















If blends were imported, refer to the table of HCFC blends provided in the Blend Breakout tab, as needed.















The transaction number is autopopulated. Transaction Number Enter the date for when the shipment entered the United States. Date of Import Select the country from which the shipment was imported. If copying and pasting data into the table, please refer to the Reference List for the valid list of countries. Source Country Select the name of the chemical imported. If the chemical is a blend, select the name of the blend. A table of HCFC blends is provided in the 'Blends Breakout' tab for reference. If the import is a blend and the name of the blend is not listed in the dropdown list, select 'Other' and manually enter the name and quantity of each class II chemical contained within the blend in columns I-N. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Name of the Chemical Imported Enter the total quantity (kg) of the chemical imported. If the chemical is a blend, the quantity should equal the total quantity of the blend. Quantity of Chemical Imported Enter the 10-digit commodity code of the chemical imported as it appears on Customs documentation. Refer to the Reference List for a list of commonly used commodity codes for class II chemicals. Commodity Code These fields will automatically populate unless the name of the chemical imported is identified as 'Other'. Summary of Class II Controlled Substances Imported Enter the name of the port where the shipment entered the United States. Port of Entry into the United States Enter the Customs Entry Summary Number for the shipment. This number identifies the specific shipment. The Customs Entry Summary Number is generally three (3) letters followed by nine (9) digits. Customs Entry Summary Number Enter the Importer Number of the shipment. Your company's Importer Number as entered in Section 1 of this report will automatically populate for each transaction entered. Revise the number if the Importer Number of the shipment is different from your company's Importer Number. The number entered should have no dashes. Shipment Importer Number Select the transaction type of the material. The transaction type can be New, Used, or Heels. Heels should only be reported at the end of the year (i.e., on Q4 reports). If copying and pasting data into the table, please refer to the Reference List for the valid list of transaction types. Transaction Type Select the intended use of the material. Note that the Transaction Type in Column R must be selected prior to completing this field. - If the material is New, the intended use can be In-House Transformation, 2nd Party Transformation, In-House Destruction, 2nd Party Destruction, or None Apply. - If the material is Used, the intended use can be In-House Transformation, 2nd Party Transformation, In-House Destruction, 2nd Party Destruction, or Other. - If the material is a Heel, the intended use can be Included in Future Shipment, Transformation, Destruction, or Non-Emissive Use. If copying and pasting data into the table, please refer to the Reference List for the valid list of intended uses. Intended Use Enter the date of the non-objection notice or acknowledgement letter issued by EPA for the shipment if the material imported is used. Date of Non-Objection Notice or Acknowledgement Letter





If the chemical imported is identified as 'Other', enter the name of the class II chemical imported as part of the blend or mixture. Please refer to the Reference List for the valid list of chemical names. Class II Chemical If the chemical imported is identified as 'Other', enter the quantity of the class II chemical imported as part of the blend or mixture. Quantity Imported (kg) If the chemical imported is identified as 'Other' and the mixture or blend contains more than one class II chemical, enter the name of the second class II chemical imported as part of the blend or mixture. Please refer to the Reference List for the valid list of chemical names. Class II Chemical If the chemical imported is identified as 'Other' and the mixture or blend contains more than one class II chemical, enter the quantity of the second class II chemical imported as part of the blend or mixture. Quantity Imported (kg) If the chemical imported is identified as 'Other' and the mixture or blend contains more than two class II chemicals, enter the name of the third class II chemical imported as part of the blend or mixture. Please refer to the Reference List for the valid list of chemical names. Class II Chemical If the chemical imported is identified as 'Other' and the mixture or blend contains more than two class II chemicals, enter the quantity of the third class II chemical imported as part of the blend or mixture. Quantity Imported (kg)





Autopopulated Date Selection Selection kg Text Autopopulated Autopopulated Autopopulated Autopopulated Autopopulated Autopopulated Text Text Number Selection Selection Date





1 1/15/2018 Australia HCFC-22 5,000.00 2903.71.0000 HCFC-22 5,000.00



Miami, FL abc123456789 12345678900 New None Apply




1st






































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































1


























x x










x x








Afghanistan HCFC-21










New In-House Trans








Albania HCFC-22










Used 2nd Party Trans








Algeria HCFC-31










Heels In-House Dest








Andorra HCFC-121











2nd Party Dest








Angola HCFC-122











None Apply








Antigua and Barbuda HCFC-123











In-House Trans








Argentina HCFC-123a











In-House Dest








Armenia HCFC-123b











Other








Australia HCFC-124











Future Shipment








Austria HCFC-124a











Transformation








Azerbaijan HCFC-131











Destruction








Bahamas HCFC-132b











Non-Emissive Use








Bahrain HCFC-133a





















Bangladesh HCFC-141b





















Barbados HCFC-142b





















Belarus HCFC-151





















Belgium HCFC-221





















Belize HCFC-222





















Benin HCFC-223





















Bermuda HCFC-224





















Bhutan HCFC-225ca





















Bolivia (Plurinational State of) HCFC-225cb





















Bosnia and Herzegovina HCFC-226





















Botswana HCFC-231





















Brazil HCFC-232





















Brunei Darussalam HCFC-233





















British Virgin Islands HCFC-234





















Bulgaria HCFC-235





















Burkina Faso HCFC-241





















Burundi HCFC-242





















Cambodia HCFC-243





















Cameroon HCFC-244





















Canada HCFC-251





















Cape Verde HCFC-252





















Central African Republic HCFC-253





















Chad HCFC-261





















Chile HCFC-262





















China HCFC-271





















Colombia R-401A





















Comoros R-401B





















Congo R-401C





















Cook Islands R-402A





















Costa Rica R-402B





















Cote d'Ivoire R-403A





















Croatia R-403B





















Cuba R-405A





















Cyprus R-406A





















Czech Republic R-408A





















Democratic Republic of the Congo R-409A





















Denmark R-409B





















Djibouti R-411A





















Dominica R-411B





















Dominican Republic R-411C





















Ecuador R-412A





















Egypt R-414A





















El Salvador R-414B





















Equatorial Guinea R-415A





















Eritrea R-415B





















Estonia R-416A





















Ethiopia R-418A





















European Union R-420A





















Fiji Other





















Finland






















France






















Gabon






















Gambia






















Georgia






















Germany






















Ghana






















Greece






















Grenada






















Guatemala






















Guinea






















Guinea-Bissau






















Guyana






















Haiti






















Holy See






















Honduras






















Hong Kong






















Hungary






















Iceland






















India






















Indonesia






















Iran (Islamic Republic of)






















Iraq






















Ireland






















Israel






















Italy






















Jamaica






















Japan






















Jordan






















Kazakhstan






















Kenya






















Kiribati






















Kuwait






















Kyrgyzstan






















Lao People's Democratic Republic






















Latvia






















Lebanon






















Lesotho






















Liberia






















Libya






















Liechtenstein






















Lithuania






















Luxembourg






















Madagascar






















Malawi






















Malaysia






















Maldives






















Mali






















Malta






















Marshall Islands






















Mauritania






















Mauritius






















Mexico






















Micronesia (Federated States of)






















Monaco






















Mongolia






















Montenegro






















Morocco






















Mozambique






















Myanmar






















Namibia






















Nauru






















Nepal






















Netherlands






















New Zealand






















Nicaragua






















Niger






















Nigeria






















Niue






















North Korea (Democratic People's Republic of Korea)






















Norway






















Oman






















Pakistan






















Palau






















Panama






















Papua New Guinea






















Paraguay






















Peru






















Philippines






















Poland






















Portugal






















Qatar






















Republic of Moldova






















Romania






















Russian Federation






















Rwanda






















Saint Kitts and Nevis






















Saint Lucia






















Saint Vincent and the Grenadines






















Samoa






















San Marino






















Sao Tome and Principe






















Saudi Arabia






















Senegal






















Serbia






















Seychelles






















Sierra Leone






















Singapore






















Slovakia






















Slovenia






















Solomon Islands






















Somalia (Federal Republic of)






















South Africa






















South Korea (Republic of Korea)






















South Sudan






















Spain






















Sri Lanka






















Sudan






















Suriname






















Swaziland






















Sweden






















Switzerland






















Syrian Arab Republic






















Tahiti






















Taiwan






















Tajikistan






















Thailand






















The Former Yugoslav Republic of Macedonia






















Timor-Leste






















Togo






















Tonga






















Trinidad and Tobago






















Tunisia






















Turkey






















Turkmenistan






















Tuvalu






















Uganda






















Ukraine






















United Arab Emirates






















United Kingdom of Great Britain and Northern Ireland






















United Republic of Tanzania






















#NAME?






















Uruguay






















Uzbekistan



















Sheet 4: Section 3











U.S. Environmental Protection Agency




Class II Importer Quarterly Report








Company Name:



Reporting Period:










Section 3: Shipment Data




Identify the recipient company(s) of the material imported for second party transformation or second party destruction, and the amount shipped to each company during the quarter.



Note: Due to a potential time lag between the date of import and the date of shipment, it is recognized that for a given quarter the information in Section 3 may not match the information reported in Section 2; however, it is expected that all material imported for second party transformation or second party destruction will eventually be shipped to a second party and must be reported as such in the applicable quarterly report.



If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.



As a reminder, a copy of the transformation or destruction verification from each second party for whom material was imported must be provided to EPA along with the submission of this report.



Select the chemical name from the dropdown list if the controlled substance was imported during the reporting period and subsequently shipped to or purchased by a second party for transformation or destruction. If the material was shipped to more than one company, enter the chemical name in more than one row. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Chemical Name Enter the name of the company that received or purchased material during the quarter for transformation or destruction. Recipient Company Name Enter the quantity (kg) of the chemical shipped to or purchased by the recipient company during the reporting period. Quantity Identify whether the material will be (1) transformed, or (2) destroyed. Purpose



Selection Text kg Selection



HCFC-22 Company A 100.50 Transformation



















































































x

x



HCFC-21

Transformation



HCFC-22

Destruction



HCFC-31






HCFC-121






HCFC-122






HCFC-123






HCFC-123a






HCFC-123b






HCFC-124






HCFC-124a






HCFC-131






HCFC-132b






HCFC-133a






HCFC-141b






HCFC-142b






HCFC-151






HCFC-221






HCFC-222






HCFC-223






HCFC-224






HCFC-225ca






HCFC-225cb






HCFC-226






HCFC-231






HCFC-232






HCFC-233






HCFC-234






HCFC-235






HCFC-241






HCFC-242






HCFC-243






HCFC-244






HCFC-251






HCFC-252






HCFC-253






HCFC-261






HCFC-262






HCFC-271





Sheet 5: Summary















U.S. Environmental Protection Agency








Class II Importer Quarterly Report
















Company Name:








Reporting Period:


















Import Totals










The values in the table below are calculated based on data entered in Section 2. If the totals appear to be incorrect, please return to Section 2 to review your data.


Chemical Name New Imports (kg) Total Used Imports (kg) Total Heel Imports (kg)


Gross Imports In-House Transformation Second Party Transformation In-House Destruction Second Party Destruction Net Imports






































































































































Allowance Summary










The values in the table below are calculated based on data entered in Section 2 for chemicals that have allowances. If the totals appear to be incorrect, please return to Section 2 to review your data.







Chemical Name Consumption Allowances Expended (kg)
























































































Sheet 6: Blend Breakout










U.S. Environmental Protection Agency






Class II Importer Quarterly Report






Blend Breakout Table









Chemical Name HCFC-22 HCFC-124 HCFC-142b



R-401A 53% 34%




R-401B 61% 28%




R-401C 33% 52%




R-402A 38%





R-402B 60%





R-403A 75%





R-403B 56%





R-405A 45%
5.5%



R-406A 55%
41%



R-408A 46%





R-409A 60% 25% 15%



R-409B 65% 25% 10%



R-411A 87.5%





R-411B 94%





R-411C 95.5%





R-412A 70%
25%



R-414A 51% 28.5% 16.5%



R-414B 50% 39% 9.5%



R-415A 82%





R-415B 25%





R-416A
39%




R-418A 96%





R-420A

12%



















Sheet 7: Reference List





















































U.S. Environmental Protection Agency

















































Class II Importer Quarterly Report















































Reference List


































































































Copying and Pasting Data: If data is pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be accepted into EPA’s ODS tracking system. When copying and pasting data into the form, please ensure consistency with the formatting of the lists provided below.









































Chemical Name List: The table below lists the valid chemical names that may be used when entering data into Section 2 and Section 3 of this form.
Country List: The table below lists the valid country names that may be used when entering data into Section 2 of this form.




























































































Class II Chemicals (including blends)
Source Country









































HCFC-21 HCFC-141 HCFC-226 HCFC-261 R-411A
Afghanistan Greece Papua New Guinea









































HCFC-22 HCFC-141a HCFC-231 HCFC-262 R-411B
Albania Grenada Paraguay









































HCFC-31 HCFC-141b HCFC-232 HCFC-271 R-411C
Algeria Guatemala Peru









































HCFC-121 HCFC-142 HCFC-233 R-401A R-412A
Andorra Guinea Philippines









































HCFC-122 HCFC-142a HCFC-234 R-401B R-414A
Angola Guinea-Bissau Poland









































HCFC-123 HCFC-142b HCFC-235 R-401C R-414B
Antigua and Barbuda Guyana Portugal









































HCFC-123a HCFC-151 HCFC-241 R-402A R-415A
Argentina Haiti Qatar









































HCFC-123b HCFC-221 HCFC-242 R-402B R-415B
Armenia Holy See Republic of Moldova









































HCFC-124 HCFC-222 HCFC-243 R-403A R-416A
Australia Honduras Romania









































HCFC-124a HCFC-223 HCFC-244 R-405A R-418A
Austria Hong Kong Russian Federation









































HCFC-131 HCFC-224 HCFC-251 R-408A R-420A
Azerbaijan Hungary Rwanda









































HCFC-132b HCFC-225ca HCFC-252 R-409A Other
Bahamas Iceland Saint Kitts and Nevis









































HCFC-133a HCFC-225cb HCFC-253 R-409B

Bahrain India Saint Lucia















































Bangladesh Indonesia Saint Vincent and the Grenadines









































Transaction Type List: The table below lists the valid transaction types that may be used when entering data into Section 2 of this form.
Barbados Iran (Islamic Republic of) Samoa










































Belarus Iraq San Marino















































Belgium Ireland Sao Tome and Principe









































Transaction Type


Belize Israel Saudi Arabia









































New Used Heels


Benin Italy Senegal















































Bermuda Jamaica Serbia









































Intended Use Lists: The tables below list the valid intended uses that may be used when entering data into Section 2 of this form.
Bhutan Japan Seychelles










































Bolivia (Plurinational State of) Jordan Sierra Leone















































Bosnia and Herzegovina Kazakhstan Singapore









































Intended Uses - If Transaction Type = New
Botswana Kenya Slovakia









































In-House Trans 2nd Party Trans In-House Dest 2nd Party Dest None Apply
Brazil Kiribati Slovenia















































Brunei Darussalam Kuwait Solomon Islands









































Intended Uses - If Transaction Type = Used


British Virgin Islands Kyrgyzstan Somalia (Federal Republic of)









































Transformation Destruction Other


Bulgaria Lao People's Democratic Republic South Africa















































Burkina Faso Latvia South Korea (Republic of Korea)









































Intended Uses - If Transaction Type = Heels

Burundi Lebanon South Sudan









































Future Shipment Transformation Destruction Non-Emissive Use

Cambodia Lesotho Spain















































Cameroon Liberia Sri Lanka









































Commodity Code List: The table below lists the commonly used class II commodity codes that may be used when entering data into Section 2 of this form. A complete list of commodity codes can be found in the Official Harmonized Tariff Schedule.
Canada Libya Sudan










































Cape Verde Liechtenstein Suriname










































Central African Republic Lithuania Swaziland















































Chad Luxembourg Sweden









































Class II Commodity Codes/Description
Chile Madagascar Switzerland









































2903.71.0000 Chlorodifluoromethane (HCFC-22)
China Malawi Syrian Arab Republic









































2903.72.0020 Dichlorotrifluoroethane (HCFC-123)
Colombia Malaysia Tahiti









































2903.72.0050 Other Dichlorotrifluoroethanes (HCFC-123a, HCFC-123b)
Comoros Maldives Taiwan









































2903.73.0000 Dichlorofluoroethanes (HCFC-141b)
Congo Mali Tajikistan









































2903.74.0000 Chlorodifluoroethanes (HCFC-142b)
Cook Islands Malta Thailand









































2903.75.0000 Dichloropentafluoropropanes (HCFC-225ca, HCFC-225cb)
Costa Rica Marshall Islands The Former Yugoslav Republic of Macedonia









































2903.79.9030 Monochlorotetrafluoroethane (HCFC-124)
Cote d'Ivoire Mauritania









































2903.79.9070 Other HCFCs
Croatia Mauritius Timor-Leste









































3824.74.0000 Mixtures containing hydrochlorofluorocarbons (HCFCs) but not containing chlorofluorocarbons (CFCs)
Cuba Mexico Togo











































Cyprus Micronesia (Federated States of) Tonga















































Czech Republic Monaco Trinidad and Tobago















































Democratic Republic of the Congo Mongolia Tunisia















































Denmark Montenegro Turkey















































Djibouti Morocco Turkmenistan















































Dominica Mozambique Tuvalu















































Dominican Republic Myanmar Uganda















































Ecuador Namibia Ukraine















































Egypt Nauru United Arab Emirates















































El Salvador Nepal United Kingdom of Great Britain and Northern Ireland















































Equatorial Guinea Netherlands















































Eritrea New Zealand United Republic of Tanzania















































Estonia Nicaragua Uruguay















































Ethiopia Niger Uzbekistan















































European Union Nigeria Vanuatu















































Fiji Niue Venezuela (Bolivarian Republic of)















































Finland North Korea (Democratic People's Republic of Korea) Viet Nam















































France Yemen















































Gabon Norway Zambia















































Gambia Oman Zimbabwe















































Georgia Pakistan
















































Germany Palau
















































Ghana Panama




























































































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