5900-506 HFC Domestic Transfers Report

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Overview

Instructions
Section 1
Section 2
Section 3
Section 4

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Sheet 1: Instructions

	OMB Control Number: 2060-XXXX
	Expiration Date: X/XX/202X
	U.S. Environmental Protection Agency
	Allowance Allocation and Trading Program under the AIM Act
	HFC Domestic Transfers Report (Sec 84.19 and 84.21)
	Version 1.0
	Last Updated:
	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/climate-hfcs-reduction/collection-data-support-establishment-hfc-allowance-allocation-and-trading
	This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-XXXX). Responses to this collection of information are mandatory (40 CFR 84.31). 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. The public reporting and recordkeeping burden for this collection of information is estimated to be X hours per response. Send comments on the Agency’s need this formation, 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, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 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 # 5900-506

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Sheet 2: Section 1

	U.S. Environmental Protection Agency
	HFC Domestic Transfers Report
	Date Prepared:
	Section 1: Transferor Identification Information
	Complete all fields below. No fields may be left blank.
	Company Name:
	Submission Type:
	Reporting Year:

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Sheet 3: Section 2

	U.S. Environmental Protection Agency
Err:508	HFC Domestic Transfers Report
	Company Name:
	Reporting Period:
	Section 2: Transferee Information
	In the table below, enter the contact information for the recipient of the transfer or sale (§84.19(a)(2)(i) and §84.19(a)(2)(ii)).
	Transferee Company Name	Transferee Contact Name	Transferee Contact Phone Number	Transferee Contact Email	Transferee Street Address	Transferee City	Transferee State	Transferee Zip Code
	Text	Text	Text	Text	Text	Text	Selection	Text
		x	x	x	x

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Sheet 4: Section 3

		U.S. Environmental Protection Agency
		HFC Domestic Transfers Report
		Company Name:
		Reporting Period:
		Section 3: Transaction Data
		In the table below, enter data for each transfer request. For all regulated substances that are transferred, all fields are required unless otherwise indicated. For transfers of application-specific allowances, additionally provide a signed document from the transferee certifying that the transferee will use the application-specific allowances only for the same application for which the application-specific allowance was allocated (§84.19(a)(2)(viii)).
		Transaction Number	Allowance Type		Quantity of Allowances Being Transferred (§84.19(a)(2)(iv))	Total Cost of Allowance Transfer (§84.19(a)(2)(v))	Quantity of Unexpended Allowances Held by Transferor (§84.19(a)(2)(vi))	Calculated Values
			Production, Consumption, or Application-Specific (§84.19(a)(2)(iii))	Application, if applicable (§84.19(a)(2)(iii))				Amount of Offset (§84.19(a)(2)(vii))	Number of Allowances Subtracted from Transferor's Allowance Balance
		Autopopulated	Selection	Selection	MTEVs	(US$)	MTEVs	MTEVs	MTEVs
0
			x	x	x	x			x
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Sheet 5: Section 4

	U.S. Environmental Protection Agency
Err:508	HFC Domestic Transfers Report
	Company Name:
	Reporting Period:
	Section 4: Application-Specific Allowance Transfers or Sales
	If transfering application-specific allowances, describe below or in supporting documentation the specific products that the transferee plans to produce with the HFCs (§84.21(b)(2)(v)).
		x