5900-507 HFC Exporter Quarterly Report

---

Overview

Instructions
Section 1
Section 2
Section 3
Summary
Reference List

---

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 Exporter Quarterly Report (Sec 84.31)
	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 HFC 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 # 5900-507

---

Sheet 2: Section 1

	U.S. Environmental Protection Agency
	HFC Exporter Quarterly Report
	Date Prepared:
	Section 1: Report Identification Information
	Complete all fields below. No fields may be left blank.
	Company Name:
	Submission Type:
	Reporting Year:
	Reporting Quarter:
	Employer Identification Number (EIN):
		x

---

Sheet 3: Section 2

U.S. Environmental Protection Agency

HFC Exporter Quarterly Report

Company Name:

Reporting Period:

Section 2: Export Transaction Data

In the table below, enter data for each export transaction containing a regulated substance that took place during the reporting period. If no regulated substances were exported, the table may be left blank. As a reminder, if material was exported for second party transformation or second party destruction, the invoice or sales agreement containing language similar to the transformation verifications that importers use, or destruction verifications showing that the purchaser or recipient intends to destroy the regulated substances 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.

Transaction Number

Date of Export (§84.31(d)(1)(iv))

Recipient Company (§84.31(d)(1)(i))

Recipient Company Street Address (§84.31(d)(1)(i))

Recipient Company City (§84.31(d)(1)(i))

Recipient Company Country (§84.31(d)(1)(v))

Name of the Substance Exported

Quantity of the Substance Exported

Commodity Code (§84.31(d)(1)(vi))

Summary of Regulated Substances Exported (§84.31(d)(1)(iii))

Port of Exit from the United States (§84.31(d)(1)(iv))

Shipment EIN (§84.31(d)(1)(ii))

Transaction Type (§84.31(d)(1)(iii))

Intended Use (§84.31(b)(2)(vi)

Regulated Substance in Export

Percentage of Export

Regulated Substance in Export

Percentage of Export

Regulated Substance in Export

Percentage of Export

Number

Date

Text

Text

Text

Selection

Text

kg

Text

Selection

%

Selection

%

Selection

%

Text

Text

Selection

Selection

x

---

Sheet 4: Section 3

	U.S. Environmental Protection Agency
	HFC Exporter Quarterly Report
	Company Name:
	Reporting Period:
	Section 3: End-of-Year Inventory (FOURTH QUARTER REPORT ONLY)
	In the table below, provide the quantity of each regulated substance held in inventory on December 31.
	If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.
	HFC Name	End-of-Year Inventory (§84.31(d)(1)(viii))
	Selection	kg

---

Sheet 5: Summary

	U.S. Environmental Protection Agency
	HFC Exporter Quarterly Report
	Company Name:
	Reporting Period:
	Export 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.
	HFC Name	Country	Total Exported (kg)

---

Sheet 6: Reference List

	U.S. Environmental Protection Agency
	HFC Exporter Quarterly Report
	Reference List
	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 HFC tracking system. When copying and pasting data into the form, please ensure consistency with the formatting of the list 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.
	Chemical Name
	HFC-23	HFC-134	HFC-152	HFC-236ea	HFC-365mfc
	HFC-32	HFC-134a	HFC-152a	HFC-236fa	HFC-43-10mee
	HFC-41	HFC-143	HFC-227ea	HFC-245ca
	HFC-125	HFC-143a	HFC-236cb	HFC-245fa