5900-516 HFC Reclaimers One-Time Report

U.S. Environmental Protection Agency Allowance Allocation and Trading Program under the AIM Act

OMB Control Number: XXXX-XXXX Expiration Date: MM/DD/YYYY

Instructions

Complete this form by responding to each question below. Provide supporting documentation, as needed, to respond to the questions. Once completed, submit the report along with any attachments 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

HFC Reclaimers One-Time Report (Sec. 84.31)

Submitter Information

Company Name	Click or tap here to enter text.
Company Address	Click or tap here to enter text.
Facility Address	Click or tap here to enter text.
Contact Name	Click or tap here to enter text.
Email	Click or tap here to enter text.
Phone	Click or tap here to enter text.
Submission Date	Click or tap here to enter text.

1. Provide the quantity of each regulated substance held in inventory as of December 31, 2021 (§84.31(j)(1)(i)): Click or tap here to enter text.

2. Provide the name of the laboratory that conducts the batch testing and a signed statement from that laboratory confirming there is an ongoing business relationship with the reclaimer (§84.31(j)(1)(ii)): Click or tap here to enter text.

3. Provide the number of batches tested for each regulated substance or blend containing a regulated substance in the prior year (§84.31(j)(1)(iii)): Click or tap here to enter text.

4. Provide the number of batches that did not meet the specifications in Appendix A of 40 CFR Part 82, Subpart F in the prior year (§84.31(j)(1)(iv)): Click or tap here to enter text.

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. XXXX-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 # 5900-516