5900-517 HFC Transformation 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 Transformation 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. Identify the regulated substance(s) your company transforms that this report pertains to: Click or tap here to enter text.

2. For each substance identified in question 1, describe the transformation use(s) (§84.31(e)(5)(i)): Click or tap here to enter text.

3. Describe all technologies and actions taken to minimize emissions of the regulated substance(s) (§84.31(e)(5)(ii)): Click or tap here to enter text.

4. For each use listed in question 2, what is/are the final product(s) manufactured in the process (§84.31(e)(5)(iii)): Click or tap here to enter text.

5. Provide a list of any coproducts, byproducts, or emissions from the production line using any regulated substance that are other regulated substances, ozone-depleting substances listed in 40 CFR part 82, subpart A, or hazardous air pollutants initially identified in Section 112 of the Clean Air Act, and as revised through rulemaking and codified in 40 CFR 63 (§84.31(e)(5)(iv)): Click or tap here to enter text.

6. Provide the estimated annual fugitive emissions by chemical associated with each transformation process (§84.31(e)(5)(v)): Click or tap here to enter text.

7. Provide the anticipated ratio (by mass) of regulated substance used for transformation to the amount of end product manufactured (§84.31(e)(5)(vi)): Click or tap here to enter text.

8. Provide the mass balance equation of each transformation reaction (§84.31(e)(5)(vii)): 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 # 5900-517