5900-200 Class 2 Importer Quarterly Report

---

Overview

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

---

Sheet 1: Instructions

	OMB Control Number: 2060-0170
	Expiration Date: 4/16/2023
	U.S. Environmental Protection Agency
	Stratospheric Ozone Protection Program
	Class II Importer Quarterly Report (Sec 82.24)
	Version 5.0
	Last Updated: April 2020
	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.
	This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0170). Responses to this collection of information are mandatory (40 CFR 82.24). 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 number and expiration date are displayed in the upper right corner of the form. The public reporting and recordkeeping burden for this collection of information is estimated to be 4 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 #5900-200

---

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