5900-553 HFC Process Agent Use Annual Reporting Form

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Overview

Facility Identification
Lists

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Sheet 1: Facility Identification

OMB Control Number: 2060-XXXX

Expiration Date: X/XX/202X

American Innovation and Manufacturing Act - HFC Process Agent Use Annual Reporting Form

Worksheet Instructions:

Version:

r0.1

Updated:

9/24/2021

External Links:

Reporting Form Navigation:

Section 1 - Facility Identification

Section 2 - Process Agent Use Information

Section 3 - HFC Emission Reduction Plans

Section 1 - Facility Identification

Instructions: Complete the following facility information.

Facility Name:

AIMRS Facility ID:

Reporting Year:

Section 2 - Process Agent Use Information

Instructions: Provide the quantiy of each HFC that was used as a process agent during the reporting period, along with the amount of products and byproducts manufacutred and the mass of stack point source emissions.

Process Agent Product and Byproduct Information

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Byproduct (1)

Byproduct (2)

Byproduct (3)

HFC

Quantity Used as Process Agent (kg) §84.31(g)(2)(ii)

Stack-Point Source Emissions Quantity (kg) §84.31(g)(2)(iv)

Name of Product Manufactured

Quantity of Product Manufactured (kg) §84.31(g)(2)(iii)

Name of Byproduct Manufactured

Quantity Manufactured (kg) §84.31(g)(2)(iii)

Quantity Eventually Destroyed (kg) §84.31(g)(2)(iii)

Quantity Eventually Used as Feedstock (kg) §84.31(g)(2)(iii)

Name of Byproduct Manufactured

Quantity Manufactured (kg) §84.31(g)(2)(iii)

Quantity Eventually Destroyed (kg) §84.31(g)(2)(iii)

Quantity Eventually Used as Feedstock (kg) §84.31(g)(2)(iii)

Name of Byproduct Manufactured

Quantity Manufactured (kg) §84.31(g)(2)(iii)

Quantity Eventually Destroyed (kg) §84.31(g)(2)(iii)

Quantity Eventually Used as Feedstock (kg) §84.31(g)(2)(iii)

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Section 3 - HFC Emission Reduction Plans

Instructions: Provide a description of any HFC emission reduction actions planned or currently under investigation. §84.31(g)(2)(v)

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 6 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 # 5900-553

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Sheet 2: Lists

Chemical Name	[Common Name]		[Year]
CHF3	HFC-23		2022
CH2F2	HFC-32		2023
CH3F	HFC-41		2024
CF3CHFCHFCF2CF3	HFC-43-10mee		2025
CHF2CF3	HFC-125		2026
CHF2CHF2	HFC-134		2027
CH2FCF3	HFC-134a		2028
CH2FCHF2	HFC-143		2029
CH3CF3	HFC-143a		2030
CH2FCH2F	HFC-152
CH3CHF2	HFC-152a
CF3CHFCF3	HFC-227ea
CH2FCF2CF3	HFC-236cb
CHF2CHFCF3	HFC-236ea
CF3CH2CF3	HFC-236fa
CH2FCF2CHF2	HFC-245ca
CF3CH2CF3	HFC-245fa
CF3CH2CF2CH3	HFC-365mfc