HFC Producer One-Time Reporting Form

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American Innovation and Manufacturing Act - HFC Producer One-Time Reporting Fo
Worksheet Instructions:
Version:
r0.1
Updated:
9/24/2021
External Links:
Reporting Form Navigation:
Section 1 - Facility Identification
Section 2 - Production Facility Information
Section 3 - HFC-23 Production Information

Section 1 - Facility Identification
Instructions: Complete the following facility information.
Company Name:
Facility Name:
AIMRS Facility ID:

Section 2 - Production Facility Information

Instructions: Provide the following information on the production facility. Information on only one producing facility may b
reporting form. Provide supporting documentation, as needed, to respond to these reporting requirements.

1
HFC

Production Process Information
2
3
Estimates Percent Efficiency of
Quantity of Fugitive Losses
the Production Process
§84.31(b)(1)(iv)
§84.31(b)(1)(vi)

1
2
3
4
5

Describe the method by which the producer in practice measures daily quantities of regulated substances produced. §84.3

Provide the conversion factors by which the daily records as currently maintained can be converted into kilograms of reg
substances produced, including any constants or assumptions used in making those calculations (e.g., tank specification
temperature or pressure, density of the regulated substance). §84.31(b)(1)(ii)

Describe internal accounting procedures for determining plant-wide production. §84.31(b)(1)(iii)

Provide a list of any coproducts, byproducts, or emissions from the production line that are other regulated substances; o
depleting substances listed in 40 CFR part 82, subpart A; or hazardous air pollutants initially identified in Section 112 of th
Act, and as revised through rulemaking and codified in 40 CFR 63. §84.31(b)(1)(v)

Provide a description of any processes that use a regulated substance as a process agent. §84.31(b)(1)(vii)

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2
Responses to this collection of information are mandatory (40 CFR 84.31). An agency may not conduct or sponsor, and a person is
respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeep
this collection of information is estimated to be 200 hours per response. Send comments on the Agency’s need this formation, the a
provided burden estimates and any suggested methods for minimizing respondent burden including through the use of automated c
techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., N
Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address

EPA Form # 5900-540

OMB Control Number: 2060-XXXX
Expiration Date: X/XX/202X

ucer One-Time Reporting Form

ion on only one producing facility may be reported per
e reporting requirements.

of regulated substances produced. §84.31(b)(1)(i)

can be converted into kilograms of regulated
ose calculations (e.g., tank specifications, ambient

84.31(b)(1)(iii)

e that are other regulated substances; ozonents initially identified in Section 112 of the Clean Air

ss agent. §84.31(b)(1)(vii)

44 U.S.C. 3501 et seq. (OMB Control No. 2060-XXXX).
ay not conduct or sponsor, and a person is not required to
mber. The public reporting and recordkeeping burden for
on the Agency’s need this formation, the accuracy of the
en including through the use of automated collection
Agency (2821T), 1200 Pennsylvania Ave., NW,
ot send the completed form to this address.

American Innovation and Manufacturing Act - HFC Producer One-Time Reporting Fo
Worksheet Instructions:
Version:
r0.1
Updated:
9/24/2021
External Links:
Reporting Form Navigation:
Section 1 - Facility Identification
Section 2 - Production Facility Information
Section 3 - HFC-23 Production Information

Section 3 - HFC-23 Production Information

Instructions: Provide the following information if a producer of HFC-23. Provide supporting documentation, as needed, to
these reporting requirements.

Provide information on the capacity to produce the intended chemical on the line on which HFC-23 is produced. §84.31(b)(

Provide a description of actions taken at the facility to control the generation of HFC-23 and its emissions. §84.31(b)(4)(i)(B

Provide identification of approved destruction technology and its location intended for use for HFC-23 destruction. §84.31
In addition, provide a copy of the destruction removal efficiency report associated with the destruction technology. §84.31

OMB Control Number: 2060-XXXX
Expiration Date: X/XX/202X

Act - HFC Producer One-Time Reporting Form

er of HFC-23. Provide supporting documentation, as needed, to respond to

d chemical on the line on which HFC-23 is produced. §84.31(b)(4)(i)(A)

rol the generation of HFC-23 and its emissions. §84.31(b)(4)(i)(B)

and its location intended for use for HFC-23 destruction. §84.31(b)(4)(i)(C)
iency report associated with the destruction technology. §84.31(b)(4)(i)(D)

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