HFC Sale or Conveyance Report

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American Innovation and Manufacturing Act - HFC Sale or Conveyance Report
Worksheet Instructions:
Version:
r0.1
Updated:
9/23/2021
External Links:
Reporting Form Navigation:
Section 1 - Application-Specific Seller Identification
Section 2 - Application-Specific Purchaser Information
Section 3 - Transaction Information

Section 1 - Application-Specific Seller Identification
Instructions: Complete the following company information.
Company Name:
AIMRS Company ID:
Reporting Year:

Section 2 - Application-Specific Purchaser Identification
Instructions: Complete the following company information.
Purchaser Company Name:
AIMRS Purchaser Company ID:

Section 3 - Transaction Information

Instructions: Provide the following information for each HFC produced or imported using application-specific allowances
or conveyed. In addition, provide a certification that the regulated substances will be used only for the same application f
application-specific allowance under which the substances were produced or imported was allocated. §84.21(a)(2)(vi)
Transaction Data
1
2
3
Total Cost of the Regulated
Quantity Sold or Conveyed
Substance being Sold or Conveyed
HFC
(kg)
(USD)
§84.21(a)(2)(iii)
§84.21(a)(2)(iv)
1
2
3
Provide the specific products that the application-specific purchaser plans to produce with the HFCs. §84.21(a)(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. 2
Responses to this collection of information are mandatory (40 CFR 84.21). An agency may not conduct or sponsor, and a person i
respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkee
collection of information is estimated to be 6 hours per response. Send comments on the Agency’s need this formation, the accura
burden estimates and any suggested methods for minimizing respondent burden including through the use of automated collection
Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington,
the OMB control number in any correspondence. Do not send the completed form to this address.

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 84.21). An agency may not conduct or sponsor, and a person i
respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkee
collection of information is estimated to be 6 hours per response. Send comments on the Agency’s need this formation, the accura
burden estimates and any suggested methods for minimizing respondent burden including through the use of automated collection
Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington,
the OMB control number in any correspondence. Do not send the completed form to this address.
EPA Form # 5900-538

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

veyance Report

pplication-specific allowances that is being sold
only for the same application for which the
allocated. §84.21(a)(2)(vi)
4
Application for Which Allowances
Were Allocated
§84.21(a)(2)(v)

s. §84.21(a)(2)(v)

3501 et seq. (OMB Control No. 2060-XXXX).
duct or sponsor, and a person is not required to
public reporting and recordkeeping burden for this
need this formation, the accuracy of the provided
the use of automated collection techniques to the
sylvania Ave., NW, Washington, D.C. 20460. Include

Chemical Name
CHF3
CH2F2

[Common Name]
HFC-23
HFC-32

CH3F

HFC-41

CF3CHFCHFCF2CF3

HFC-43-10mee

CHF2CF3
CHF2CHF2
CH2FCF3
CH2FCHF2
CH3CF3
CH2FCH2F
CH3CHF2
CF3CHFCF3
CH2FCF2CF3
CHF2CHFCF3
CF3CH2CF3
CH2FCF2CHF2
CF3CH2CF3
CF3CH2CF2CH3

HFC-125
HFC-134
HFC-134a
HFC-143
HFC-143a
HFC-152
HFC-152a
HFC-227ea
HFC-236cb
HFC-236ea
HFC-236fa
HFC-245ca
HFC-245fa
HFC-365mfc

[Application-Specific Allowance]
Propellants in Metered-dose Inhalers
Defense Spray
Structural Composite Preformed Polyurethane Foam
(Marine and Trailer Use)
Etching of Semiconductor Material or Wafers and the
Cleaning of Chemical Vapor Desposition (CVD)
Chambers within the Semiconductor Manufafturing
Sector
On-board Aerospace Fire Suppression

[Year]
2022
2023
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2025
2026
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2030