5900-542 HFC Transformation One-Time Reporting Form

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Overview

Facility Information
Lists

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Sheet 1: Facility Information

				OMB Control Number: 2060-XXXX
				Expiration Date: X/XX/202X
	American Innovation and Manufacturing Act - HFC Transformation One-Time Reporting Form
	Worksheet Instructions:
	Version:
	r0.2
	Updated:
	9/21/2021
	External Links:
	Reporting Form Navigation:
	Section 1 - Facility Identification
	Section 2 - Transformation Process Information
	Section 1 - Facility Identification
	Instructions: Complete the following Facility information.
	Company Name:
	Facility Name:
	AIMRS Facility ID:
	Section 2 - Transformation Process Information
	Instructions: Provide the following information on the transformation process performed at your facility. Provide supporting documentation, as needed, to respond to these reporting requirements.
	Transformation Process
	1	2	3	4
	HFC	Product Manufactured §84.31(e)(5)(iii)	Estimated Annual Fugitive Emissions (kg) §84.31(e)(5)(v)	Anticipated Ratio of HFC Used to Amount of End Product Manufactured §84.31(e)(5)(vi)
1
2
3
4
	Describe the transformation use. §84.31(e)(5)(i)
	List and describe all technologies and actions taken to minimize emissions of HFCs. §84.31(e)(5)(ii)
	Provide a list of any coproducts, byproducts, or emissions from the production line of any HFC 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)
	Provide the mass balance equation of the transformation reaction. §84.31(e)(5)(vii)
	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 100 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 # 5900-542

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Sheet 2: Lists

Chemical Name	Common Name
CHF3	HFC-23
CH2F2	HFC-32
CH3F	HFC-41
CF3CHFCHFCF2CF3	HFC-43-10mee
CHF2CF3	HFC-125
CHF2CHF2	HFC-134
CH2FCF3	HFC-134a
CH2FCHF2	HFC-143
CH3CF3	HFC-143a
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