| OMB Control Number: 2060-XXXX | |||||||
| Expiration Date: X/XX/202X | |||||||
| American Innovation and Manufacturing Act - HFC Application-Specific Allowance Holder Biannual Reporting Form | |||||||
| Worksheet Instructions: | |||||||
| Version: | |||||||
| r0.2 | |||||||
| Updated: | |||||||
| 12/14/2021 | |||||||
| External Links: | |||||||
| Reporting Form Navigation: | |||||||
| Section 1 - Company Identification | Section 4 - Transition Plan | Section 7 - Quantiity Acquired in Previous Three Years | |||||
| Section 2 - Application-Specific Data | Section 5 - Additional Application-Specific Allowances for Next Calendar Year | ||||||
| Section 3 - Allowance Conferral Data | Section 6 - Contracting Information | ||||||
| EPA may request additional information or ask follow up questions to verify the accuracy of this submission and supporting documentation, including pursuant to CAA section 114 as authorized under the AIM Act. | |||||||
| Section 1 - Company Identification | |||||||
| Instructions: Complete the following company information. | |||||||
| Company Name: | |||||||
| Company ID: | |||||||
| Reporting Year: | |||||||
| Reporting Period: | |||||||
| Section 2 - Application-Specific Data | |||||||
| Instructions: Enter the quantity of each regulated substance that was acquired through conferring allowances, directly imported, or purchased without expending application-specific allowances (i.e., from the open market) during the previous six months. Additionally, provide the quantity held in inventory on the last day of the previous six-month period, and the quantity destroyed or recycled during the previous six months. | |||||||
| Acquired, Held in Inventory, Destroyed or Recycled | |||||||
| 1 | 2 | 4 | 5 | 7 | 8 | 9 | |
| HFC | Quantity Acquired through Conferring Allowances (kg) §84.31(h)(1)(i) |
Quantity Acquired through Expending Allowances and Directly Imported (kg) §84.31(h)(1)(ii) |
Quantity Purchased for Application-Specific Allowances without Expending Application-Specific Allowances (kg) §84.31(h)(1)(iii) |
Quantity Held in Inventory by the Reporting Company or Held under Contract by Another Company for the Reporting Company’s Use (kg) §84.31(h)(1)(iv) |
Quantity Destroyed (kg) §84.31(h)(1)(v) |
Quantity Recycled (kg) §84.31(h)(1)(v) |
|
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||
| Section 3 - Allowance Conferral Data | |||||||
| Instructions: Provide the names of the companies to which application-specific allowances were conferred. | |||||||
| HFC Allowance Conferral Data | |||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | |
| HFC | Company to Which Allowances Were Conferred | Company Contact Name §84.31(h)(1)(vi) |
Company Contact Email §84.31(h)(1)(vi) |
Company Contact Phone §84.31(h)(1)(vi) |
Quantity of Allowances Conferred (MTEVe) §84.31(h)(1)(vi) |
Quantity of HFC Received (kg) §84.31(h)(1)(vi) |
|
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||
| 5 | |||||||
| 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 12 hours per response. Send comments on the Agency’s need for this information, 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 # 5900-551 | |||||||
| OMB Control Number: 2060-XXXX | ||||||||||||||
| Expiration Date: X/XX/202X | ||||||||||||||
| American Innovation and Manufacturing Act - HFC Application-Specific Allowance Holder Biannual Reporting Form | ||||||||||||||
| Worksheet Instructions: | ||||||||||||||
| Version: | ||||||||||||||
| r0.2 | ||||||||||||||
| Updated: | ||||||||||||||
| 12/14/2021 | ||||||||||||||
| External Links: | ||||||||||||||
| Reporting Form Navigation: | ||||||||||||||
| Section 1 - Company Identification | Section 4 - Transition Plan | Section 7 - Quantiity Acquired in Previous Three Years | ||||||||||||
| Section 2 - Application-Specific Data | Section 5 - Additional Application-Specific Allowances for Next Calendar Year | |||||||||||||
| Section 3 - Allowance Conferral Data | Section 6 - Contracting Information | |||||||||||||
| Section 4 - Transition Plan | ||||||||||||||
| Provide a description of plans to transition application-specific use of regulated substances to regulated substances with a lower exchange value or alternatives to regulated substances. §84.31(h)(1)(vii) | ||||||||||||||
| Section 5 - Additional Application-Specific Allowances for Next Calendar Year | ||||||||||||||
| Instructions: If the company is requesting additional allowances due to one or more of the circumstances listed in 84.13(b)(1), provide a projection of the monthly quantity of additional regulated substances needed for application-specific uses by month in the next calendar year. | ||||||||||||||
| Quantity Needed for Application-Specific Use (kg) §84.31(h)(1)(viii) |
||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | |
| HFC | January | February | March | April | May | June | July | August | September | October | November | December | Total | |
| 1 | ||||||||||||||
| 2 | ||||||||||||||
| 3 | ||||||||||||||
| 4 | ||||||||||||||
| Instructions: Provide a detailed explanation, including relevant supporting documentation (e.g., explanation of amounts of products that must be delivered under new contracts, copies of permits or other documentation to clarify when the new line or facility is opening, more recent sales numbers to document growth in MDI sales resulting from a public health emergency) to justify the additional need. §84.31(h)(1)(viii) | ||||||||||||||
| Section 6 - Contracting Information | ||||||||||||||
| Instructions: If the company is contracting out the manufacturing of defense sprays or metered dose inhalers, or paying another person (whether it is in cash, credit, goods, or services) to perform the servicing of onboard aerospace fire suppression, complete the following information for the contact doing to manufacturing or servicing: | ||||||||||||||
| Manufacturing/Serviving Representative | ||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | ||||||||
| Company Name §84.31(h)(1)(ix) |
Contact Name §84.31(h)(1)(ix) |
Contact Email §84.31(h)(1)(ix) |
Contact Street Address §84.31(h)(1)(ix) |
Contract City §84.31(h)(1)(ix) |
Contact State §84.31(h)(1)(ix) |
Contact Zip §84.31(h)(1)(ix) |
||||||||
| 1 | ||||||||||||||
| 2 | ||||||||||||||
| 3 | ||||||||||||||
| 4 | ||||||||||||||
| 5 | ||||||||||||||
| 6 | ||||||||||||||
| Provide clarification on whether the responses in this report apply to the company that is allocated application-specific allowances or the company receiving the contract for manufacturing and/or servicing using application-specific allowances: §84.31(h)(1)(ix) | ||||||||||||||
| Section 7 - Quantity Acquired in Previous Three Years | ||||||||||||||
| Instructions: For July 2022 reports and for persons requesting application-specific allowances for the first time, provide the total quantity of all regulated substances acquired for application-specific use in the previous three years. Provide a copy of the sales records, invoices, or other records documenting that quantity. Make sure to specify the HFC weight per cylinder or unit if not included in the sales records or invoices. §84.31(h)(2)(ii) | ||||||||||||||
| Year | ||||||||||||||
| Reporting Period | July 1 - December 31 | January 1 - June 30 | July 1 - December 31 | January 1 - June 30 | July 1 - December 31 | January 1 - June 30 | ||||||||
| HFC | Quantity Acquired (kg) | |||||||||||||
| Chemical Name | [Common Name] | [Common_Name_1] | [Common_Name_2] | [Common_Name_5] | [CASRN] | [Period] | [Month] | [Year] | [State] | [Reporting Period] | ||||||
| CHF3 | HFC-23 | 2 | 2 | 2 | HFC-23 | HFC-23 | HFC-23 | 75-46-7 | January 1 - June 30 | January | 2022 | Alabama | 2019-2020 | |||
| CH2F2 | HFC-32 | 3 | 3 | 3 | HFC-32 | HFC-32 | HFC-32 | 75-10-5 | July 1 - December 31 | February | 2023 | Alaska | 2020-2021 | |||
| CH3F | HFC-41 | 4 | 4 | 4 | HFC-41 | HFC-41 | HFC-41 | 593-53-3 | March | 2024 | American Samoa | 2021-2022 | ||||
| CF3CHFCHFCF2CF3 | HFC-43-10mee | 5 | 5 | 5 | HFC-43-10mee | HFC-43-10mee | HFC-43-10mee | 138495-42-8 | April | 2025 | Arizona | 2022-2023 | ||||
| CHF2CF3 | HFC-125 | 6 | 6 | 6 | HFC-125 | HFC-125 | HFC-125 | 354-33-6 | May | 2026 | Arkansas | 2023-2024 | ||||
| CHF2CHF2 | HFC-134 | 7 | 7 | 7 | HFC-134 | HFC-134 | HFC-134 | 359-35-3 | June | 2027 | California | 2024-2025 | ||||
| CH2FCF3 | HFC-134a | 8 | 8 | 8 | HFC-134a | HFC-134a | HFC-134a | 811-97-2 | July | 2028 | Colorado | 2025-2026 | ||||
| CH2FCHF2 | HFC-143 | 9 | 9 | 9 | HFC-143 | HFC-143 | HFC-143 | 430-66-0 | August | 2029 | Connecticut | 2026-2027 | ||||
| CH3CF3 | HFC-143a | 10 | 10 | 10 | HFC-143a | HFC-143a | HFC-143a | 420-46-2 | September | 2030 | Delaware | 2027-2028 | ||||
| CH2FCH2F | HFC-152 | 11 | 11 | 11 | HFC-152 | HFC-152 | HFC-152 | 624-72-6 | October | District of Columbia | 2028-2029 | |||||
| CH3CHF2 | HFC-152a | 12 | 12 | 12 | HFC-152a | HFC-152a | HFC-152a | 75-37-6 | November | Florida | 2029-2030 | |||||
| CF3CHFCF3 | HFC-227ea | 13 | 13 | 13 | HFC-227ea | HFC-227ea | HFC-227ea | 431-89-0 | December | Georgia | ||||||
| CH2FCF2CF3 | HFC-236cb | 14 | 14 | 14 | HFC-236cb | HFC-236cb | HFC-236cb | 677-56-5 | Guam | |||||||
| CHF2CHFCF3 | HFC-236ea | 15 | 15 | 15 | HFC-236ea | HFC-236ea | HFC-236ea | 431-63-0 | Hawaii | |||||||
| CF3CH2CF3 | HFC-236fa | 16 | 16 | 16 | HFC-236fa | HFC-236fa | HFC-236fa | 690-39-1 | Idaho | |||||||
| CH2FCF2CHF2 | HFC-245ca | 17 | 17 | 17 | HFC-245ca | HFC-245ca | HFC-245ca | 1814-88-6 | Illinois | |||||||
| CF3CH2CF3 | HFC-245fa | 18 | 18 | 18 | HFC-245fa | HFC-245fa | HFC-245fa | 460-73-1 | Indiana | |||||||
| CF3CH2CF2CH3 | HFC-365mfc | 19 | 19 | 19 | HFC-365mfc | HFC-365mfc | HFC-365mfc | 406-58-6 | Iowa | |||||||
| Kansas | ||||||||||||||||
| [Option 1] | Kentucky | |||||||||||||||
| Yes | Louisiana | |||||||||||||||
| No | Maine | |||||||||||||||
| Maryland | ||||||||||||||||
| Massachusetts | ||||||||||||||||
| Michigan | ||||||||||||||||
| Minnesota | ||||||||||||||||
| Mississippi | ||||||||||||||||
| Missouri | ||||||||||||||||
| Montana | ||||||||||||||||
| Nebraska | ||||||||||||||||
| Nevada | ||||||||||||||||
| New Hampshire | ||||||||||||||||
| New Jersey | ||||||||||||||||
| New Mexico | ||||||||||||||||
| New York | ||||||||||||||||
| North Carolina | ||||||||||||||||
| North Dakota | ||||||||||||||||
| Northern Mariana Islands | ||||||||||||||||
| Ohio | ||||||||||||||||
| Oklahoma | ||||||||||||||||
| Oregon | ||||||||||||||||
| Pennsylvania | ||||||||||||||||
| Pueto Rico | ||||||||||||||||
| Rhode Island | ||||||||||||||||
| South Carolina | ||||||||||||||||
| South Dakota | ||||||||||||||||
| Tennessee | ||||||||||||||||
| Texas | ||||||||||||||||
| Utah | ||||||||||||||||
| Vermont | ||||||||||||||||
| Virginia | ||||||||||||||||
| Washington | ||||||||||||||||
| West Virginia | ||||||||||||||||
| Wisconsin | ||||||||||||||||
| Wyoming | ||||||||||||||||
| U.S. Virgin Islands |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |