HFC Application-Specific Allowance Holder Biannual Reporting Form

Status: Original and derived artifacts are available for this document.

Download: xlsx | pdf | html

American Innovation and Manufacturing Act - HFC Application-Specific Allowanc
Worksheet Instructions:
Version:
r0.2
Updated:
12/14/2021
External Links:
Reporting Form Navigation:
Section 1 - Company Identification
Section 2 - Application-Specific Data
Section 3 - Allowance Conferral Data

Section 4 - Transition Plan
Section 7 - Quantiity Acquired in Previous Three Yea
Section 5 - Additional Application-Specific Allowances for Next Calendar Year
Section 6 - Contracting Information

EPA may request additional information or ask follow up questions to verify the accuracy of this submission and supp

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, directl
previous six months. Additionally, provide the quantity held in inventory on the last day of the previous six-month per
Acquired, Held in Inventory
1
2
4

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)

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
1
2
3
HFC
1
2
3
4
5

Company to Which
Allowances Were Conferred

Company Contact Name
§84.31(h)(1)(vi)

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control N
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it display
this collection of information is estimated to be 12 hours per response. Send comments on the Agency’s need for this informati
respondent burden including through the use of automated collection techniques to the Director, Regulatory Support Division, U
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

ion-Specific Allowance Holder Biannual Reporting Form

ty Acquired in Previous Three Years
es for Next Calendar Year

acy of this submission and supporting documentation, including pursuant to CAA section 114 as authorized under the AIM Act.

h conferring allowances, directly imported, or purchased without expending application-specific allowances (i.e., from the open market) du
ay of the previous six-month period, and the quantity destroyed or recycled during the previous six months.
Acquired, Held in Inventory, Destroyed or Recycled
5
7
8
Quantity Purchased for
Application-Specific Allowances
without Expending ApplicationSpecific Allowances
(kg)
§84.31(h)(1)(iii)

nces were conferred.
HFC Allowance Conferral Data
4
Company Contact Email
§84.31(h)(1)(vi)

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)

5
Company Contact Phone
§84.31(h)(1)(vi)

Quantity Destroyed
(kg)
§84.31(h)(1)(v)

6
Quantity of Allowances Conferred
(MTEVe)
§84.31(h)(1)(vi)

S.C. 3501 et seq. (OMB Control No. 2060-XXXX). Responses to this collection of information are mandatory (40 CFR 84.31).
on of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for
e Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing
tor, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington,
eted form to this address.

under the AIM Act.

(i.e., from the open market) during the

9

Quantity Recycled
(kg)
§84.31(h)(1)(v)

7
Quantity of HFC Received
(kg)
§84.31(h)(1)(vi)

American Innovation and Manufacturing Act - HFC Application-Spec
Worksheet Instructions:
Version:
r0.2
Updated:
12/14/2021
External Links:
Reporting Form Navigation:
Section 1 - Company Identification
Section 2 - Application-Specific Data
Section 3 - Allowance Conferral Data

Section 4 - Transition Plan
Section 5 - Additional Application-Specific Allowances for Next C
Section 6 - Contracting Information

Section 4 - Transition Plan

Provide a description of plans to transition application-specific use of regulated substances to reg
§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 circums

1
HFC

2
January

1
2
3
4

Instructions: Provide a detailed explanation, including relevant supporting documentation (e.g., ex
permits or other documentation to clarify when the new line or facility is opening, more recent sale
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 do
perform the servicing of onboard aerospace fire suppression, complete the following information f

Manufacturing/Servivin
1

2

Company Name
§84.31(h)(1)(ix)

Contact Name
§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
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
specific use in the previous three years. Provide a copy of the sales records, invoices, or other rec
not included in the sales records or invoices. §84.31(h)(2)(ii)
Year
Reporting Period
HFC

July 1 - December 31

ring Act - HFC Application-Specific Allowance Holder Biannual Reporting Form

nsition Plan
Section 7 - Quantiity Acquired in Previous Three Years
itional Application-Specific Allowances for Next Calendar Year
tracting Information

n-specific use of regulated substances to regulated substances with a lower exchange value or alternatives to regulat

c Allowances for Next Calendar Year

allowances due to one or more of the circumstances listed in 84.13(b)(1), provide a projection of the monthly quantity

Quantity Needed for Applica
§84.31(h)(1)
3
February

4
March

5
April

g relevant supporting documentation (e.g., explanation of amounts of products that must be delivered under new cont
ew line or facility is opening, more recent sales numbers to document growth in MDI sales resulting from a public heal

anufacturing of defense sprays or metered dose inhalers, or paying another person (whether it is in cash, credit, good
pression, complete the following information for the contact doing to manufacturing or servicing:
Manufacturing/Serviving Representative
3
4
Contact Email
§84.31(h)(1)(ix)

Contact Street Address
§84.31(h)(1)(ix)

5
Contract City
§84.31(h)(1)(ix)

s report apply to the company that is allocated application-specific allowances or the company receiving the contract f
s: §84.31(h)(1)(ix)

Three Years

equesting application-specific allowances for the first time, provide the total quantity of all regulated substances acqu
py of the sales records, invoices, or other records documenting that quantity. Make sure to specify the HFC weight pe
h)(2)(ii)
January 1 - June 30

July 1 - December 31
January 1 - June 30
Quantity Acquired (kg)

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

iannual Reporting Form

hange value or alternatives to regulated substances.

e a projection of the monthly quantity of additional regulated substances needed for application-specific uses by mont
Quantity Needed for Application-Specific Use (kg)
§84.31(h)(1)(viii)
6
May

7
June

hat must be delivered under new contracts, copies of
MDI sales resulting from a public health emergency) to

8
July

9
August

on (whether it is in cash, credit, goods, or services) to
ing or servicing:
6

7

Contact State
§84.31(h)(1)(ix)

Contact Zip
§84.31(h)(1)(ix)

the company receiving the contract for manufacturing

ntity of all regulated substances acquired for applicationake sure to specify the HFC weight per cylinder or unit if

July 1 - December 31

January 1 - June 30

ation-specific uses by month in the next calendar year.

10
September

11
October

12
November

13
December

14
Total

Chemical Name
CHF3
CH2F2
CH3F
CF3CHFCHFCF2CF3
CHF2CF3
CHF2CHF2
CH2FCF3
CH2FCHF2
CH3CF3
CH2FCH2F
CH3CHF2
CF3CHFCF3
CH2FCF2CF3
CHF2CHFCF3
CF3CH2CF3
CH2FCF2CHF2
CF3CH2CF3
CF3CH2CF2CH3
[Option 1]
Yes
No

[Common Name]
HFC-23
HFC-32
HFC-41
HFC-43-10mee
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

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

[Common_Name_1] [Common_Name_2] [Common_Name_5]
HFC-23
HFC-23
HFC-23
HFC-32
HFC-32
HFC-32
HFC-41
HFC-41
HFC-41
HFC-43-10mee
HFC-43-10mee
HFC-43-10mee
HFC-125
HFC-125
HFC-125
HFC-134
HFC-134
HFC-134
HFC-134a
HFC-134a
HFC-134a
HFC-143
HFC-143
HFC-143
HFC-143a
HFC-143a
HFC-143a
HFC-152
HFC-152
HFC-152
HFC-152a
HFC-152a
HFC-152a
HFC-227ea
HFC-227ea
HFC-227ea
HFC-236cb
HFC-236cb
HFC-236cb
HFC-236ea
HFC-236ea
HFC-236ea
HFC-236fa
HFC-236fa
HFC-236fa
HFC-245ca
HFC-245ca
HFC-245ca
HFC-245fa
HFC-245fa
HFC-245fa
HFC-365mfc
HFC-365mfc
HFC-365mfc

[CASRN]
75-46-7
75-10-5
593-53-3
138495-42-8
354-33-6
359-35-3
811-97-2
430-66-0
420-46-2
624-72-6
75-37-6
431-89-0
677-56-5
431-63-0
690-39-1
1814-88-6
460-73-1
406-58-6

[Period]
January 1 - June 30
July 1 - December 31

[Month]
January
February
March
April
May
June
July
August
September
October
November
December

[Year]
2022
2023
2024
2025
2026
2027
2028
2029
2030

[State]
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
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

[Reporting Period]
2019-2020
2020-2021
2021-2022
2022-2023
2023-2024
2024-2025
2025-2026
2026-2027
2027-2028
2028-2029
2029-2030