HFC Importer of Record Report

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American Innovation and Manufacturing Act - HFC Importer of Record Report
Worksheet Instructions:
Submit this cover sheet along with any supporting documentation to EPA through the ODS Tracking System (ODSTS). Instructions
Version:
1.1
Updated:
11/18/2021
Reporting Form Navigation:
Section 1 - Company Identification
Section 2 - Plan for importing HFCs

EPA may request additional information or ask follow up questions to verify the accuracy of this submission and supporti
section 114 as authorized under the AIM Act.

Section 1 - Company Identification

Instructions: Complete the following company information for each importer of record under common control or that is a s
provide the Importer of Record Name and Number for each company that intends to import using your company's allowan
Allowance Holder Name:
Reporting Year:
Importer 1

Importer 2

Importer 3

Importer of Record - Name:
Importer of Record - Number:

Section 2 - Plan for Importing HFCs
Instructions: Identify the single component HFC(s) your company commonly imports and expects to
import in the coming year and the CAS number for each.
Intended HFC Imports
HFC
CAS Number

Instructions: Identify the HFC blends your company commonly imports and expects to import in the coming year, and the
substance and the CAS numbers for each neat HFC.
Intended HFC Ble
HFC Component (1)
HFC Blend
HFC Composition of
HFC
CAS Number
Blend (%)

Instructions: Identify the HTS codes for the HFCs and HFC blends your company commonly imports
and expects to import in the coming year.
HTS Codes

Instructions: Identify the types of cylinders commonly used to import HFCs and HFC blends.
Cylinder Information
Description

Typical Range of Mass (kg) Contained in
Each Cylinder

Instructions: Identify the ports of entry through which your company expects to import HFCs and
HFC blends in the coming year.
Commonly used Ports of Entry

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2
information are voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of inform
control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 2 hours per resp
this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden inclu
techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., N
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
information are voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of inform
control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 2 hours per resp
this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden inclu
techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., N
control number in any correspondence. Do not send the completed form to this address.
EPA Form # 5900-556

OMB Control Number: 2060-0735
Expiration Date: 4/30/2022

f Record Report

ng System (ODSTS). Instructions on how to report data through the ODSTS are available at <https://www.epa.gov/ods-phaseout/submitting-other-doc

of this submission and supporting documentation, including pursuant to CAA

der common control or that is a subsidiary of the allowance holder. Please
t using your company's allowances.

Importer 4

Importer 5

port in the coming year, and the ASHRAE numerical designation of the refrigerant or the percentage of the mixture containing each regulat
Intended HFC Blend Imports
HFC Component (2)
HFC Composition of
HFC
Blend (%)

CAS Number

HFC

HFC Component (3)
HFC Composition of
Blend (%)

. 3501 et seq. (OMB Control No. 2060-0735). Responses to this collection of
o respond to, a collection of information unless it displays a currently valid OMB
s estimated to be 2 hours per response. Send comments on the Agency’s need for
minimizing respondent burden including through the use of automated collection
2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB

e containing each regulated

ponent (3)
CAS Number