5900-536 Petition to Import for Transformation or Destruction

---

Overview

Importer Information
Shipment Information
T&D Facility Information

---

Sheet 1: Importer Information

			OMB Control Number: 2060-0735
			Expiration Date: 4/30/2022
American Innovation and Manufacturing Act - Petition to Import for Transformation or Destruction
Worksheet Instructions:
If your company intends to import HFCs for use in a process resulting in transformation or destruction, complete this reporting form and submit it to EPA through EPA's electronic Greenhouse Gas Reporting Tool (e-GGRT) at least 30 days before the shipment is to arrive at a U.S. port. Sections 1-3 and 5 must be completed prior to submission. Section 4 must also be completed if your company intends to have an intermediary company hold the imported HFCs prior to their destruction or transformation; if not, Section 4 may be left blank. 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.
Version:
r0.10
Updated:
12/13/2021
External Links:
HFC Allocation Rule Reporting HelpDesk		AIM Act Paperwork Reduction Act Burden
Reporting Form Navigation:
Section 1 - Company Information	Section 4 - Transformation and Destruction Intermediary Information
Section 2 - Import Information	Section 5 - Transformation and Destruction Facility Information
Section 3 - Shipment Information
Section 1 - Company Information
Instructions: Complete the following company information.
Company Name:
Company ID:
Importer Number:
Form Alias:
Section 2 - Import Information
Instructions: Provide the following information for the shipment you are petitioning to import. As part of your submission, additionally provide an English translation of the export license, application for an export license, or official communication acknowledging the export from the appropriate government agency in the country of export (§84.25(a)(1)(viii)).
Import Information
1	2	3	4	5	6
Vessel Name §84.25(a)(1)(v)	Expected Year of Import §84.25(a)(1)(v)	Expected Month of Import §84.25(a)(1)(v)	Intended Port of Entry §84.25(a)(1)(v)	Source Country §84.25(a)(1)(iv)	Intended Use
Should the export license, application for an export license, or official communication acknowledging the export from the appropriate government agency in the country of export be treated as confidential business information (CBI)?
Consignee Information
1	2	3	4	5	6	7	8	9
Company Name §84.25(a)(1)(iii)	Contact Name §84.25(a)(1)(iii)	Contact Phone §84.25(a)(1)(iii)	Contact Email §84.25(a)(1)(iii)	Street Address §84.25(a)(1)(iii)	City §84.25(a)(1)(iii)	State/U.S. Territory §84.25(a)(1)(iii)	Zip §84.25(a)(1)(iii)	Country §84.25(a)(1)(iii)
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0735). Responses to this collection of information are mandatory (40 CFR 84.25). 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 2 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 # 5900-536

---

Sheet 2: Shipment Information

					OMB Control Number: 2060-0735
					Expiration Date: 4/30/2022
	American Innovation and Manufacturing Act - Petition to Import for Transformation or Destruction
	Worksheet Instructions:
	If your company intends to import HFCs for use in a process resulting in transformation or destruction, complete this reporting form and submit it to EPA through EPA's electronic Greenhouse Gas Reporting Tool (e-GGRT) at least 30 days before the shipment is to arrive at a U.S. port. Sections 1-3 and 5 must be completed prior to submission. Section 4 must also be completed if your company intends to have an intermediary company hold the imported HFCs prior to their destruction or transformation; if not, Section 4 may be left blank. 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.
	Version:
	r0.10
	Updated:
	12/13/2021
	External Links:
	HFC Allocation Rule Reporting HelpDesk		AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Information	Section 4 - Transformation and Destruction Intermediary Information
	Section 2 - Import Information	Section 5 - Transformation and Destruction Facility Information
	Section 3 - Shipment Information
	Section 3 - Shipment Information
	Instructions: Provide the following information for each shipment you are petitioning to import. If a container contains more than one regulated substance, identify the type and quantity of each HFC in a separate row. If the shipment includes more than one container, enter the amount of each HFC contained in each container in a separate row.
	Shipment Information
	1	2	3	4	5	6
	Unique Identification Number of Container §84.25(a)(1)(x)	Container Capacity (kg) §84.25(a)(1)(ix)	U.S. Customs Entry Number	HFC to be Imported §84.25(a)(1)(i)	HTS Code §84.25(a)(1)(i)	Quantity Imported (kg) §84.25(a)(1)(i)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

---

Sheet 3: T&D Facility Information

					OMB Control Number: 2060-0735
					Expiration Date: 4/30/2022
	American Innovation and Manufacturing Act - Petition to Import for Transformation or Destruction
	Worksheet Instructions:
	If your company intends to import HFCs for use in a process resulting in transformation or destruction, complete this reporting form and submit it to EPA through EPA's electronic Greenhouse Gas Reporting Tool (e-GGRT) at least 30 days before the shipment is to arrive at a U.S. port. Sections 1-3 and 5 must be completed prior to submission. Section 4 must also be completed if your company intends to have an intermediary company hold the imported HFCs prior to their destruction or transformation; if not, Section 4 may be left blank. 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.
	Version:
	r0.10
	Updated:
	12/13/2021
	External Links:
	HFC Allocation Rule Reporting HelpDesk		AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Information	Section 4 - Transformation and Destruction Intermediary Information
	Section 2 - Import Information	Section 5 - Transformation and Destruction Facility Information
	Section 3 - Shipment Information
	Section 4 - Transformation and Destruction Intermediary Information
	Instructions: Provide the following information for each intermediary who will hold the material before the HFCs are transformed or destroyed, if applicable. If there is no intermediary, the table may be left blank
	Intermediary Information
	1	2	3	4	5	6	7	8	9
	Company Name §84.25(a)(1)(vi)	Contact Name §84.25(a)(1)(vi)	Contact Phone §84.25(a)(1)(vi)	Contact Email §84.25(a)(1)(vi)	Street Address §84.25(a)(1)(vi)	City §84.25(a)(1)(vi)	State/U.S. Territory §84.25(a)(1)(vi)	Zip §84.25(a)(1)(vi)	Country §84.25(a)(1)(vi)
1
2
3
4
	Should the intermediary information be treated as confidential business information (CBI)?
	Section 5 - Transformation and Destruction Facility Information
	Instructions: Provide the following information for each facility where the imported HFCs will be transformed or destroyed. These may be facilities owned or operated by the importer, or facilities owned and operated by other persons.
	T&D Facility Information
	1	2	3	4	5	6	7	8	9
	Company Name §84.25(a)(1)(vii)	Contact Name §84.25(a)(1)(vii)	Contact Phone §84.25(a)(1)(vii)	Contact Email §84.25(a)(1)(vii)	Facility Street Address §84.25(a)(1)(vii)	Facility City §84.25(a)(1)(vii)	Facility State/U.S. Territory §84.25(a)(1)(vii)	Facility Zip §84.25(a)(1)(vii)	Facility Country §84.25(a)(1)(vii)
1
2
3
4