5900-543 HFC Reclaimer One-Time Reporting Form

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Overview

Reclamation Information
Lists

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Sheet 1: Reclamation Information

					OMB Control Number: 2060-XXXX
					Expiration Date: X/XX/202X
	American Innovation and Manufacturing Act - HFC Reclaimer One-Time Reporting Form
	Worksheet Instructions:
	Version:
	r0.2
	Updated:
	9/21/2021
	External Links:
	Reporting Form Navigation:
	Section 1 - Company Identification
	Section 2 - 2021 End of Year Inventory
	Section 3 - Laboratory Batch Testing 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:
	AIMRS Company ID:
	Section 2 - 2021 End-of-Year Inventory
	Instructions: Provide the quantity of each HFC held in inventory on December 31, 2021.
	End-of-Year Inventory
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	HFC	Quantity Recovered (kg) §84.31(i)(1)(i)	Quantity Reclaimed (kg) §84.31(i)(1)(i)	Quantity of Virgin Material (kg) §84.31(i)(1)(i)	Total Quantity of Inventory (kg) §84.31(i)(1)(i)
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	Section 3 - Laboratory Batch Testing Information
	Instructions: Provide the following information on laboratory batch testing conducted during the prior year. For each laboratory identified, provide a signed statement from the laboratory confirming there is an ongoing business relationship with your company. Provide additional supporting documentation, as needed, to respond to these reporting requirements.
	Batch Testing
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	Laboratory Name §84.31(i)(1)(ii)	Number of Batches Tested in Prior Year §84.31(i)(1)(iii)	Number of Batches that Did Not Meet the Specifications in Appendix A to 40 CFR part 82, Subpart F in the Prior Year §84.31(i)(1)(iv)
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	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 40 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 # 5900-543

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Sheet 2: Lists

Chemical Name			[Common_Name_1]
CHF3	HFC-23	2	HFC-23
CH2F2	HFC-32	3	HFC-32
CH3F	HFC-41	4	HFC-41
CF3CHFCHFCF2CF3	HFC-43-10mee	5	HFC-43-10mee
CHF2CF3	HFC-125	6	HFC-125
CHF2CHF2	HFC-134	7	HFC-134
CH2FCF3	HFC-134a	8	HFC-134a
CH2FCHF2	HFC-143	9	HFC-143
CH3CF3	HFC-143a	10	HFC-143a
CH2FCH2F	HFC-152	11	HFC-152
CH3CHF2	HFC-152a	12	HFC-152a
CF3CHFCF3	HFC-227ea	13	HFC-227ea
CH2FCF2CF3	HFC-236cb	14	HFC-236cb
CHF2CHFCF3	HFC-236ea	15	HFC-236ea
CF3CH2CF3	HFC-236fa	16	HFC-236fa
CH2FCF2CHF2	HFC-245ca	17	HFC-245ca
CF3CH2CF3	HFC-245fa	18	HFC-245fa
CF3CH2CF2CH3	HFC-365mfc	19	HFC-365mfc