5900-535 Payment of Antidumping and Countervailing Duties

Initial Reporting of the Hydrofluorocarbon Allowance Allocation and Trading Program

HFC ADCVD One-Time Reporting Form v0.2.xlsx

OMB: 2060-0735

Document [xlsx]
Download: xlsx | pdf

Overview

Company Idenfification
ADCVD Documentation
Lists


Sheet 1: Company Idenfification








OMB Control Number: 2060-XXXX







Expiration Date: X/XX/202X









American Innovation and Manufacturing Act - Payment of Antidumping and Countervailing Duties














Worksheet Instructions:

Submit this cover sheet along with any supporting documentation to EPA through the ODS Tracking System (ODSTS). Instructions on how to report data through the ODSTS are available at <https://www.epa.gov/ods-phaseout/submitting-other-documents-epa>. Select "AD/CVD Documentation" as the document type when submitting your documentation.



Version:

r0.2






Updated:

10/20/2021






Reporting Form Navigation:

Section 1 - Company Identification






Section 2 - Import Summary






Section 3 - Duties Paid Summary






Section 4 - Antidumping and Countervailing Duties Documentation














Section 1 - Company Identification






Instructions: Complete the following company information.






1 2 3 4 5 6 7

Company Name Contact Name Contact Phone Contact Email City State/U.S. Territory Zip

















Importer Number:














Section 2 - Import Summary






Instructions: List all HFCs and HTS codes as reported to Customs that were imported by your company in each year from January 1, 2017, through May 19, 2021.

HFCs Imported


2017 2018 2019 2020 2021
(through May 19)





1






2






3






4






5






6






7






8






9






10






11






12






13






14






15






16






17






18















HTS Codes Reported to Customs


2017 2018 2019 2020 2021
(through May 19)





1






2






3






4






5






6






7






8






9






10















Instructions: Identify the foreign exporter(s) from which HFCs were imported in each year from January 1, 2017, through May 19, 2021.

Foreign Exporter


2017 2018 2019 2020 2021
(through May 19)








































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 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 # 5900-535






Sheet 2: ADCVD Documentation







OMB Control Number: 2060-XXXX








Expiration Date: X/XX/202X












American Innovation and Manufacturing Act - Payment of Antidumping and Countervailing Duties


















Worksheet Instructions:


Submit this cover sheet along with any supporting documentation to EPA through the ODS Tracking System (ODSTS). Instructions on how to report data through the ODSTS are available at <https://www.epa.gov/ods-phaseout/submitting-other-documents-epa>. Select "AD/CVD Documentation" as the document type when submitting your documentation.








Version:


r0.2








Updated:


10/20/2021








Reporting Form Navigation:


Section 1 - Company Identification








Section 2 - Import Summary








Section 3 - Duties Paid Summary








Section 4 - Antidumping and Countervailing Duties Documentation


















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 3 - Duties Paid Summary








Instructions: Identify the total amount of duties paid for imports in each year from January 1, 2017, through May 19, 2021.
Total or Estimated Amount of Duties Paid for Imports in Each Year (USD)




2017 2018 2019 2020 2021
(through May 19)






























Instructions: Provide an explanation if no duties were owed.
Explanation if No Duties were Owed




2017 2018 2019 2020 2021
(through May 19)




























































Section 4 - Antidumping and Countervailing Duties Documentation








Instructions: Provide documentation of cash deposit of and final payment of antidumping and countervailing duties for the regulated substances imported from January 1, 2017, through May 19, 2021, or evidence that those imports were not subject to such duties for those years. (§84.31(c)(8)) Documentation may include entry numbers, dates of entry, AD/CVD case number and AD/CVD cash deposit amount and if liquidated, final AD/CVD duty amount for each entry.










Describe the documentation provided to EPA:











Should the documentation provided be treated as confidential business information (CBI)?






Sheet 3: Lists

Chemical Name [Common Name]
[State]
[Option 1]
CHF3 HFC-23
Alabama
Yes
CH2F2 HFC-32
Alaska
No
CH3F HFC-41
American Samoa

CF3CHFCHFCF2CF3 HFC-43-10mee
Arizona

CHF2CF3 HFC-125
Arkansas

CHF2CHF2 HFC-134
California

CH2FCF3 HFC-134a
Colorado

CH2FCHF2 HFC-143
Connecticut

CH3CF3 HFC-143a
Delaware

CH2FCH2F HFC-152
District of Columbia

CH3CHF2 HFC-152a
Florida

CF3CHFCF3 HFC-227ea
Georgia

CH2FCF2CF3 HFC-236cb
Guam

CHF2CHFCF3 HFC-236ea
Hawaii

CF3CH2CF3 HFC-236fa
Idaho

CH2FCF2CHF2 HFC-245ca
Illinois

CF3CH2CF3 HFC-245fa
Indiana

CF3CH2CF2CH3 HFC-365mfc
Iowa




Kansas




Kentucky




Louisiana




Maine




Marshall Islands




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




Palau




Puerto Rico




Rhode Island




South Carolina




South Dakota




Tennessee




Texas




Utah




Vermont




Virginia




Washington




West Virginia




Wisconsin




Wyoming




U.S. Virgin Islands

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