2022 Draft F6627

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Form

6627

(Rev. June 2022)
Department of the Treasury
Internal Revenue Service
Name (as shown on Form 720)

Part I
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2
3
4
5
6

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8
9
10
11
12
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17
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19
20
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22
23
43

Go to www.irs.gov/Form6627 for instructions and the latest information.
Employer identification number (EIN)

Quarter ending
(a)
Barrels

(b)
Rate

DRAFT AS OF
March 25, 2022
DO NOT FILE

Tax on Petroleum

(c)
Tax

$ .09 bbl $
$ .09 bbl $
$

Imported petroleum products oil spill tax. Enter the number of barrels
imported in column (a). Multiply column (a) by column (b) and enter the
amount of tax in column (c). Also enter the amount on Form 720 on the
line for IRS No. 21 . . . . . . . . . . . . . . . . . . .

$ .09 bbl $

Tax on Chemicals (Other Than Ozone-Depleting Chemicals (ODCs)), IRS No. 54

Chemical
(General formula
or symbol)

5
6

OMB No. 1545-0023

Attach to Form 720.

Crude oil received at a U.S. refinery . . . . . . . . . . . . .
Crude oil taxed before receipt at refinery . . . . . . . . . . .
Taxable crude oil. Subtract line 2 from line 1. Multiply column (a) by column
(b) and enter the amount of tax in column (c) . . . . . . . . . .
Crude oil used in or exported from the U.S. before the tax was imposed.
Multiply column (a) by column (b) and enter the amount of tax in column (c)
Total domestic petroleum oil spill tax. Add lines 3 and 4, column (c). Enter
the total here and on Form 720 on the line for IRS No. 18 . . . . . .

Part II

1
2
3
4

Environmental Taxes

Acetylene (C2H2)
Ammonia (NH3) .
Antimony (Sb) .
Antimony trioxide
(Sb2O3)
. . .
Arsenic (As) . .
Arsenic trioxide
(As2O3) . . . .
Barium sulfide
(BaS) . . . .
Benzene (C6H6) .
Bromine (Br) . .
Butadiene (C4H6)
Butane (C4H10) .
Butylene (C4H8) .
Cadmium (Cd) .
Chlorine (Cl) . .
Chromite (FeCr2O4)
Chromium (Cr) .
Cobalt (Co) . .
Cupric oxide (CuO)
Cupric sulfate
(CuSO4) . . .
Cuprous oxide
(Cu2O) . . . .
Ethylene (C2H4) .
Hydrochloric acid
(HCI) . . . .
Hydrogen fluoride
(HF) . . . . .

(a) Tons

(b) Rate

$9.74
5.28
8.90
7.50
8.90
6.82
4.60
9.74
8.90
9.74
9.74
9.74
8.90
5.40
3.04
8.90
8.90
7.18
3.74
7.94
9.74
0.58
8.46

(c) Tax
(multiply column (a)
by column (b))

Chemical
(General formula
or symbol)

24
25
26
27
28
29
30
31

(a) Tons

Lead oxide (PbO)
Mercury (Hg) . .
Methane (CH4) .
Naphthalene
(C10H8) . . . .
Nickel (Ni) . . .
Nitric acid (HNO3)
Phosphorus (P) .
Potassium
dichromate
(K2Cr2O7) . . .

$8.28
8.90
6.88
9.74
8.90
0.48
8.90

3.38

32 Potassium
hydroxide (KOH) .
33 Propylene (C3H6) .
34 Sodium dichromate
(NaCr2O7) . . .
35 Sodium hydroxide
(NaOH) . . . .
36 Stannic chloride
(SnCl4) . . . .
37 Stannous chloride
(SnCl2) . . . .
38 Sulfuric acid
(H2SO4) . . . .
39 Toluene (C7H8) .
40 Xylene (C8H10) .
41 Zinc chloride
(ZnCl2) . . . .
42 Zinc sulfate
(ZnSO4) . . . .

0.44
9.74
3.74
0.56
4.24
5.70
0.52
9.74
9.74
4.44
3.80

Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line for IRS No. 54

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 720.

(c) Tax
(multiply column (a)
by column (b))

(b) Rate

Cat. No. 43490I

$
Form 6627 (Rev. 6-2022)

Page 2

Form 6627 (Rev. 6-2022)

Part III

Tax on Imported Chemical Substances, IRS No. 17
(a) Imported chemical
substance

1
2
3
4

(b) Tons

(c) Taxable chemical
used in manufacture
of substance

(d) Conversion factor or
entry value

(f) Tax
(see instructions)

(e) Rate

DRAFT AS OF
March 25, 2022
DO NOT FILE

Total Imported Chemical Substances Tax. Add all amounts in column (f). Enter here and on Form 720
on the line for IRS No. 17 . . . . . . . . . . . . . . . . . . . . . . . . .
$

Part IV

Tax on Ozone-Depleting Chemicals (ODCs), IRS No. 98

Elections. If you elect to report the tax on post-1989 ODCs at the time you sell or use a mixture containing such chemicals
instead of when you make the mixture, check this box (the 1990 election) . . . . . . . . . . . . . . . . . .
If you elect to report the tax on post-1990 ODCs at the time you sell or use a mixture containing such chemicals instead of when
you make the mixture, check this box (the 1991 election) . . . . . . . . . . . . . . . . . . . . . . . .
(b) Number
of pounds

(a) ODC

1

(d) Tax
(multiply column (b)
by column (c))

(c) Tax per pound
(see Part IV instructions)

2
3
4

Total ozone-depleting chemicals tax. Add all amounts in column (d), include amounts from any additional
sheets. Enter the total here and on Form 720 on the line for IRS No. 98 . . . . . . . . . . .
$

Part V

ODC Tax on Imported Products, IRS No. 19

Election. If you elect to report the tax on imported products at the time you import the products instead of when you sell or use
the products, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(a) Imported product and
the applicable ODC

(b) Number
of products

(c) ODC weight
of product

(d) Tax
per pound

(e) Entry value

(f) Tax
(see Part V instructions)

1
2
3
4

Total ODC tax on imported products. Add all amounts in column (f), include amounts from any additional
sheets. Enter the total here and on Form 720 on the line for IRS No. 19 . . . . . . . . . . .
$

Part VI

Tax on Floor Stocks of ODCs, IRS No. 20
(a) ODC

(b) Number
of pounds

(d) Tax
(multiply column (b)
by column (c))

(c) Tax per pound
(see Part VI instructions)

1
2
3
4

Total floor stocks tax. Add all amounts in column (d), include amounts from any additional sheets.
Enter the total here and on Form 720 on the line for IRS No. 20 . . . . . . . . . . . . .
$
Form 6627 (Rev. 6-2022)