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Form

6627

(Rev. January 2023)
Department of the Treasury
Internal Revenue Service
Name (as shown on Form 720)

Part I

Environmental Taxes
OMB No. 1545-0023

Attach to Form 720.
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 16, 2023
DO NOT FILE

Tax on Petroleum

1 Crude oil received at a U.S. refinery . . . . . . . . . . . .
2 Crude oil taxed before receipt at refinery . . . . . . . . . .
3 Taxable crude oil. Subtract line 2 from line 1. Enter the result on both
lines 3(a) and 3(b), column (a). Enter in column (c) the amount of tax by
multiplying column (a) by column (b) for both lines.
(a)

(b)
4 Crude oil used in the U.S. before the tax was imposed. Multiply column
(a) by column (b) and enter the amount of tax in column (c). Enter on both
lines 4(a) and 4(b), column (a). Enter in column (c) the amount of tax by
multiplying column (a) by column (b) for both lines.
(a)
(b)
5 Total domestic petroleum superfund tax (add lines 3(a) and 4(a), column
(c)). Enter here and on Form 720 on the line for IRS No. 53 . . . .
6 Total domestic petroleum oil spill tax. Add lines 3(b) and 4(b), column (c).
Enter the total here and on Form 720 on the line for IRS No. 18 . . .

$ .164 bbl $
$ .09 bbl $

$ .164 bbl $
$ .09 bbl $
$
$

7 Imported petroleum products superfund tax. Enter the number of barrels
imported in column (a). (Must agree with line 8, column (a).) Enter in
column (c) the amount of tax by multiplying column (a) by column (b), and
also enter it on Form 720 on the line for IRS No. 16 . . . . . . .

$ .164 bbl $

8 Imported petroleum products oil spill tax. Enter the number of barrels
imported in column (a). (Must agree with line 7, 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 $

Part II

(c)
Tax

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

Chemical
(general formula
or symbol)

(a) Tons

(b) Rate

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

Chemical
(general formula
or symbol)

(a) Tons

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

(b) Rate

1
2
3
4

Acetylene (C2H2)
24 Lead oxide (PbO)
$9.74
$8.28
Ammonia (NH3) .
25 Mercury (Hg) . .
5.28
8.90
Antimony (Sb) .
26 Methane (CH4) .
8.90
6.88
27 Naphthalene (C10H8)
9.74
Antimony trioxide
(Sb2O3)
. . .
28 Nickel (Ni) . . .
8.90
7.50
29 Nitric acid (HNO3)
5 Arsenic (As) . .
0.48
8.90
30 Phosphorus (P) .
8.90
6 Arsenic trioxide
31 Potassium
(As2O3) . . . .
6.82
dichromate (K2Cr2O7)
7 Barium sulfide (BaS)
3.38
4.60
8 Benzene (C6H6) .
9.74
32 Potassium
hydroxide (KOH) .
9 Bromine (Br) . .
8.90
0.44
33 Propylene (C3H6) .
10 Butadiene (C4H6)
9.74
9.74
11 Butane (C4H10) .
9.74
34 Sodium dichromate
(NaCr2O7) . . .
12 Butylene (C4H8) .
9.74
3.74
13 Cadmium (Cd) .
8.90
35 Sodium hydroxide
(NaOH) . . . .
14 Chlorine (Cl) . .
5.40
0.56
15 Chromite (FeCr2O4)
3.04
36 Stannic chloride
(SnCl4) . . . .
16 Chromium (Cr) .
8.90
4.24
17 Cobalt (Co) . .
8.90
37 Stannous chloride
(SnCl2) . . . .
18 Cupric oxide (CuO)
7.18
5.70
19 Cupric sulfate (CuSO4)
38 Sulfuric acid (H2SO4)
3.74
0.52
20 Cuprous oxide (Cu2O)
39 Toluene (C7H8) .
7.94
9.74
21 Ethylene (C2H4) .
40 Xylene (C8H10) .
9.74
9.74
22 Hydrochloric acid (HCI)
41 Zinc chloride (ZnCl2)
0.58
4.44
23 Hydrogen fluoride (HF)
42 Zinc sulfate (ZnSO4)
8.46
3.80
43
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.

Cat. No. 43490I

Form 6627 (Rev. 1-2023)

Page 2

Form 6627 (Rev. 1-2023)

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 16, 2023
DO NOT FILE

Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any
additional sheets. 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. 1-2023)