5900-547 American Innovation and Manufacturing Act - HFC Importer

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Overview

Quarterly Information
Shipments and Sales
Import Summary

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Sheet 1: Quarterly Information

					OMB Control Number: 2060-0734
					Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Importer Quarterly Report
	Worksheet Instructions:
	Complete and submit an HFC Importer Quarterly Report if your company imports HFCs. Section 1 must be completed prior to submission. Section 2 must be completed if your company imported HFCs during the reporting quarter; if no HFCs were imported during the quarter, Section 2 may be left blank. Section 3 must be completed if imported material was shipped off-site during the quarter for second party transformation or second party destruction. Section 4 must be completed if orders were placed or material was imported for application-specific allowance holders. Section 5 is automatically populated based on data entered in Section 2. Section 6 must be completed if your company is reporting quarter 4 activity.
	Version:
	Updated:
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 4 - Application-Specific Allowance Holder Information
	Section 2 - Import Information	Section 5 - Quarterly Import Summary
	Section 3 - Recipient Facility Information	Section 6 - End-of-Year Inventory
	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:
	Company ID:
	Reporting Year:
	Reporting Quarter:
	Were HFCs imported during the reporting period?
	Were any imported HFCs shipped off-site during the reporting period to a second party for transformation or destruction?
	Were any orders placed from application-specific allowance holders, were any application-specific allowances conferred, or were HFCs imported for application-specific end-uses?
	Section 2 - Import Information
	Instructions: Enter data for each HFC import transaction that took place during the reporting period. If no HFCs were imported, the table may be left blank. If HFCs were imported for second party transformation or second party destruction, a copy of the transformation verifications showing that the purchaser or recipient of imported regulated substances intends to transform those substances or destruction verifications showing that the purchaser or recipient intends to destroy the regulated substances. Additionally provide records required under §82.25(b)(5) and §84.31(c)(2)(xvii) documenting proof that used material imported for destruction was destroyed and documenting proof that allowances were expended, respectively.
	Import Information
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	Transaction Number	Date of Import / Date Allowances were Expended §84.31(c)(2)(v); §84.31(c)(1)(vii)	U.S. Customs Entry Number §84.31(c)(2)(xiii)	Is the Imported Substance a Blend? §84.31(c)(2)(i)	HTS Code §84.31(c)(1)(iii)	Shipment Importer Number §84.31(c)(2)(x)	HFC or HFC Blend Imported §84.31(c)(2)(i)	Quantity of HFC or HFC Blend Imported (kg) §84.31(c)(2)(i)	Blend Information §84.31(c)(2)(i)						Port of Entry §84.31(c)(2)(vi)	Source Country §84.31(c)(2)(vii)	Transaction Type §84.31(c)(2)(ii)	Intended Use §84.31(c)(2)(iii) §84.31(c)(2)(iv)
									HFC Imported (1)	HFC Composition of Blend (1) (%)	HFC Imported (2)	HFC Composition of Blend (2) (%)	HFC Imported (3)	HFC Composition of Blend (3) (%)
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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. 2060-0734). 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 16 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 # 5900-547

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Sheet 2: Shipments and Sales

				OMB Control Number: 2060-0734
				Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Importer Quarterly Report
	Worksheet Instructions:
	Complete and submit an HFC Importer Quarterly Report if your company imports HFCs. Section 1 must be completed prior to submission. Section 2 must be completed if your company imported HFCs during the reporting quarter; if no HFCs were imported during the quarter, Section 2 may be left blank. Section 3 must be completed if imported material was shipped off-site during the quarter for second party transformation or second party destruction. Section 4 must be completed if orders were placed or material was imported for application-specific allowance holders. Section 5 is automatically populated based on data entered in Section 2. Section 6 must be completed if your company is reporting quarter 4 activity.
	Version:
	0
	Updated:
	12/30/1899
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 4 - Application-Specific Allowance Holder Information
	Section 2 - Import Information	Section 5 - Quarterly Import Summary
	Section 3 - Recipient Facility Information	Section 6 - End-of-Year Inventory
	Section 3 - Recipient Facility Information
	Instructions: Provide the quantity of HFCs sold or transferred during the quarter to a person for use in processes resulting in their transformation or destruction. For each recipient listed, provide a copy of the transformation verifications showing that the purchaser or recipient of imported regulated substances intends to transform those substances or destruction verifications showing that the purchaser or recipient intends to destroy the regulated substances. §84.31(c)(1)(vii)
	Off-site Transformation or Destruction
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	HFC	Recipient Facility Name §84.31(c)(1)(vi)	Quantity (kg) §84.31(c)(1)(vi)	Purpose
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	Section 4 - Application-Specific Allowance Holder Information
	Instructions: Identify the application-specific allowance holders from whom orders were placed, the number of application-specific allowances conferred, and the quantity of specific HFCs imported for those listed applications during the quarter.
	Application-Specific Allowance Holder Information
	1	2	3	4
	HFC	Application-Specific Allowance Holder From Whom Orders Were Placed §84.31(c)(1)(iv)	Quantity Conferred (MTEVe) §84.31(c)(1)(iv)	Quantity Imported (kg) §84.31(c)(1)(iv)
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Sheet 3: Import Summary

					OMB Control Number: 2060-0734
					Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Importer Quarterly Report
	Worksheet Instructions:
	Complete and submit an HFC Importer Quarterly Report if your company imports HFCs. Section 1 must be completed prior to submission. Section 2 must be completed if your company imported HFCs during the reporting quarter; if no HFCs were imported during the quarter, Section 2 may be left blank. Section 3 must be completed if imported material was shipped off-site during the quarter for second party transformation or second party destruction. Section 4 must be completed if orders were placed or material was imported for application-specific allowance holders. Section 5 is automatically populated based on data entered in Section 2. Section 6 must be completed if your company is reporting quarter 4 activity.
	Version:
	r0.1
	Updated:
	12/30/1899
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 4 - Application-Specific Allowance Holder Information
	Section 2 - Import Information	Section 5 - Quarterly Import Summary
	Section 3 - Recipient Facility Information	Section 6 - End-of-Year Inventory
	Section 5 - Quarterly Import Summary
	Instructions: The values in the table below are calculated based on data entered in Section 2. If the totals appear to be incorrect, please return to Section 2 to review your data.
	Quarterly Import Summary
	1	2	3	4	5	6	7	8	9	10	11
	HFC Imported	Gross Imports (kg)	Application-Specific End-Uses (kg)	In-House Transformation (kg)	Second-Party Transformation (kg)	In-House Destruction (kg)	Second-Party Destruction (kg)	Transhipped (kg)	Net Imports (kg)	Amount of Consumption Allowances Expended (MTEVe)	Amount of Application-Specific Allowances Expended (MTEVe)
1	HFC-23	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
2	HFC-32	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
3	HFC-41	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
4	HFC-43-10mee	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
5	HFC-125	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
6	HFC-134	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
7	HFC-134a	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
8	HFC-143	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
9	HFC-143a	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
10	HFC-152	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
11	HFC-152a	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
12	HFC-227ea	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
13	HFC-236cb	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
14	HFC-236ea	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
15	HFC-236fa	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
16	HFC-245ca	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
17	HFC-245fa	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0
18	HFC-365mfc	0.00	0.00	0.00	0.00	0.00	0.00		0.00	0.0	0.0