5900-545 American Innovation and Manufacturing Act - HFC Request

---

Overview

Export Information
Export Summary

---

Sheet 1: Export Information

						OMB Control Number: 2060-0734
						Expiration Date: XX/XX/202X
	American Innovation and Manufacturing Act - HFC Request for Additional Consumption Allowances Report
	Worksheet Instructions:
	Complete and submit an HFC Request for Additional Consumption Allowances Report if your company is requesting additional consumption allowances following the export of HFCs. Additional consumption allowances may only be requested for exports that have occurred during the current calendar year. All refunded allowances must also be expended in the same calendar year. Section 1 and Section 2 of the report must be completed prior to submission. Section 4 is automatically populated based on data entered in Section 3.
	Version:
	Updated:
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 3 - Export Information
	Section 2 - Allowance Recipient Identification	Section 4 - Summary of Additional Consumption Allowances Requested
	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:
	Employer Identification Number (EIN):
	Should the information provided in columns 26-28 in the table below (i.e., source of the regulated substance) be treated as confidential business information (CBI)?
	Section 2 - Allowance Recipient Identification
	Instructions: Identify the person to whom the consumption allowances will be granted, whether the producer, the importer, or the exporter. §84.17(b)(1)(ii)
	Allowance Recipient Company Name:
	Allowance Recipient Company ID:
	Section 3 - Export Information
	Instructions: Enter data for each export transaction containing an HFC for which you are requesting additional consumption allowances. For each transaction, provide a copy of the bill of lading and the invoice indicating the net quantity (in kilograms) of HFC shipped and documenting the sale of the HFC to the purchaser. Additionally provide a written statement from the producer or importer certifying that the HFCs were produced or imported by expending allowances. §84.17(a)(1)(viii)
	HFC Export Information
	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21a	21b	22
	Transaction Number	Date of Export §84.17(a)(1)(vi)	Shipment Reference Number	Internal Transaction Number (ITN) §84.17(a)(10)	Vessel Name §84.17(a)(11)	Vessel IMO §84.17(a)(12)	Container/ISO Tank Number §84.17(a)(13)	Port of Exit §84.17(a)(1)(vi)	HTS Code §84.17(a)(1)(ix)	Country to which the HFCs were Exported §84.17(a)(1)(vii)	HFC Exported §84.17(a)(1)(iv)	Quantity Exported §84.17(a)(1)(iv)	Recipient Company §84.17(a)(1)(i)	Recipient Company Address §84.17(a)(1)(i)	Recipient Company City §84.17(a)(1)(i)	Recipient Company Country §84.17(a)(1)(vii)	Recipient Company Contact Name §84.17(a)(1)(iii)	Recipient Company Contact Telephone Number §84.17(a)(1)(iii)	Recipient Company Contact Email §84.17(a)(1)(iii)	If Produced in the U.S.	If Imported into the U.S.		Date of Purchase §84.17(a)(1)(v)
																				Company that Produced the HFC §84.17(a)(1)(v)	Company that Imported the HFC §84.17(a)(1)(v)	Source Country §84.17(a)(1)(v)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
	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 84.17). 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 6 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 # 5900-545

---

Sheet 2: Export Summary

						OMB Control Number: 2060-0734
						Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Request for Additional Consumption Allowances Report
	Worksheet Instructions:
	Complete and submit an HFC Request for Additional Consumption Allowances Report if your company is requesting additional consumption allowances following the export of HFCs. Additional consumption allowances may only be requested for exports that have occurred during the current calendar year. All refunded allowances must also be expended in the same calendar year. Section 1 and Section 2 of the report must be completed prior to submission. Section 4 is automatically populated based on data entered in Section 3.
	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 3 - Export Information
	Section 2 - Allowance Recipient Identification	Section 4 - Summary of Additional Consumption Allowances Requested
	Section 4 - Summary of Additional Consumption Allowances Requested
	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.
	Additional Consumption Allowances Requested
	1	2	3
	HFC Exported §84.17(a)(1)(iv)	Total Quantity Exported (kg)	Amount of Allowances (MTEVe)
1	HFC-23	0.00	0.0
2	HFC-32	0.00	0.0
3	HFC-41	0.00	0.0
4	HFC-43-10mee	0.00	0.0
5	HFC-125	0.00	0.0
6	HFC-134	0.00	0.0
7	HFC-134a	0.00	0.0
8	HFC-143	0.00	0.0
9	HFC-143a	0.00	0.0
10	HFC-152	0.00	0.0
11	HFC-152a	0.00	0.0
12	HFC-227ea	0.00	0.0
13	HFC-236cb	0.00	0.0
14	HFC-236ea	0.00	0.0
15	HFC-236fa	0.00	0.0
16	HFC-245ca	0.00	0.0
17	HFC-245fa	0.00	0.0
18	HFC-365mfc	0.00	0.0