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OMB Control Number: 2060-0170 |
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Expiration Date: 4/16/2023 |
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U.S. Environmental Protection Agency |
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Stratospheric Ozone Protection Program |
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Request for Additional Class II Consumption Allowances (Sec 82.20) |
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Version 5.0 |
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Last Updated: April 2020 |
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Instructions |
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Complete this form by filling in the data fields that are highlighted in blue. Guidance on how to complete individual data fields are provided in comment bubbles. Use the arrows to navigate between the tabs. Once completed, use the 'prepare submission' button on the Summary tab to generate your CSV file. |
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Copying and Pasting Data: If data are pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be |
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accepted into EPA’s ODS Tracking System. Refer to the Reference List to identify the valid naming scheme for specific data fields. Additionally, select "Paste As Values" when pasting data into the form. |
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Report Submission: This Excel file, the generated CSV file, and all supporting attachments should be submitted to EPA through the Central Data Exchange (CDX). Refer to EPA's website for additional information on form submission: |
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https://www.epa.gov/ods-phaseout/ods-recordkeeping-and-reporting. |
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All information submitted to EPA will be treated as confidential in accordance with 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart. |
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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. 2060-0170). Responses to this collection of information are mandatory (40 CFR 82.20). 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 number and expiration date are displayed in the upper right corner of the form. The public reporting and recordkeeping burden for this collection of information is estimated to be 4 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. |
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EPA Form #5900-201 |
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U.S. Environmental Protection Agency |
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Request for Additional Class II Consumption Allowances |
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Company Name: |
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Reporting Period: |
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Section 2: Export Transaction Data |
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In the table below, enter export transaction data for each class II controlled substance for which additional consumption allowances are being requested. For all export transactions, all fields are required unless otherwise indicated. As a reminder, if the material was produced or imported by a company other than the exporter,a written statement from the producer or importer stating that the material was produced or imported with expended allowances must be provided to EPA along with the submission of this report. Additionally, for each export transaction, a copy of the invoice and bill of lading documenting the sale and indicating the net quantity shipped must be provided to EPA. |
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If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.
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The transaction number is autopopulated.
Transaction Number |
Enter the date for when the shipment exited the United States.
Date of Export |
Enter the name of the company that received or purchased material.
Recipient Company |
Enter the street address of the recipient company.
Recipient Company Street Address |
Enter the city of the recipient company.
Recipient Company City |
Select the country to which the shipment was exported.
If copying and pasting data into the table, please refer to the Reference List for the valid list of countries.
Recipient Company Country |
Enter the postal code of the recipient company.
Recipient Company Postal Code |
Enter the name of the contact for the recipient company. If this information is not available, enter "Not Available."
Recipient Company Contact Name |
Enter the phone number of the contact from the recipient company. If this information is not available, enter "Not Available."
Recipient Company Phone Number |
Select the name of the class II chemical exported.
If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names.
Name of the Class II Chemical Exported |
Enter the total quantity (kg) of the class II chemical exported.
Quantity of the Class II Chemical Exported |
Enter the 10-digit commodity code of the chemical exported as it appears on Customs documentation.
Refer to the Reference List for a list of commonly used commodity codes for class II chemicals.
Commodity Code |
Enter the name of the port where the shipment exited the United States.
Port of Exit from the United States |
Enter the Employer Identification Number (EIN) shown on the Shipper's Export Declaration Form. This number may or may not refer to the exporter as defined by EPA. If a shipping agent is acting on behalf of the exporter as defined by the regulation, the EIN of the agent shown on the U.S. Customs Form 7525 should be reported here.
Your company's EIN as entered in Section 1 of this report will automatically populate for each transaction entered. Revise the number if the EIN for the shipment is different from your company's EIN.
The number entered should have no dashes.
Shipment EIN |
Complete this field if the material was produced in the United States.
If Produced in the U.S. |
Complete these columns if the material was imported into the United States.
If Imported into the U.S. |
Enter the date of when the chemical was purchased from the producer or importer, if the company that exported the material is not the same company that produced or imported the material.
Date Purchased |
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Enter the name of the company that produced the chemical, if applicable.
Company that Produced the Class II Chemical |
Enter the name of the company that imported the chemical into the United States, if applicable.
Company that Imported the Class II Chemical |
Select the country from which the material was imported into the United States, if applicable.
Source Country |
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Autopopulated |
Date |
Text |
Text |
Text |
Selection |
Text |
Text |
Text |
Selection |
kg |
Text |
Text |
Number |
Text |
Text |
Selection |
Date |
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1 |
1/15/2018 |
Company A |
1 Main Street |
Melbourne |
Australia |
3000 |
John Smith |
011 46 8 508 280 00 |
HCFC-124 |
1,000.00 |
2903.71.0000 |
Miami, FL |
12345678900 |
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Company B |
New Zealand |
3/7/2018 |
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| 0 |
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x |
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x |
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x |
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Afghanistan |
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#NAME? |
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Afghanistan |
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Albania |
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HCFC-123 |
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Albania |
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Algeria |
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HCFC-124 |
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Algeria |
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Andorra |
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#NAME? |
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Andorra |
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Angola |
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#NAME? |
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Angola |
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Antigua and Barbuda |
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#NAME? |
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Antigua and Barbuda |
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Argentina |
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Argentina |
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Armenia |
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Armenia |
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Australia |
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Australia |
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Austria |
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Austria |
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Azerbaijan |
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Azerbaijan |
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Bahamas |
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Bahamas |
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Bahrain |
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Bahrain |
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Bangladesh |
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Bangladesh |
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Barbados |
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Barbados |
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Belarus |
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Belarus |
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Belgium |
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Belgium |
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Belize |
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Belize |
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Benin |
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Benin |
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Bermuda |
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Bermuda |
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Bhutan |
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Bhutan |
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Bolivia (Plurinational State of) |
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Bolivia (Plurinational State of) |
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Bosnia and Herzegovina |
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Bosnia and Herzegovina |
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Botswana |
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Botswana |
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Brazil |
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Brazil |
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Brunei Darussalam |
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Brunei Darussalam |
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British Virgin Islands |
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British Virgin Islands |
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Bulgaria |
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Bulgaria |
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Burkina Faso |
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Burkina Faso |
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Burundi |
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Burundi |
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Cambodia |
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Cambodia |
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Cameroon |
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Cameroon |
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Canada |
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Canada |
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Cape Verde |
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Cape Verde |
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Central African Republic |
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Central African Republic |
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Chad |
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Chad |
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Chile |
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Chile |
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China |
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China |
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Colombia |
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Colombia |
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Comoros |
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Comoros |
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Congo |
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Congo |
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Cook Islands |
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Cook Islands |
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Costa Rica |
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Costa Rica |
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Cote d'Ivoire |
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Cote d'Ivoire |
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Croatia |
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Croatia |
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Cuba |
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Cuba |
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Cyprus |
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Cyprus |
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Czech Republic |
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Czech Republic |
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|
Democratic Republic of the Congo |
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|
Democratic Republic of the Congo |
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Denmark |
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Denmark |
|
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Djibouti |
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Djibouti |
|
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|
Dominica |
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Dominica |
|
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Dominican Republic |
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Dominican Republic |
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|
Ecuador |
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Ecuador |
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Egypt |
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Egypt |
|
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El Salvador |
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El Salvador |
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|
Equatorial Guinea |
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Equatorial Guinea |
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Eritrea |
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Eritrea |
|
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Estonia |
|
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Estonia |
|
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|
Ethiopia |
|
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Ethiopia |
|
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|
European Union |
|
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|
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|
|
European Union |
|
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|
Fiji |
|
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|
Fiji |
|
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|
|
Finland |
|
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|
Finland |
|
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|
France |
|
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|
France |
|
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Gabon |
|
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|
Gabon |
|
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|
Gambia |
|
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|
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|
|
|
|
Gambia |
|
|
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|
|
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|
|
Georgia |
|
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|
|
Georgia |
|
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|
Germany |
|
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Germany |
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Ghana |
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Ghana |
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Greece |
|
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Greece |
|
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Grenada |
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Grenada |
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|
Guatemala |
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|
Guatemala |
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|
Guinea |
|
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|
Guinea |
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|
Guinea-Bissau |
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Guinea-Bissau |
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Guyana |
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Guyana |
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Haiti |
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Haiti |
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Holy See |
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Holy See |
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Honduras |
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Honduras |
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Hong Kong |
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Hong Kong |
|
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|
Hungary |
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|
Hungary |
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|
Iceland |
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|
Iceland |
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|
India |
|
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|
|
India |
|
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|
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|
|
Indonesia |
|
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|
Indonesia |
|
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|
|
Iran (Islamic Republic of) |
|
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|
|
Iran (Islamic Republic of) |
|
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|
Iraq |
|
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|
Iraq |
|
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|
Ireland |
|
|
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|
|
Ireland |
|
|
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|
|
Israel |
|
|
|
|
|
|
|
|
|
|
Israel |
|
|
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|
Italy |
|
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|
|
Italy |
|
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|
|
Jamaica |
|
|
|
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|
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|
|
|
|
Jamaica |
|
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|
Japan |
|
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|
Japan |
|
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|
Jordan |
|
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|
Jordan |
|
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Kazakhstan |
|
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|
Kazakhstan |
|
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|
Kenya |
|
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|
|
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|
|
Kenya |
|
|
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|
|
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|
Kiribati |
|
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|
Kiribati |
|
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|
Kuwait |
|
|
|
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|
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|
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|
|
Kuwait |
|
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|
Kyrgyzstan |
|
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|
Kyrgyzstan |
|
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|
|
Lao People's Democratic Republic |
|
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|
|
Lao People's Democratic Republic |
|
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|
Latvia |
|
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|
Latvia |
|
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Lebanon |
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Lebanon |
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Lesotho |
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Lesotho |
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Liberia |
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Liberia |
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Libya |
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Libya |
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Liechtenstein |
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Liechtenstein |
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Lithuania |
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Lithuania |
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Luxembourg |
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Luxembourg |
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Madagascar |
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Madagascar |
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Malawi |
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Malawi |
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Malaysia |
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Malaysia |
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Maldives |
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Maldives |
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Mali |
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Mali |
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Malta |
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Malta |
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Marshall Islands |
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Marshall Islands |
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Mauritania |
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Mauritania |
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Mauritius |
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Mauritius |
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Mexico |
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Mexico |
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Micronesia (Federated States of) |
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Micronesia (Federated States of) |
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Monaco |
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Monaco |
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Mongolia |
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Mongolia |
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Montenegro |
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Montenegro |
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Morocco |
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Morocco |
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Mozambique |
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Mozambique |
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Myanmar |
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Myanmar |
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Namibia |
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Namibia |
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Nauru |
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Nauru |
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Nepal |
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Nepal |
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Netherlands |
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Netherlands |
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New Zealand |
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New Zealand |
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Nicaragua |
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Nicaragua |
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Niger |
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Niger |
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Nigeria |
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Nigeria |
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Niue |
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Niue |
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North Korea (Democratic People's Republic of Korea) |
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North Korea (Democratic People's Republic of Korea) |
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Norway |
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Norway |
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Oman |
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Oman |
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Pakistan |
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Pakistan |
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Palau |
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Palau |
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Panama |
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Panama |
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Papua New Guinea |
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Papua New Guinea |
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Paraguay |
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Paraguay |
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Peru |
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Peru |
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Philippines |
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Philippines |
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Poland |
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Poland |
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Portugal |
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Portugal |
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Qatar |
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Qatar |
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Republic of Moldova |
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Republic of Moldova |
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Romania |
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Romania |
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Russian Federation |
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Russian Federation |
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Rwanda |
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Rwanda |
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Saint Kitts and Nevis |
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Saint Kitts and Nevis |
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Saint Lucia |
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Saint Lucia |
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Saint Vincent and the Grenadines |
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Saint Vincent and the Grenadines |
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Samoa |
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Samoa |
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San Marino |
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San Marino |
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Sao Tome and Principe |
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Sao Tome and Principe |
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Saudi Arabia |
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Saudi Arabia |
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Senegal |
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Senegal |
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Serbia |
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Serbia |
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Seychelles |
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Seychelles |
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Sierra Leone |
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Sierra Leone |
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Singapore |
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Singapore |
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Slovakia |
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Slovakia |
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Slovenia |
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Slovenia |
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Solomon Islands |
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Solomon Islands |
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Somalia (Federal Republic of) |
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Somalia (Federal Republic of) |
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South Africa |
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South Africa |
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South Korea (Republic of Korea) |
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South Korea (Republic of Korea) |
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South Sudan |
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South Sudan |
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Spain |
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Spain |
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Sri Lanka |
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Sri Lanka |
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Sudan |
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Sudan |
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Suriname |
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Suriname |
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Swaziland |
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Swaziland |
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Sweden |
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Sweden |
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Switzerland |
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Switzerland |
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Syrian Arab Republic |
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Syrian Arab Republic |
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Tahiti |
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Tahiti |
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Taiwan |
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Taiwan |
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Tajikistan |
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Tajikistan |
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Thailand |
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Thailand |
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|
The Former Yugoslav Republic of Macedonia |
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|
The Former Yugoslav Republic of Macedonia |
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Timor-Leste |
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Timor-Leste |
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Togo |
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Togo |
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Tonga |
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Tonga |
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Trinidad and Tobago |
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Trinidad and Tobago |
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Tunisia |
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Tunisia |
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Turkey |
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Turkey |
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Turkmenistan |
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Turkmenistan |
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Tuvalu |
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Tuvalu |
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Uganda |
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Uganda |
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Ukraine |
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Ukraine |
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United Arab Emirates |
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|
United Arab Emirates |
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|
United Kingdom of Great Britain and Northern Ireland |
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|
United Kingdom of Great Britain and Northern Ireland |
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|
United Republic of Tanzania |
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|
United Republic of Tanzania |
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|
#NAME? |
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|
#NAME? |
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|
#NAME? |
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|
#NAME? |
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Uruguay |
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|
Uruguay |
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Uzbekistan |
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Uzbekistan |
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Vanuatu |
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Vanuatu |
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|
Venezuela (Bolivarian Republic of) |
|
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|
Venezuela (Bolivarian Republic of) |
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|
U.S. Environmental Protection Agency |
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Request for Additional Class II Consumption Allowances |
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Reference List |
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Copying and Pasting Data: If data is pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be accepted into EPA’s ODS tracking system. When copying and pasting data into the form, please ensure consistency with the formatting of the lists provided below. |
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Chemical Name List: The table below lists the valid chemical names that may be used when entering data into Section 2 of this form. |
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Country List: The table below lists the valid country names that may be used when entering data into Section 2 of this form. |
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Class II Chemicals with Allowances |
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Source Country |
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HCFC-123 |
HCFC-124 |
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Afghanistan |
Greece |
Papua New Guinea |
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Albania |
Grenada |
Paraguay |
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Algeria |
Guatemala |
Peru |
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Commodity Code List: The table below lists the commonly used class II commodity codes that may be used when entering data into Section 2 of this form. A complete list of commodity codes can be found in the Official Harmonized Tariff Schedule. |
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Andorra |
Guinea |
Philippines |
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Angola |
Guinea-Bissau |
Poland |
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Antigua and Barbuda |
Guyana |
Portugal |
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Argentina |
Haiti |
Qatar |
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Armenia |
Holy See |
Republic of Moldova |
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Class II Commodity Codes/Description |
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Australia |
Honduras |
Romania |
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2903.72.0020 |
Dichlorotrifluoroethane (HCFC-123) |
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Austria |
Hong Kong |
Russian Federation |
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2903.79.9030 |
Monochlorotetrafluoroethane (HCFC-124) |
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Azerbaijan |
Hungary |
Rwanda |
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3824.74.0000 |
Mixtures containing hydrochlorofluorocarbons (HCFCs) but not containing chlorofluorocarbons (CFCs) |
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Bahamas |
Iceland |
Saint Kitts and Nevis |
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Bahrain |
India |
Saint Lucia |
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Bangladesh |
Indonesia |
Saint Vincent and the Grenadines |
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Barbados |
Iran (Islamic Republic of) |
Samoa |
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Belarus |
Iraq |
San Marino |
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Belgium |
Ireland |
Sao Tome and Principe |
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Belize |
Israel |
Saudi Arabia |
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Benin |
Italy |
Senegal |
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Bermuda |
Jamaica |
Serbia |
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Bhutan |
Japan |
Seychelles |
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Bolivia (Plurinational State of) |
Jordan |
Sierra Leone |
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Bosnia and Herzegovina |
Kazakhstan |
Singapore |
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Botswana |
Kenya |
Slovakia |
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Brazil |
Kiribati |
Slovenia |
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Brunei Darussalam |
Kuwait |
Solomon Islands |
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British Virgin Islands |
Kyrgyzstan |
Somalia (Federal Republic of) |
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Bulgaria |
Lao People's Democratic Republic |
South Africa |
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Burkina Faso |
Latvia |
South Korea (Republic of Korea) |
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Burundi |
Lebanon |
South Sudan |
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Cambodia |
Lesotho |
Spain |
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Cameroon |
Liberia |
Sri Lanka |
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Canada |
Libya |
Sudan |
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Cape Verde |
Liechtenstein |
Suriname |
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Central African Republic |
Lithuania |
Swaziland |
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Chad |
Luxembourg |
Sweden |
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Chile |
Madagascar |
Switzerland |
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China |
Malawi |
Syrian Arab Republic |
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Colombia |
Malaysia |
Tahiti |
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Comoros |
Maldives |
Taiwan |
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Congo |
Mali |
Tajikistan |
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Cook Islands |
Malta |
Thailand |
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Costa Rica |
Marshall Islands |
The Former Yugoslav Republic of Macedonia |
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Cote d'Ivoire |
Mauritania |
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Croatia |
Mauritius |
Timor-Leste |
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Cuba |
Mexico |
Togo |
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Cyprus |
Micronesia (Federated States of) |
Tonga |
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Czech Republic |
Monaco |
Trinidad and Tobago |
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Democratic Republic of the Congo |
Mongolia |
Tunisia |
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Denmark |
Montenegro |
Turkey |
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Djibouti |
Morocco |
Turkmenistan |
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Dominica |
Mozambique |
Tuvalu |
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Dominican Republic |
Myanmar |
Uganda |
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Ecuador |
Namibia |
Ukraine |
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Egypt |
Nauru |
United Arab Emirates |
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El Salvador |
Nepal |
United Kingdom of Great Britain and Northern Ireland |
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Equatorial Guinea |
Netherlands |
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Eritrea |
New Zealand |
United Republic of Tanzania |
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Estonia |
Nicaragua |
Uruguay |
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Ethiopia |
Niger |
Uzbekistan |
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European Union |
Nigeria |
Vanuatu |
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Fiji |
Niue |
Venezuela (Bolivarian Republic of) |
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Finland |
North Korea (Democratic People's Republic of Korea) |
Viet Nam |
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France |
Yemen |
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Gabon |
Norway |
Zambia |
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Gambia |
Oman |
Zimbabwe |
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Georgia |
Pakistan |
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Germany |
Palau |
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Ghana |
Panama |
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