Form 637 NB Questionnaire OMB_Rev_Feb_2022

Name:		EIN:
Address:		637 Reg No.:
City, State, Zip:		OMB No.:	1545-1835

In addition to the Form 637 General Questionnaire, please answer the following questions specific to this activity. (Attach additional sheets, if needed.)

Activity Letter NB - Producers and importers of biodiesel (other than agri-biodiesel), including renewable diesel.

See Notice 2005-04, 2(f).

These persons are required to be registered under IRC 4101(a)(1) and Notice 2005-04.

To ensure Form 637 Registration compliance, the IRS will periodically obtain samples of biodiesel and renewable diesel produced or imported to ensure the registration requirements for fuel and fuel additives established by Environmental Protection Agency under section 211 of the Clean Air Act (42 U.S.C. 7545) and the requirements of the American Society of Testing and Materials are met.

“NB” QUESTIONNAIRE

1. Does your business qualify for the Form 637 “NB” Registration?

☐Yes ☐ No

• If yes, please complete questions below and return this form.

• If no, please sign the statement below, date, and return this form.

I request that my Form 637 “NB” Registration be denied or revoked as I am no longer engaged in this activity.

____________________________________ __________________

Printed Name Title

____________________________________ __________________

Signature Date

Note: This request must be signed by a person with authority to bind the applicant or registrant. Refer to Form 637, Application for Registration (For Certain Excise Tax Activities), General Instructions, under the Signature section for additional guidance.

1. Is your business currently using your business’s registration to produce and/or import biodiesel (other than agri-biodiesel) and/or renewable diesel?

☐Yes ☐No

If yes, when was the last time that your business produced and/or imported biodiesel (other than agri-biodiesel) and/or renewable diesel?

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   Does your business plan to continue using your business’s registration to produce and/or import biodiesel (other than agri-biodiesel) and/or renewable diesel?

☐Yes ☐No

If yes, give a brief description of your business’s plans for producing and/or importing biodiesel (other than agri-biodiesel) and/or renewable diesel.

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   Check the box(es) representing activities in which your business is engaged.

☐ Producer of Biodiesel (other than agri-biodiesel)

☐ Producer of Renewable Diesel

☐ Importer of Biodiesel (other than agri-biodiesel)

☐ Importer of Renewable Diesel

5. Has your business’s biodiesel (other than agri-biodiesel) been tested to determine if it meets the ASTM D6751 standard?

☐Yes ☐No ☐Not Applicable

If yes, please provide a copy of the latest independent third-party certificate of analysis performed on your business’s biodiesel (other than agri-biodiesel) that certifies the ASTM D6751 standard has been met.

6. Has your business’s renewable diesel been tested to determine if it meets the ASTM D975 or D396 standard?

☐Yes ☐No ☐Not Applicable

If yes, please provide a copy of the latest independent third party certificate of analysis performed on your business’s renewable diesel that certifies the ASTM D975 or D396 standard has been met.

7. Is the biodiesel (other than agri-biodiesel) or renewable diesel that is produced or imported blended with petroleum diesel? ☐Yes ☐No

If yes, please list all blend percentages (e.g., (B5 (5% Bio), B20 (20% Bio), B99.9 (99.9% Bio), etc.).

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   List the type and annual volume of biodiesel (other than agri-biodiesel) or renewable diesel produced and/or imported.

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   If your business produces renewable diesel, is the renewable diesel derived from coprocessing biomass with a feedstock which is not biomass?

☐ Yes ☐ No

10. List the name and address of all feedstock suppliers, include the type and annual volume of product purchased (e.g., waste restaurant grease, etc.).

    Feedstock	Name and Address of Supplier	Expected Annual Volume

11. List all locations of storage facilities where feedstock, biodiesel (other than agri-biodiesel), renewable diesel, and/or products used in blending are stored. Include a description of the product (e.g., Waste Restaurant Grease - feedstock, Diesel - blending component, and B99 - finished product).

    Product Description	Name and Address of Facility	Fuel Tank Capacity (Gallons)	Expected Annual Volume

12. Does your business sell biodiesel (other than agri-biodiesel) or renewable diesel as a fuel?

☐Yes ☐No

If yes, list the customer and type of product/blend being sold (B100, B99, B20, R100, R99, R20).

Customer Name	Product/Blend

13. Does your business use biodiesel (other than agri-biodiesel) or renewable diesel as a fuel?

☐Yes ☐No

If yes, how is it being used?

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    Please list all production agreements that your business already have or plan to implement within the year.

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    Does your business store any biodiesel (other than agri-biodiesel) or renewable diesel to which it does not hold title?

☐Yes ☐No

If yes, where is this inventory stored, and for whom is it stored? Are separate inventory records maintained? Who is filing claims for the production or importation of the fuel?

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    Does your business sell or plan to sell any biodiesel (other than agri-biodiesel) or renewable diesel to a related company?

☐Yes ☐No

If yes, describe the arrangements.

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    Does your business sell biodiesel (other than agri-biodiesel) or renewable diesel on consignment?

☐Yes ☐No

If yes, where is this inventory stored and whom is it stored for? Are separate inventory records maintained? Who is filing claims for the production or importation of the fuel?

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    Does your business export or plan to export any biodiesel (other than agri-biodiesel) or renewable diesel product? ☐Yes ☐No

If yes, please explain.

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    List the name and phone number of a person whom we can contact about this application/registration.

Form 637 NB Questionnaire 3 Revised Feb 2022