5900-540 HFC Producer One-Time Report

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Overview

Facility Information
HFC-23 Information

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Sheet 1: Facility Information

			OMB Control Number: 2060-0734
			Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Producer One-Time Report
	Worksheet Instructions:
	Complete and submit an HFC Producer One-Time Report if your company produces regulated HFCs. Information on only one facility may be reported per reporting form. Sections 1 and Section 2 must be completed prior to submission. Section 3 must be completed if your facility produces HFC-23. Provide supporting documentation, as needed, to respond to these reporting requirements.
	Version:
	r0.1
	Updated:
	3/16/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Facility Identification	Section 3 - HFC-23 Information
	Section 2 - Production Information
	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 - Facility Identification
	Instructions: Complete the following facility information.
	Company Name:
	Facility Name:
	Facility ID:
	Section 2 - Production Information
	Instructions: Provide the following information on the production facility.
	Production Process Information
	1	2	3
	HFC	Quantity of Fugitive Losses (%) §84.31(b)(1)(iv)	Estimated Percent Efficiency of the Production Process §84.31(b)(1)(vi)
1
2
3
4
5
	Describe the method by which the producer in practice measures daily quantities of regulated substances produced. §84.31(b)(1)(i)
	Provide conversion factors by which the daily records as currently maintained can be converted into kilograms of regulated substances produced, including any constants or assumptions used in making those calculations (e.g., tank specifications, ambient temperature or pressure, density of the regulated substance). §84.31(b)(1)(ii)
	Should the conversion factors, including any constants or assumptions used in making those calculations be treated as confidential business information (CBI)?
	Describe internal accounting procedures for determining plant-wide production. §84.31(b)(1)(iii)
	Provide a list of any coproducts, byproducts, or emissions from the production line that are other regulated substances; ozone-depleting substances listed in 40 CFR part 82, subpart A; or hazardous air pollutants initially identified in Section 112 of the Clean Air Act, and as revised through rulemaking and codified in 40 CFR 63. §84.31(b)(1)(v)
	Provide a description of any processes that use a regulated substance as a process agent. §84.31(b)(1)(vii)
	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 200 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 # 5900-540

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Sheet 2: HFC-23 Information

		OMB Control Number: 2060-0734
		Expiration Date: 12/31/2024
American Innovation and Manufacturing Act - HFC Producer One-Time Report
Worksheet Instructions:
Complete and submit an HFC Producer One-Time Report if your company produces regulated HFCs. Information on only one facility may be reported per reporting form. Sections 1 and Section 2 must be completed prior to submission. Section 3 must be completed if your facility produces HFC-23. Provide supporting documentation, as needed, to respond to these reporting requirements.
Version:
r0.1
Updated:
3/16/2022
External Links:
HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
Reporting Form Navigation:
Section 1 - Facility Identification	Section 3 - HFC-23 Information
Section 2 - Production Information
Section 3 - HFC-23 Information
Instructions: Provide the following information if your facility produces HFC-23. Provide supporting documentation, as needed, to respond to these reporting requirements.
Provide information on the capacity to produce the intended chemical on the line on which HFC-23 is produced. §84.31(b)(4)(i)(A)
Provide a description of actions taken at the facility to control the generation of HFC-23 and its emissions. §84.31(b)(4)(i)(B)
Identify the approved destruction technology and its location intended for use for HFC-23 destruction. §84.31(b)(4)[i](C) In addition, provide a copy of the destruction removal efficiency report associated with the destruction technology. §84.31(b)(4)(i)(D)