5900-543 HFC Reclamation One-Time Report

				OMB Control Number: 2060-0734
				Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Reclamation One-Time Report
	Worksheet Instructions:
	Complete and submit an HFC Reclamation One-Time Report if your company reclaims HFCs. All sections of the report must be completed prior to submission.
	Version:
	r0.2
	Updated:
	2/2/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk		AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification
	Section 2 - 2021 End-of-Year Inventory
	Section 3 - Laboratory Batch Testing 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 - Company Identification
	Instructions: Complete the following company information.
	Company Name:
	Company ID:
	Section 2 - 2021 End-of-Year Inventory
	Instructions: Provide the quantity of each HFC held in inventory on December 31, 2021.
	End-of-Year Inventory
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	HFC	Quantity Recovered (kg) §84.31(i)(1)(i)	Quantity Reclaimed (kg) §84.31(i)(1)(i)	Quantity of Virgin Material (kg) §84.31(i)(1)(i)	Total Quantity of Inventory (kg) §84.31(i)(1)(i)
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	Section 3 - Laboratory Batch Testing Information
	Instructions: Provide the following information on laboratory batch testing conducted during the prior year. For each laboratory identified, provide a signed statement from the laboratory confirming there is an ongoing business relationship with your company. Provide additional supporting documentation, as needed, to respond to these reporting requirements.
	Batch Testing
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	Laboratory Name §84.31(i)(1)(ii)	Number of Batches Tested In Prior Year §84.31(i)(1)(iii)	Number of Batches that Did Not Meet the Specifications in Appendix A to 40 CFR Part 82, Subpart F in the Prior Year §84.31(i)(1)(iv)
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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 40 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 # 5900-543