5900-556 HFC Importer of Record Annual Report

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Overview

Company Identification
Blend List

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Sheet 1: Company Identification

							OMB Control Number: 2060-0734
							Expiration Date: XX/XX/202X
	American Innovation and Manufacturing Act - HFC Importer of Record Annual Report
	Worksheet Instructions:
	Complete and submit an HFC Importer of Record Annual Report if your company is an HFC allowance holder and anticipates being the importer of record for a shipment of regulated substances. All sections of the report must be completed prior to submission. Provide supporting documentation, as needed, to respond to this reporting request.
	Version:
	r0.1
	Updated:
	9/16/2022
	Reporting Form Navigation:
	Section 1 - Company Identification
	Section 2 - Corporate Relationships
	Section 3 - Plan for Importing HFCs
	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:
	Importer of Record Number:
	Reporting Year:
	Section 2 - Corporate Relationships
	Instructions: Please provide the names of all subsidiaries, entities majority owned and/or controlled by the allowance holder, and all entities operating under different names (i.e., "Doing Business As") along with the importer of record number for each entity (even if it is identical to the allowance holder) that intends to import using your company's allowances.
	Entity Name	Importer of Record Number
1
2
3
4
5
6
7
8
9
10
	Instructions: Please describe the corporate structure of the allowance holder, including the relationship between the allowance holder and each subsidiary, entity majority owned and/or controlled by the allowance holder, and DBAs. Also provide information on the owners and their respective percentage of ownership of each subsidiary, entity that is majority owned and/or controlled by the allowance holder, and DBA.
	Section 3 - Plan for Importing HFCs
	Instructions: Identify the single component HFC(s) your company commonly imports and expects to import in the coming year as well as the CAS number for each and/or the HTS code under which each HFC will be imported.
	Intended HFC Imports
	HFC	CAS Number	HTS Code
1
2
3
4
5
6
7
8
9
10
	Instructions: Identify the HFC blends your company commonly imports and/or expects to import in the coming year, including the ASHRAE numerical designation of the refrigerant or the percentage of the mixture containing each regulated substance, the CAS numbers for each neat HFC, and the HTS code under which each blend will be imported. A list of common HFC Blend compositions can be found on the "Blend List" tab.
	Intended HFC Blend Imports
	1	2a	2b	2c	3a	3b	3c	4a	4b	4c	5a	5b	5c	6a	6b	6c	7
	HFC Blend	HFC Component (1)			HFC Component (2)			HFC Component (3)			HFC Component (4)			HFC Component (5)			HTS Code
		HFC	HFC Composition of Blend (%)	CAS Number	HFC	HFC Composition of Blend (%)	CAS Number	HFC	HFC Composition of Blend (%)	CAS Number	HFC	HFC Composition of Blend (%)	CAS Number	HFC	HFC Composition of Blend (%)	CAS Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
	Instructions: Identify the types of cylinders commonly used to import HFCs and HFC blends.
	Cylinder Information
	Description		Typical Range of Mass (kg) Contained in Each Cylinder
1
2
3
4
5
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7
	Instructions: Identify the ports of entry through which your company expects to import HFCs and HFC blends in the coming year.
	Commonly Used Ports of Entry
1
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9
	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 voluntary. 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 2 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 # 5900-556

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Sheet 2: Blend List

HFC Blends	HFC-23	HFC-32	HFC-125	HFC-134a	HFC-143a	HFC-152a	HFC-227ea	HFC-236fa
R-401A						0.13
R-401B						0.11
R-401C						0.15
R-402A			0.6
R-402B			0.38
R-404A			0.44	0.04	0.52
R-405A						0.07
R-407A		0.2	0.4	0.4
R-407B		0.1	0.7	0.2
R-407C		0.23	0.25	0.52
R-407D		0.15	0.15	0.7
R-407E		0.25	0.15	0.6
R-407F		0.3	0.3	0.4
R-407G		0.025	0.025	0.95
R-407H		0.325	0.15	0.525
R-407I		0.195	0.085	0.72
R-408A			0.07		0.46
R-410A		0.5	0.5
R-410B		0.45	0.55
R-411A						0.11
R-411B						0.03
R-413A				0.88
R-415A						0.18
R-415B						0.75
R-416A				0.59
R-417A			0.466	0.5
R-417B			0.79	0.183
R-417C			0.195	0.788
R-418A						0.025
R-419A			0.77	0.19
R-419B			0.485	0.48
R-420A				0.88
R-421A			0.58	0.42
R-421B			0.85	0.15
R-422A			0.851	0.115
R-422B			0.55	0.42
R-422C			0.82	0.15
R-422D			0.651	0.315
R-422E			0.58	0.393
R-423A				0.525			0.475
R-424A			0.505	0.47
R-425A		0.185		0.695			0.12
R-426A			0.051	0.93
R-427A		0.15	0.25	0.5	0.1
R-427C		0.25	0.25	0.4	0.1
R-428A			0.775		0.2
R-429A						0.1
R-430A						0.76
R-431A						0.29
R-434A			0.632	0.16	0.18
R-435A						0.2
R-437A			0.195	0.785
R-438A		0.085	0.45	0.442
R-439A		0.5	0.47
R-440A				0.016		0.978
R-442A		0.31	0.31	0.3		0.03	0.05
R-444A		0.12				0.05
R-444B		0.415				0.1
R-445A				0.09
R-446A		0.68
R-447A		0.68	0.035
R-447B		0.68	0.08
R-448A		0.26	0.26	0.21
R-448B		0.21	0.21	0.31
R-449A		0.243	0.247	0.257
R-449B		0.252	0.243	0.273
R-449C		0.2	0.2	0.29
R-450A				0.42
R-451A				0.102
R-451B				0.112
R-452A		0.11	0.59
R-452B		0.67	0.07
R-452C		0.125	0.61
R-453A		0.2	0.2	0.538			0.05
R-454A		0.35
R-454B		0.689
R-454C		0.215
R-455A		0.215
R-456A		0.06		0.45
R-457A		0.18				0.12
R-457B		0.35				0.1
R-458A		0.205	0.04	0.614			0.135	0.006
R-459A		0.68
R-459B		0.21
R-460A		0.12	0.52	0.14
R-460B		0.28	0.25	0.2
R-460C		0.025	0.025	0.46
R-461A			0.55	0.32	0.05		0.05
R-462A		0.09	0.42	0.44	0.02
R-463A		0.36	0.3	0.14
R-464A		0.27	0.27				0.06
R-465A		0.21
R-466A		0.49	0.115
R-467A		0.22	0.05	0.724
R-468A		0.215
R-469A		0.325	0.325
R-470A		0.17	0.19	0.07			0.03
R-470B		0.115	0.115	0.03			0.07
R-471A							0.043
R-472A		0.12		0.19
R-473A	0.1		0.1
R-500						0.262
R-503	0.401
R-504		0.482
R-507			0.5		0.5
R-507A			0.5		0.5
R-508A	0.39
R-508B	0.46
R-512A				0.05		0.95
R-513A				0.44
R-513B				0.415
R-515A							0.12
R-515B							0.089
R-516A				0.085		0.14