5900-655 Class I Process Agent Annual Report

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Overview

Instructions
Section 1
Section 2
Section 3
Reference List
Lists

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Sheet 1: Instructions

	OMB Control Number: xxxx-xxxx
	Expiration Date: xx/xx/xxxx
	U.S. Environmental Protection Agency
	Stratospheric Ozone Protection Program
	Class I Process Agent Annual Report (Sec 82.13)
	Version 1.0
	Last Updated: September 2024
	Instructions
	Complete and submit a Class I ODS Process Agent Annual Report if your company uses regulated Class I ODS as process agents regularly. Please provide information for only one facility per reporting form.
	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 in Section 3 to generate your CSV file.
	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
	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.
	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:
	https://www.epa.gov/ods-phaseout/ods-recordkeeping-and-reporting
	This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. XXXX-XXXX). Responses to this collection of information are mandatory (40 CFR 82.13). 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 X 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.
	EPA Form #5900-655

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Sheet 2: Section 1

	U.S. Environmental Protection Agency
	Class I Process Agent Annual Report
	Date Prepared:	7/17/2025
	Section 1: Report Identification Information
	Complete all fields below for each facility in which the process agent was used. No fields may be left blank.
	Company Name:
	Submission Type:
	Reporting Year:
	Facility Name:
	Facility Address:
	Facility Start Up Date:
	Plant Start Up Date(s):

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Sheet 3: Section 2

U.S. Environmental Protection Agency

Class I Process Agent Annual Report

Facility Name:

Reporting Period:

Section 2: Class II Substance Use Information

Complete all fields below for each process agent use of a Class I controlled substance. No fields may be left blank.

If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.

Name

Purpose

Final Products Manufactured

Obtained

Amount Used (kg)

Recycled for continued use in same process agent application in the same facility?

If not recycled, substance was ultimately:

Total Air Emissions (kg)

Fugitive Air Emissions (kg)

Stack Point Air Emissions (kg)

ODS Substance (1)

ODS Substance (2)

ODS Substance (3)

Name

Amount Used

Final Product Manufactured (1)

Amount of Final Product (1) Produced

Final Product Manufactured (2)

Amount of Final Product (2) Produced

Name of Byproduct (1)

Amount of Byproduct (1) Produced

Name of Byproduct (2)

Amount of Byproduct (2) Produced

ODS Substance (1)

ODS Substance (2)

ODS Substance (3)

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Sheet 4: Section 3

	U.S. Environmental Protection Agency
	Class I Process Agent Annual Report
	Facility Name:
	Reporting Period:
	Section 3: Substance Use Mitigation
	Complete all fields below for each process agent use of a Class I controlled substance.
	Description of technologies used or actions taken to minimized use or emissions of Class I controlled substances, including estimated emissions reductions:
	x			x
	#REF!
	#REF!
	#REF!

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Sheet 5: Reference List

	U.S. Environmental Protection Agency
	Class I Process Agent Annual Report
	Reference List
	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 accepted into EPA’s ODS tracking system. When copying and pasting data into the form, please ensure consistency with the formatting of the list below.
	Chemical Name List: The table below lists the valid chemical names that may be used when entering data into Section 2 and Section 3 of this form.
	Chemical Name
	CFC-12	CFC-114	CFC-214	Halon 1211	CH3CCL3
	CFC-13	CFC-115	CFC-215	Halon 1301	HBFCs
	CFC-111	CFC-211	CFC-216	Halon 2402
	CFC-112	CFC-212	CFC-217	CBM
	CFC-113	CFC-213	Halon 1202	CCL4

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Sheet 6: Lists

Chemical Name	Submission Type	Reporting Year	Current Year	ODS obtained by	ODS recycled?	ODS disposal
CFC-12	Original Submission	2024	2025	obtained as virgin	yes	transformed
CFC-13	Re-Submittal	2025		obtained as used	no	reused or recylced for use in a different process agent application
CFC-111		2026		produced by the entity		destroyed by approved destruction technologies
CFC-112		2027		purchased from a US producer
CFC-113		2028		imported
CFC-114		2029		reclaimed by the entity from a different use
CFC-115		2030		reclaimed by another entity
CFC-211		2031
CFC-212		2032
CFC-213		2033
CFC-214		2034
CFC-215		2035
CFC-216
CFC-217
Halon 1202
Halon 1211
Halon 1301
Halon 2402
CBM
CCL4
CH3CCL3
HBFCs