EPA Form Number 96 Section 8(e) Notice

OMB Control Number 2070-0030 expires 6/30/2024

TSCA Section 12(b) Export Notification
Submission Alias: 12(b) Mockup
Submitter Information

CBI

First Name

Brooke

Last Name

Plaisance

Phone Number

3375231765

Email Address

brooke.plaisance@cgifederal.com

Job Title
Organization Name

CGI Federal

Address Line 1

538 CAJUNDOME BLVD LAFAYETTE

Address Line 2
City

State

Postal Code

Country

LAFAYETTE

Louisiana

70506

United States

Exporter Information
Company Name

CGI Federal

Address Line 1

538 CAJUNDOME BLVD LAFAYETTE

CBI

X

CBI

X

Address Line 2
City

State

Postal Code

Country

LAFAYETTE

Louisiana

70506

United States

Exported Chemicals
Export - 1
Chemical Name

Phenol, styrenated, reaction products with polyethylene
glycol and 2-[(2-propen-1-yloxy)methyl]oxirane

CASRN

1539128-27-2

TSCA Section

Section 4

CBI

Category

Long Chain Perfluoroalkyl Carboxylate

CBI

Import Country

Bahamas

CBI

Export Date

08/28/2021

CBI

Regular File

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CBI

Sanitized File

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CBI

X

CBI Substantiation

EPA Form Number 9600-031

X

X

OMB Control Number 2070-0030 expires 6/30/2024

CBI Substantiation
Claim: Chemical Identification

Applicable Only to Chemical Identification CBI Claims

Yes

No

CBI

A person may assert a claim of confidentiality for the specif ic chemical identity of a chemical substance as described in § 711.15(b)(3) of this part
only if the identity of that chemical substance is treated as confidential in the Master Inventory File as of the time the report is submitted for that
chemical substance. Generic chemical identities and accession numbers may not be claimed as confidential. To assert a claim of confidentiality for
the identity of a reportable chemical substance, you must submit w ith the report detailed w ritten answ ers to the questions from subsection (b) and
to the f ollow ing questions.
(i) Is this chemical substance publicly known (including by your competitors) to be in U.S. commerce? If yes, please
explain why the specific chemical identity should still be afforded confidential status (e.g., the chemical substance
is publicly known only as being distributed in commerce for research and development purposes, but no other
information about the current commercial distribution of the chemical substance in the United States is publicly
available). If no, please complete the certification statement:

X

I certify that on the date referenced I searched the internet for the chemical substance identity (i.e., by both
chemical substance name and CASRN). I did not find a reference to this chemical substance that would
indicate that the chemical is being manufactured or imported by anyone for a commercial purpose in the
United States. [provide date].

test
(ii) Does this specific chemical substance leave the site of manufacture (including import) in any form, e.g., as a
product, effluent, emission? If yes, please explain what measures have been taken to guard against the
discovery of its identity.

X

test
(iii) If the chemical substance leaves the site in a form that is available to the public or your competitors, can the
chemical identity be readily discovered by analysis of the substance (e.g., product, effluent, emission), in light of
existing technologies and any costs, difficulties, or limitations associated with such technologies? Please
explain why or why not.

X

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(iv) Would disclosure of the specific chemical identity release confidential process information? If yes, please
explain.
test

EPA Form Number 9600-031

X

CBI Substantiation

OMB Control Number 2070-0030 expires 6/30/2024

Claim: Submitter Information

Applicable to All CBI Claims

Yes

No

CBI

A person may assert a claim of confidentiality for the specif ic chemical identity of a chemical substance as described in § 711.15(b)(3) of this part
only if the identity of that chemical substance is treated as confidential in the Master Inventory File as of the time the report is submitted for that
chemical substance. Generic chemical identities and accession numbers may not be claimed as confidential. To assert a claim of confidentiality for
the identity of a reportable chemical substance, you must submit w ith the report detailed w ritten answ ers to the questions from subsection (b) and
to the f ollow ing questions.
(i) Will disclosure of the information claimed as confidential likely cause substantial harm to your business's
competitive position? If you answered yes, describe the substantial harmful effects that would likely result to your
competitive position if the information is disclosed, including but not limited to how a competitor could use such
information, and the causal relationship between the disclosure and the harmful effects.

X

test
(ii) Has your business taken precautions to protect the confidentiality of the disclosed information? If yes, please
explain and identify the specific measures, including but not limited to internal controls, that your business has
taken to protect the information claimed as confidential. If the same or similar information was previously
reported to EPA as non-confidential (such as in an earlier version of this submission), please explain the
circumstances of that prior submission and reasons for believing the information is nonetheless still confidential.

X

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(iii) A. Is any of the information claimed as confidential required to be publicly disclosed under any other Federal
law? If yes, please explain.

X

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(iii) B. Does any of the information claimed as confidential otherwise appear in any public documents, including
(but not limited to) safety data sheets; advertising or promotional material; professional or trade publications;
state, local, or Federal agency files; or any other media or publications available to the general public? If yes,
please explain why the information should be treated as confidential.

X

test
(iii) C. Does any of the information claimed as confidential appear in one or more patents or patent applications? If
yes, provide the associated patent number or patent application number (or numbers) and explain why the
information should be treated as confidential.

X

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(iv) Is the claim of confidentiality intended to last less than 10 years (see TSCA section 14(e)(1)(B))? If yes,
please indicate the number of years (between 1-10 years) or the specific date after which the claim is
withdrawn.

X

test
(v) Has EPA, another federal agency, or court made any confidentiality determination regarding information
associated with this chemical substance? If yes, please provide the circumstances associated with the prior
determination, whether the information was found to be entitled to confidential treatment, the entity that made
the decision, and the date of the determination.

X

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Paperwork Reduction Act Notice
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2070-0030). Responses to this collection of information
are mandatory for certain persons, as specified at 40 CFR 707 Subpart D. 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 0.62 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 to the Regulatory
Support Division Director, 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 Number 9600-031