5900-544 HFC Process Agent One-Time Report

						OMB Control Number: 2060-0734
						Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Process Agent One-Time Report
	Worksheet Instructions:
	Complete and submit an HFC Process Agent One-Time Report if your company uses regulated HFCs as a process agents. Information on only one facility may be reported per reporting form. All sections of the report must be completed prior to submission. Provide supporting documentation, as needed, to respond to these reporting requirements.
	Version:
	r0.1
	Updated:
	2/18/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk		AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Facility Identification
	Section 2 - Process Agent Facility 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 - Process Agent Use Information
	Instructions: Provide the following information on the process agent use at the facility. Information on only one facility may be reported per reporting form. Provide supporting documentation, as needed, to respond to these reporting requirements.
	Product and Byproduct Information
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	HFC	Name of Product Manufactured §84.31(g)(1)(iii)	Name of Byproduct (1) Manufactured §84.31(g)(1)(iii)	Name of Byproduct (2) Manufactured §84.31(g)(1)(iii)	Name of Byproduct (3) Manufactured §84.31(g)(1)(iii)	Anticipated Ratio of Process Agent Emissions to End Product Manufactured §84.31(g)(1)(iv)
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	Provide a description of the process agent use that includes details of the percentages of process agent retained within the process, recovered after the process, and emitted or entrained in the final product. §84.31(g)(1)(i)
	Provide a description of all technologies and actions taken to minimize emissions of regulated substances. §84.31(g)(1)(ii)
	Should the description of technologies and actions taken to minimize emissions of regulated substances be treated as confidential business information (CBI)?
	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 # 5900-544