5900-548 HFC Exporter Quarterly Report

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Overview

Quarterly Information
Export Summary
End-of-Year Inventory

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Sheet 1: Quarterly Information

					OMB Control Number: 2060-0734
					Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Exporter Quarterly Report
	Worksheet Instructions:
	Complete and submit an HFC Exporter Quarterly Report if your company exports HFCs. Section 1 must be completed prior to submission. Section 2 must be completed if your company exported HFCs during the reporting quarter; if no HFCs were exported during the quarter, Section 2 may be left blank. Section 3 is automatically populated based on data entered in Section 2. Section 4 must be completed if your company is reporting quarter 4 activity.
	Version:
	r0.2
	Updated:
	9/16/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 3 - Export Summary
	Section 2 - Export Information	Section 4 - End-of-Year Inventory
	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:
	Reporting Year:
	Reporting Quarter:
	Employer Identification Number (EIN):
	Were HFCs exported during the reporting quarter?
	Section 2 - Export Information
	Instructions: Provide the following information for each HFC export shipment that took place during the quarter. If no HFCs were exported, the table may be left blank. As a reminder, if HFCs were exported for second party transformation or second party destruction, the invoice or sales agreement containing language similar to the transformation verifications that importers use, or destruction verifications showing that the purchaser or recipient intends to destroy the HFCs must be provided to EPA along with the submission of this report. §84.31(d)(1)(vii)
	HFC Export Data
	1	2	3	4	5	6	7	8	9a	9b	9c	9d	9e	9f	9g	9h	9i	9j	10	11	12	13	14	15
	Transaction Number	Date of Export §84.31(d)(1)(iv)	Shipment Reference Number	Port of Exit §84.31(d)(1)(iv)	HTS Code §84.31(d)(1)(vi)	Country to which the HFCs were Exported §84.17(d)(1)(v)	HFC or HFC Blend Exported §84.31(d)(1)(iii)	Quantity of HFC or HFC Blend Exported (kg) §84.31(d)(1)(iii)	Blend Information
									HFC Exported (1)	HFC Composition of Blend (1) (%)	HFC Exported (2)	HFC Composition of Blend (2) (%)	HFC Exported (3)	HFC Composition of Blend (3) (%)	HFC Exported (4)	HFC Composition of Blend (4) (%)	HFC Exported (5)	HFC Composition of Blend (5) (%)	Recipient Company §84.31(d)(1)(i)	Recipient Company Address §84.31(d)(1)(i)	Recipient Company City §84.31(d)(1)(i)	Recipient Company Country §84.31(d)(1)(v)	Transaction Type §84.31(d)(1)(iii)	Intended Use §84.31(d)(1)(vii)
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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 16 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 # 5900-548

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Sheet 2: Export Summary

			OMB Control Number: 2060-0734
			Expiration Date: XX/XX/202X
	American Innovation and Manufacturing Act - HFC Exporter Quarterly Report
	Worksheet Instructions:
	Complete and submit an HFC Exporter Quarterly Report if your company exports HFCs. Section 1 must be completed prior to submission. Section 2 must be completed if your company exported HFCs during the reporting quarter; if no HFCs were exported during the quarter, Section 2 may be left blank. Section 3 is automatically populated based on data entered in Section 2. Section 4 must be completed if your company is reporting quarter 4 activity.
	Version:
	r0.2
	Updated:
	9/16/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 3 - Export Summary
	Section 2 - Export Information	Section 4 - End-of-Year Inventory
	Section 3 - Quarterly Export Summary
	Instructions: The values in the table below are calculated based on data entered in Section 2. If the totals appear to be incorrect, please return to Section 2 to review your data.
	Export Summary
	1	2
	HFC Exported	Total Quantity Exported (kg)
1	HFC-23	0.00
2	HFC-32	0.00
3	HFC-41	0.00
4	HFC-43-10mee	0.00
5	HFC-125	0.00
6	HFC-134	0.00
7	HFC-134a	0.00
8	HFC-143	0.00
9	HFC-143a	0.00
10	HFC-152	0.00
11	HFC-152a	0.00
12	HFC-227ea	0.00
13	HFC-236cb	0.00
14	HFC-236ea	0.00
15	HFC-236fa	0.00
16	HFC-245ca	0.00
17	HFC-245fa	0.00
18	HFC-365mfc	0.00

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Sheet 3: End-of-Year Inventory

			OMB Control Number: 2060-0734
			Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC Exporter Quarterly Report
	Worksheet Instructions:
	Complete and submit an HFC Exporter Quarterly Report if your company exports HFCs. Section 1 must be completed prior to submission. Section 2 must be completed if your company exported HFCs during the reporting quarter; if no HFCs were exported during the quarter, Section 2 may be left blank. Section 3 is automatically populated based on data entered in Section 2. Section 4 must be completed if your company is reporting quarter 4 activity.
	Version:
	r0.2
	Updated:
	9/16/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification	Section 3 - Export Summary
	Section 2 - Export Information	Section 4 - End-of-Year Inventory
	Section 4 - End-of-Year Inventory
	Instructions: Provide the quantity of each HFC (including HFCs contained in blends) held in inventory on December 31. Data should only be reported in the fourth quarter report.
	HFC End-of-Year Inventory
	1	2
	HFC	Quantity of Inventory (kg) §84.31(d)(1)(viii)
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