5900-553 HFC Process Agent Use Annual Report

---

Overview

Company Information
Transfer Information

---

Sheet 1: Company Information

				OMB Control Number: 2060-0734
				Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC International Transfers Report
	Worksheet Instructions:
	Complete and submit an HFC International Transfers Report if your company is requesting a change to your production allowances due to a transfer to/from a person in a foreign country. All sections must be completed prior to submission.
	Version:
	r0.1
	Updated:
	4/21/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification
	Section 2 - Foreign Country Contact Information
	Section 3 - Transaction Data
	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:
	Is this a Request to Transfer Production Allowances from a Person in a Foreign Country or to a Person in a Foreign Country?
	Section 2 - Foreign Country Contact Information
	Instructions: Identify the foreign country authorizing the transfer and enter the contact information for the person in the foreign country that is authorizing the transfer.
	For a transfer from a person in a foreign country, additionally provide a signed document from an official representative in that country’s embassy in the United States stating that the appropriate authority within that country has revised the domestic production limits for that country equal to the lowest of the following three production quantities: (A) The maximum production level permitted in § 84.7(b) in the year of the international transfer minus the quantity of production allowances (in exchange value-weighted kilograms) to be transferred; (B) The maximum production level for the applicable HFCs that are allowed under applicable law (including the foreign country's applicable domestic law) minus the quantity of production allowances (in exchange value-weighted kilograms) to be transferred; or (C) The average of the foreign country's actual national production level of the applicable HFCs for the three calendar years prior to the year of the transfer minus the quantity of production allowances (in exchange value-weighted kilograms) to be transferred.
	For a transfer to a person in a foreign country, additionally provide a signed statement from a responsible official requesting that the relevant Agency official revise the number of production allowances the transferor holds such that the aggregate national production in the United States is equal the lowest of the following three production quantities: (A) The maximum production level permitted in § 84.7(b) in the year of the international transfer minus the quantity of production allowances (in exchange value-weighted kilograms) to be transferred; (B) The maximum production for the applicable HFCs that are allowed under applicable law minus the quantity of production allowances (in exchange value-weighted kilograms) to be transferred; or (C) The average of the United States’ actual national production level of the applicable HFCs for the three calendar years prior to the year of the transfer minus the quantity of production allowances (in exchange value-weighted kilograms) to be transferred.
	Foreign Country Information
	1	2	3	4
	Foreign Country Authorizing Transfer §84.19(b)(2)(ii)(B) or §84.19(b)(3)(ii)	Contact Name §84.19(b)(2)(ii)(C) or §84.19(b)(3)(iii)	Contact Phone §84.19(b)(2)(ii)(C) or §84.19(b)(3)(iii)	Contact Email §84.19(b)(2)(ii)(C) or §84.19(b)(3)(iii)
1
	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 84.19). 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 6 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 # 5900-552

---

Sheet 2: Transfer Information

				OMB Control Number: 2060-0734
				Expiration Date: 12/31/2024
	American Innovation and Manufacturing Act - HFC International Transfers Report
	Worksheet Instructions:
	Complete and submit an HFC International Transfers Report if your company is requesting a change to your production allowances due to a transfer to/from a person in a foreign country. All sections must be completed prior to submission.
	Version:
	r0.1
	Updated:
	4/21/2022
	External Links:
	HFC Allocation Rule Reporting HelpDesk	AIM Act Paperwork Reduction Act Burden
	Reporting Form Navigation:
	Section 1 - Company Identification
	Section 2 - Foreign Country Contact Information
	Section 3 - Transaction Data
	Section 3 - Transaction Data
	Instructions: Provide information for each transfer request.
	For transfers from a person in a foreign country, additionally provide documentation that the foreign country possesses the necessary quantity of unexpended production rights (§84.19(b)(2)(ii)(E)) and a signed statement from a responsible official describing whether the increased production is intended for export or the market in the United States (§84.19(b)(2)(ii)(G)).
	Transfer Request
	1	2	3	4
	Transaction Number	HFC §84.19(b)(2)(ii)(D) or §84.19(b)(3)(iv)	Quantity of Production Allowances Being Transferred (kg) §84.19(b)(2)(ii)(D) or §84.19(b)(3)(iv)	Quantity of Production Allowances Being Transferred (MTEVe)
1
2
3
4
5